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Using internet-based self-help to bridge waiting time for face-to-face outpatient treatment for Bulimia Nervosa, Binge Eating Disorder and related disorders: Study protocol of a randomized controlled trialVollert, Bianka, Beintner, Ina, Musiat, Peter, Gordon, Gemma, Görlich, Dennis, Nacke, Barbara, Schmidt-Hantke, Juliane, Potterton, Rachel, Spencer, Lucy, Grant, Nina, Schmidt, Ulrike, Jacobi, Corinna 06 December 2018 (has links)
Background: Eating disorders are serious conditions associated with an impaired health-related quality of life and increased healthcare utilization and costs. Despite the existence of evidence-based treatments, access to treatment is often delayed due to insufficient health care resources. Internet-based self-help interventions may have the potential to successfully bridge waiting time for face-to-face outpatient treatment and, thus, contribute to overcoming treatment gaps. However, little is known about the feasibility of implementing such interventions
into routine healthcare. The aim of this study is to analyze the effects and feasibility of an Internet-based selfhelp intervention (everyBody Plus) specifically designed for patients with Bulimia Nervosa, Binge Eating Disorder and other specified feeding and eating disorders (OSFED) on a waiting list for outpatient face-to-face treatment. The aim of this paper is to describe the study protocol.
Methods: A multi-country randomized controlled trial will be conducted in Germany and the UK. N=275 female patients awaiting outpatient treatment will be randomly allocated either to the guided online self-help intervention “everyBody Plus” or a waitlist control group condition without access to the intervention.
everyBody Plus comprises eight weekly sessions that cover topics related to eating and exercise patterns, coping with negative emotions and stress as well as improving body image. Participants will receive weekly individualized feedback based on their self-monitoring and journal entries. Assessments will take place at baseline, post-intervention as well as at 6- and 12-months follow up. In addition, all participants will be asked to monitor core eating disorder symptoms weekly to provide data on the primary outcome. The primary outcome will be number of weeks after randomization until a patient achieves a clinically relevant improvement in core symptoms (BMI, binge eating, compensatory behaviors) for the first time. Secondary outcomes include frequency of core symptoms and eating disorder related attitudes and behaviors, as well as associated psychopathology. Additional secondary outcomes will be the participating therapists' confidence in treating eating disorders as well as perceived benefits of everyBody Plus for patients. Discussion: To the best of our knowledge, this is the first randomized controlled trial examining the effects of Internet-based self-help for outpatients with eating disorders awaiting face-to-face outpatient treatment. If proven to be effective and successfully implemented, Internet-based self-help programs might be used as a first step of treatment within a stepped-care approach, thus reducing burden and cost for both patients and health
care providers.
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Online Self-Help as an Add-On to Inpatient Psychotherapy: Efficacy of a New Blended Treatment ApproachZwerenz, Rüdiger, Becker, Jan, Knickenberg, Rudolf J., Siepmann, Martin, Hagen, Karin, Beutel, Manfred E. 26 May 2020 (has links)
Background: Depression is one of the most frequent and costly mental disorders. While there is increasing evidence for the efficacy of online self-help to improve depression or prevent relapse, there is little evidence in blended care settings, especially combined with inpatient face-to-face psychotherapy. Therefore, we evaluated whether an evidencebased online self-help program improves the efficacy of inpatient psychotherapy. Methods: A total of 229 depressed patients were randomly allocated either to an online selfhelp program (intervention group [IG]; Deprexis) or an active control group (CG; weekly online information on depression) in addition to inpatient psychodynamic psychotherapy. Both groups had access to their respective experimental intervention for 12 weeks, regardless of inpatient treatment duration. Reduction of depressive symptoms, as measured with the Beck Depression Inventory-II, was the primary outcome at the end of the intervention (T2). Results: Depressive symptoms were statistically significantly lower in the IG compared to the active CG at T2 with a moderate betweengroup effect size of d = 0.44. The same applied to anxiety ( d = 0.33), quality of life ( d = 0.34), and self-esteem ( d = 0.38) at discharge from inpatient treatment (T1). No statistically significant differences were found regarding dysfunctional attitudes ( d = 0.14) and work ability ( d = 0.08) at T1. Conclusions: This is the first evidence for blended treatment combining online self-help with inpatient psychotherapy. The study opens new and promising avenues for increasing the efficacy of inpatient psychotherapy. Future studies should determine how integration of online self-help into the therapeutic process can be developed further.
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Styrning i företag med digitala affärsmodeller : En studie av Freemium i olika branscher / Management accounting in companies with digital business models : A studie of Freemium in multiple industriesWeberg, Eric, Eriksson, August January 2021 (has links)
This paper dives into the world of business models where more precisely the business model called Freemium is inspected. The paper has multiple purposes where one is to examine why businesses decide to use a business model that is as volatile as Freemium. The other purpose of the paper is to examine what kind of management accounting is used within the business model. Reasoning behind that is to see if there are any specific traits that originates from the usage of the business model Freemium. To fulfill this purpose the writers have decided to take a qualitative approach with the usage of interviews as the main instrument to gather data. The companies represented in the study are within different industries and are all considered to be SMEs. The chosen theoretical framework is built on previous research on business models and management accounting in SMEs and Start-ups. The results of the study indicate that the business model originates from the changes in the market due to digitalization which allowed new ways for companies to present value to customers. Thanks to this, giving away part of the product for free became an acceptable way of conducting business as costs for distributing products were severely reduced. Once companies chose to adapt to this business model its competition were left with no choice but to adapt or get left behind. Nowadays most businesses choose the model thanks to its great benefits in advertising and the possibility to expand their business further beyond the business model. The role of management accounting within these companies has somewhat shifted to a greater emphasis on what the customer desires. Customers are the foundation for almost all decisions made within the companies. To leverage the customer for utmost efficiency companies collect user data and then use the information as foundation for its decisions. Due to this the business needs to adapt to quick changes and most of the tools used for management accounting have a controlling function along with the purpose of learning more about the user within the product. / Den här uppsatsen tar sitt avstamp i området affärsmodeller och mer specifikt den affärsmodell som kallas för Freemium. Uppsatsen har flera syften och ett av dem är att undersöka varför företag väljer att använda en affärsmodell som är så volatil som Freemium. Det andra syftet med uppsatsen är att undersöka vilken typ av ekonomistyrning som används inom affärsmodellen. Resonemanget bakom det är att se om det finns några specifika drag som kan kopplas till användningen av Freemium. För att uppfylla detta syfte har författarna haft ett kvalitativt förhållningssätt med användning av intervjuer som huvudinstrument för insamlingen av data. De företag som representeras i studien finns inom olika branscher och anses alla vara små och medelstora företag. Det valda teoretiska ramverket bygger på tidigare forskning om affärsmodeller och ekonomistyrning i små och medelstora företag och nystartade företag. Resultaten av studien indikerar att affärsmodellen uppstod efter förändringar som skett på marknaden till följd av digitaliseringen som möjliggjorde nya sätt för företag att presentera värde för kunderna. Tack vare detta blev att ge bort en del av produkten gratis ett acceptabelt sätt att bedriva verksamheter eftersom kostnaderna för distribution av produkter minskade kraftigt. När företagen väl valde att anpassa sig till denna affärsmodell fick konkurrenterna inget annat val än att anpassa sig eller bli kvarlämnade i det förflutna. Numera väljer de flesta företag affärsmodellen tack vare dess stora fördelar med reklam och möjligheten att expandera. Ekonomistyrningens roll hos företag som använder Freemium har ett större behov av att tillfredsställa kunden efter vad de önskar. Kunderna är grunden för nästan alla beslut som fattas inom företagen. För att utnyttja kunden för största möjliga effektivitet samlar företag in användardata och använder sedan informationen som grund för sina beslut. På grund av detta måste företaget anpassa sig till snabba förändringar och de flesta verktyg som används för ekonomistyrning har en kontrollfunktion tillsammans med syftet att lära sig mer om användaren i produkten.
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Freeconomics in the light of EU VAT Directive : Are free digital services supplied in exchange for personal data VAT taxable?Sampaoli, Alessandro January 2020 (has links)
The digital economy is growing exponentially. Companies such as Facebook and Instagram base their business model on supplying services completely free of charge to billions of users. This model of business is called “Freeconomics”. These companies generate huge profits from the exploitation of personal data provided by Users. The peculiarity of this way of doing business, although this may seem absurd, is that the company's profit is directly proportional to the number of non-paying users. Such situations have given rise to discussions regarding the powerlessness of the tax system of states to levy tax on such profits. Regarding the indirect taxation, the question is even more difficult if one considers free digital services and personal data. Unfortunately, this flow of “digital” consumption remains completely out of a VAT assessment. Exclude a priori those transactions from being assessed for VAT purposes only because it could be arduous to assess the consumption would result in a violation of the principle of neutrality. Accordingly, issues related to the distortion of competition could also arise. The author of this thesis examines the assumption that between the Companies and the Users take place a reciprocal exchange of benefits in kind characterized by a synallagmatic relationship (quid pro quo) in the form of barter. The results of the analysis indicate that the transactions characterized by the supply of free digital services to Users in exchange for personal data - as described in the Business Reference Model - actually fall within the scope of Article 2 (1)(c) of the EU VAT Directive and therefore must be subject to indirect taxation.
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Internetbaserad kognitiv beteendeterapi mot antenatal depression: avhopp, följsamhet,symtomminskning och patientnöjdhet med bedömningssamtalet. / Internet-based cognitive behavioral therapy for antenatal depression: dropouts, adherence, symptom remission, and patient-satisfaction with the assessment interview.Jonasson, Martin, Kullebjörk, Moa January 2022 (has links)
Antenatal depression (depression under graviditeten) drabbar 10–20% av gravida och innebär risker för både den gravida och barnet. Forskning visar att internetbaserad kognitiv beteendeterapi (IKBT) tycks vara effektivt jämfört med sedvanlig mödravård. Uppsatsen var en sambands- och prediktionsstudie som genomfördes inom den randomiserade DANA-studien för IKBT vid antenatal depression. En inomgruppsdesign med upprepade mätningar tillämpades där 40 kvinnor med antenatal depression deltog. Syftet var att undersöka (a) patientnöjdhet med bedömningssamtalet i relation till behandlingsföljsamhet, avhopp och minskning av depressionssymtom under IKBTbehandlingen, samt (b) jämföra förändring i depressionssymtom mot två tidigare studier. Resultatet visade att en högre patientnöjdhet med bedömningssamtalet signifikant predicerade en mindre minskning av depressionssymtom mellan screening och förmätning. Inga signifikanta samband hittades mellan patientnöjdhet med bedömningssamtalet och behandlingsföljsamhet eller avhopp. Slutsatser bör dras med stor försiktighet utifrån metodologiska begränsningar. Resultatet visade även att depressionssymtom jämfört med förmätningen signifikant minskade från andra veckomätningen i behandlingen till och med eftermätningen vecka tio. Detta bekräftade tidigare studiers resultat. Framtida randomiserade prövningar kan ge underlag till utvecklingen av bedömningssamtal och IKBT mot antenatal depression. / Antenatal depression (depression during pregnancy) affects 10–20% of pregnant women and involves risks for both the pregnant woman and the child. Research shows that internet-based cognitive behavioral therapy (ICBT) seems to be effective compared to conventional maternity care. The thesis was a correlational predictive study that was conducted within the randomized DANAstudy for ICBT during antenatal depression. An in-group design with repeated measurements was applied in which 40 women with antenatal depression participated. The purpose was to examine (a) patient-satisfaction with the assessment interview in relation to adherence, dropouts and remissionof depressive symptoms during ICBT treatment, and (b) compare changes in depressive symptoms against two previous studies. The result showed that a higher patient-satisfaction with the assessment interview significantly predicted a lesser reduction of depressive symptoms between screening and pre-measurement. No significant correlations were found between patient-satisfaction with the assessment interview and treatment adherence or dropouts. Conclusions should be drawn with great caution based on methodological limitations. The result also showed that depressive symptoms compared with the pre-measurement decreased significantly from the second weekly measurement in the treatment until the post-measurement week ten. This confirmed the results of previous studies. Future randomized trials may provide a basis for the development of assessment interviews and ICBT for antenatal depression.
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Détection et prise en charge des troubles anxiodépressifs chez les femmes victimes des violences sexuelles à l’Est de la République Démocratique du CongoNkunku, Peguy Ndona 04 1900 (has links)
Les violences sexuelles ont de fortes répercussions sur la santé mentale des victimes. Aussi bien en temps de paix qu’en temps de guerre, les femmes payent un lourd tribut à la suite de ces violences. L’accès au traitement troubles anxiodépressifs liés à ces actes de violence est souvent limité dans les pays à faible revenu à cause de plusieurs facteurs. Le présent mémoire se propose de réfléchir sur les possibilités de traitement des troubles mentaux liés aux violences sexuelles chez les femmes en contexte de soins de santé primaires.
Objectifs
Cette étude a pour objectifs d’identifier les outils pour le dépistage et la prise en charge des troubles anxiodépressifs chez les femmes victimes de violences sexuelles au Congo Kinshasa et de proposer un modèle de psychothérapie à distance pour la prise en charge de ces victimes de violences sexuelles.
Résultats
Il existe des plateformes digitales de traitement des troubles anxiodépressifs utilisant la thérapie cognitivocomportementale ayant fait leurs preuves. Nous avons proposé un modèle de psychothérapie à distance s’intégrant dans le système de santé congolais en contexte de soins de santé primaires.
Conclusions
Malgré les obstacles à l’implantation des technologies digitales en Afrique, l’usage des plateformes à distance de thérapie web est une option envisageable dans la prise en charge des troubles anxiodépressifs chez les femmes victimes de violence sexuelle en RDC. L’intégration des plateformes de thérapie à distance dans les soins de santé primaires pourrait contribuer à diminuer efficacement la prévalence des troubles anxiodépressifs consécutifs aux violences sexuelles.
Mots-clés : violences sexuelles, troubles anxiodépressifs, thérapies à distance, soins de santé primaires. / Sexual violence has a strong impact on the mental health of victims. In both peacetime and wartime, women pay a heavy price as a result of such violence. Access to treatment for mental disorders related to the consequences of such acts is often limited in low-income countries due to several factors. This paper aims to reflect on the possibilities of treating mental disorders linked to sexual violence in women in the context of primary health care.
Objective
Identify tools for the screening and management of anxiety-depressive disorders among women victims of sexual violence in Congo Kinshasa and propose a remote psychotherapy model for the care of these victims of sexual violence.
The presentation of two articles, one of which is a narrative review providing an inventory of digital technologies for the treatment of anxiety-depressive disorders in Africa and the other a protocol on the acceptability of treatments for anxio-depressive disorders by digital technologies in the context of care primary health care was carried out.
Results
We have demonstrated the existence of digital platforms for the treatment of anxiety-depressive disorders using cognitive-behavioral therapy in the West. We have proposed a remote psychotherapy model that fits into the Congolese health system in the context of primary health care.
Conclusions
Despite the obstacles to a good establishment as well as the problems related to mental health in Africa, the use of remote web therapy platforms appears beneficial in the management of anxiety-depressive disorders. The integration of these platforms into primary health care could effectively help reduce the prevalence of anxiety-depressive disorders resulting from sexual violence.
Keywords: Internet Based Intervention, Online, anxiety disorders, post-traumatic stress, depression, third countries, gender-based violence.
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Samband mellan följsamhet till behandlingens metoder och symtomreduktion inom internetbaserad kognitiv beteendeterapi för patienter med depression i reguljär öppenvård. / Relationship between adherence to treatment methods and symptom reduction in internet-based cognitive behavioral therapy for patients with depression in regular outpatient care.Anton, Ivehed, Pontus, Jagersten January 2021 (has links)
Det råder frågetecken om hur följsamhet till behandlingens metoder inom internetbaserad kognitiv beteendeterapi (IKBT) för depression påverkar symtomreduktion. Syfte: undersöka sambandet mellan följsamhet till behandlingsmetoder inom IKBT och symtomreduktion, för depressionspatienter. Frågeställning: föreligger samband mellan följsamhet till behandlingens metoder och symtomreduktion. Metod: deltagarna var 90 patienter, vilka behandlats för depression vid Internetpsykiatrin i Stockholm. Antal moduler deltagarna genomfört registrerades, och mängd och kvalité utförande hemuppgifter skattades enligt en behandlingsspecifik följsamhetsskala. Symtomreduktion mättes genom förändring i depressionsnivå, från förmätning till eftermätning. Resultat: samband påvisades mellan antal genomförda moduler och symtomreduktion, men inte mellan mängd och kvalité utförande hemuppgifter och symtomreduktion. Mängd och kvalité tillförde ingen ytterligare förklaring av variansen för symtomreduktion än antal genomförda moduler. Slutsats: det förefaller viktigare att patienter kommer framåt i behandlingen, än hur behandlingsmetoderna utförs. / There are questions about how adherence to treatment methods in Internet-based cognitive behavioral therapy (ICBT) for depression affects symptom reduction. Purpose: explore the relationship between adherence to treatment methods within internet-based cognitive behavioral therapy (ICBT) and symptom reduction, for depressed patients. Research question: is there a relationship between adherence to treatment methods and symptom reduction. Method: the participants were 90 patients treated for depression at the Internetpsykiatri in Stockholm. The number of modules completed was registered, the amount and quality of homework was estimated by a treatment-specific adherence scale. Symptom reduction was measured by changes in level of depression, from pre-measurement to post-measurement. Results: correlation was demonstrated between number of completed modules and symptom reduction, but not between amount and quality of homework and symptom reduction. Amount and quality did not add more explanation of the variance in symptom reduction than the number of completed modules. Conclusions: it is more important that patients advance in the treatment, than how the treatment methods are performed.
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Relationsnöjdhet hos gravida med depression vid IKBT-behandling : Sambands- och prediktionsstudie av relationsnöjdhet och följsamhet, behandlingsutfall samt val av relationsrelaterade behandlingskomponenter / Relationship satisfaction in pregnant individuals with depression during IKBT-treatment : A correlation and prediction study of relationship satisfaction and adherence, treatment outcome and choice of treatment components related to relationships.Johansson, Anna, Gardelach, Amanda January 2023 (has links)
Tidigare forskning visar att det finns ett samband mellan depressionssymtom och svårigheter i partnerrelationer. Forskning visar att deltagare efter parterapi har en ökad grad av relationsnöjdhet och en lägre grad av depressionssymtom. Uppsatsen genomfördes inom DANA-projektet (IKBT vid antenatal depression) och syftet var att analysera hur relationsnöjdhet hänger ihop med behandlingsutfall, följsamhet i behandling samt vilja att arbeta med relationer i behandling. Syftet var även att analysera vilka sociodemografiska och kliniska faktorer hos gravida med depression som har ett samband med relationsnöjdhet. I resultatet framkom inget signifikant samband mellan relationsnöjdhet och behandlingsutfall, följsamhet eller val att arbeta med relationer i behandlingen. I resultatet framkom ett signifikant samband mellan högre relationsnöjdhet och högre ekonomi, högre relationsnöjdhet och högre graviditetsönskan, samt högre relationsnöjdhet och lägre grad av depressionssymtom. För att kunna dra säkrare slutsatser över hur relationsnöjdhet och större fokus på relationer påverkar behandlingsutfall vid depressionsbehandling, behövs fortsatt forskning. Fortsatt forskning behövs även för att undersöka bakomliggande faktorer och hur dessa påverkar paret och deras mående. / Previous research shows a connection between symptoms of depression and difficulties in partner-relations. It also shows that the participants relationship satisfaction increased after couples-therapy and that their symptoms of depression decreased. This thesis was conducted in the DANA-project (ICBT during antenatal depression) and the intention was to examine the effect of relationship satisfaction on treatment outcome, adherence, and motivation to work with relationships in treatment. The intention was also to analyze the connection between relationship satisfaction and sociodemographic and clinical factors during pregnancy. The result presented no significant connection between relationship satisfaction and treatment outcome, adherence, or motivation to work with relationships in treatment. Furthermore, the result presented a significant connection between higher relationship satisfaction and higher economic status, higher relationship satisfaction and higher pregnancy desire and higher relationship satisfaction and lower symptoms of depression. Further research is needed to examine how more focus on relations in treatment and relationship satisfaction effects treatment outcome. Further research is also needed to examine underlying factors and how these effect the couple and their well-being.
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Negative effects of Internet-based cognitive behavior therapy : Monitoring and reporting deterioration and adverse and unwanted eventsRozental, Alexander January 2016 (has links)
Internet-based cognitive behavior therapy (ICBT) has the potential of providing many patients with an effective form of psychological treatment. However, despite helping to improve mental health and well-being, far from everyone seem to benefit. In some cases, negative effects may also emerge. The overall aim of the present thesis was to establish the occurrence and characteristics of such incidents in ICBT using a combination of quantitative and qualitative methods. Study I determined deterioration, non-response, and adverse and unwanted events in a sample of 133 patients undergoing ICBT for social anxiety disorder. The results indicated that up to 6.8% fared worse during the treatment period, depending on the self-report measure and time point, as determined using the Reliable Change Index (RCI), while the non-response rate was between 29.3 to 86.5% at post treatment assessment, and 12.9% experienced other negative effects. Study II investigated the responses to open-ended questions on adverse and unwanted events among 556 patients in four separate clinical trials of ICBT; social anxiety disorder, panic disorder, major depressive disorder, and procrastination. In total, 9.3% reported negative effects, with a qualitative content analysis revealing two categories and four subcategories; patient-related, i.e., gaining insight and experiencing new symptoms, and treatment-related, i.e., difficulties applying the treatment interventions and problems related to the treatment format. Study III explored the number of patients achieving reliable deterioration, as determined using the RCI on the individual raw scores of 2866 patients from 29 clinical trials of ICBT. The results showed that the deterioration rate was higher among patients in a control condition, 17.4%, in comparison to treatment, 5.8%. Predictors were related to decreased odds of deterioration for patients receiving treatment; clinical severity at pre treatment assessment, being in a relationship, having a university degree, and being older. As for the control condition, only clinical severity at pre treatment assessment was associated with decreased odds of deterioration. Study IV examined a newly developed self-report measure for monitoring and reporting adverse and unwanted events, the Negative Effects Questionnaire. The results suggested a six-factor solution with 32 items; symptoms, quality, dependency, stigma, hopelessness, and failure. One-third of the patients reported experiencing unpleasant memories, stress, and anxiety, with novel symptoms and a lack of quality in the treatment and therapeutic relationship having the greatest negative impact. The general finding of the present thesis is that negative effects do occur in ICBT and that they are characterized by deterioration, non-response, and adverse and unwanted events, similar to psychological treatments delivered face-to-face. Researchers and clinicians in ICBT are recommended to monitor and report negative effects to prevent a negative treatment trend and further the understanding of what might contribute to their incidents. Future research should investigate the relationship between negative effects and treatment outcome, especially at follow-up, to examine if they are transient or enduring. Also, interviews could be conducted with those achieving reliable deterioration to explore if and how it is experienced by the patients and to see if it is attributed to the treatment interventions or other circumstances. / Internetbaserad kognitiv beteendeterapi (IKBT) har goda förutsättningar att kunna bli en form av psykologisk behandling som på ett effektivt sätt hjälper patienter med att hantera sin psykiska ohälsa och förbättra sitt välmående. Trots detta är det dock långtifrån alla som tycks bli bättre. För en del kan det till och med resultera i negativa effekter. Det övergripande syftet med denna avhandling har således varit att undersöka förekomsten av sådana fall och hur dessa uttrycks, såväl med kvantitativa som kvalitativa metoder. Studie I fastställde andelen försämrade, oförändrade samt andra ogynnsamma eller oönskade händelser bland 133 personer som behandlades med IKBT för social ångest. Resultatet visade att uppemot 6,8 % försämrades under sin behandlingsperiod beroende på vilket självskattningsformulär respektive tidpunkt som studerades, beräknat enligt metoden Reliable Change Index (RCI). Likaså var 29,3 % till 86,5 % oförändrade vid eftermätningen samt att 12,9 % rapporterade andra former av negativa effekter. Studie II undersökte svaren på öppna frågor som gällde ogynnsamma eller oönskade händelser bland 556 patienter i fyra olika kliniska studier med IKBT; social ångest, paniksyndrom, egentlig depressionsepisod och prokrastinering. Totalt sett rapporterade 9,3 % att de hade erfarit negativa effekter, vilka analyserades med hjälp av kvalitativ innehållsanalys. Två övergripande kategorier och fyra subkategorier framkom; patientrelaterade, som ökad insikt respektive nya symptom, samt behandlingsrelaterade, som svårigheter att implementera behandlingsinterventionerna respektive problem med behandlingsformatet. Studie III utrönte andelen patienter som försämrades i enlighet med RCI, baserat på insamlad rådata från 2866 personer i 29 olika kliniska studier med IKBT. Resultatet visade att försämring var mer förekommande hos de som var i en kontrollgrupp, 17,4 %, jämfört med de som fick behandling, 5,8 %. Bland de som genomgick behandling existerade det även ett par prediktorer som innebar lägre odds för försämring; större svårigheter vid förmätningen, att befinna sig i en relation, att ha en universitetsutbildning respektive att vara äldre. För de som var i en kontrollgrupp var enbart större svårigheter vid förmätningen relaterat till lägre odds för försämring. Studie IV testade ett nykonstruerat självskattningsformulär; Negative Effects Questionnaire. Resultatet visade på en faktorlösning med sex faktorer och 32 påståenden; symptom, kvalitet, beroende, stigma, hopplöshet respektive misslyckande. En tredjedel av personerna svarade att de hade upplevt obehagliga minnen, stress och ångest, samtidigt som nya symptom och bristande kvalitet i både behandlingen respektive den terapeutiska relationen hade haft störst negativ inverkan på dem. Den generella slutsatsen av denna avhandling är således att negativa effekter förekommer i IKBT och att de kännetecknas av försämring, ett oförändrat tillstånd samt andra ogynnsamma eller oönskade händelser, något som liknar tidigare forskning av psykologisk behandling som bedrivs ansikte-mot-ansikte. Forskare och behandlare i IKBT rekommenderas att övervaka och rapportera negativa effekter i syfte att förhindra en negativ utveckling i behandlingen samt för att öka kunskapen om vad som kan bidra till deras förekomst. Framtida forskning bör undersöka relationen mellan negativa effekter och behandlingsutfall utifrån längre tidsperspektiv för att se om dess påverkan är övergående eller ihållande. Vidare kan till exempel intervjuer utföras med de patienter som har försämrats för att ta reda på om och hur det uppfattas samt huruvida det har förorsakats av behandlingen eller andra omständigheter. / <p>At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 4: In press.</p>
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[en] EVOCATIVE METHODOLOGY FOR CAUSAL MAPPING AND ITS PERSPECTIVE IN THE OPERATIONS MANAGEMENT WITH INTERNET-BASED APPLICATIONS FOR SUPPLY CHAIN MANAGEMENT AND SERVICE MANAGEMENT / [pt] METODOLOGIA EVOCATIVA PARA MAPEAMENTO CAUSAL E SUA PERSPECTIVA NA GERÊNCIA DE OPERAÇÕES COM APLICAÇÕES VIA INTERNET EM GESTÃO DA CADEIA DE SUPRIMENTO E ADMINISTRAÇÃO DE SERVIÇOS25 August 2004 (has links)
[pt] A compreensão dos atuais processos produtivos é essencial
neste momento em que o conhecimento tornou-se um importante
gerador de valor. Uma visão holística dos conhecimentos que
estão disseminados, de forma dispersa, entre profissionais,
consultores e acadêmicos é necessária para a síntese de
novas teorias da produção. Pesquisadores de gerência de
operações freqüentemente usam mapeamento causal como um
mecanismo para construir e comunicar teorias,
particularmente em suporte à pesquisa empírica. As
abordagens mais usuais para capturar dados cognitivos
para um mapa causal são brainstorming e entrevistas, os
quais exigem muito tempo e apresentam um significativo
custo em sua implementação. Esta tese visa gerar uma
metodologia (Metodologia Evocativa para Mapeamento Causal -
ECMM) voltada para aplicação em pesquisa sobre gerência de
operações para coletar e estruturar dados disseminados de
forma desagregada, como conhecimento e experiência
profissional e acadêmica, contidos nas opiniões de um grande
número de especialistas dispersos demograficamente e
geograficamente. Isto é alcançado evocando opiniões,
codificando-as em variáveis e reduzindo o grupo em
conceitos e relações. Tem-se uma especial preocupação em
conseguir este objetivo em tempo factível e com baixo custo.
A coleta de dados é assíncrona, via Internet, possui dois
ou três turnos (à semelhança do método Delfos). A análise
de dados usa codificação, técnica de grupamento hierárquica
e escalamento multidimensional para identificar conceitos
na forma de mapas cognitivos. A ECMM foi ilustrada com
aplicações que demonstram sua viabilidade. Aplicou-se nas
áreas de gestão da cadeia de suprimento (SCM) e
administração de serviços (SM) com a participação de
aproximadamente 1.300 respondentes de empresas e
universidades de quase 100 países. Dentre os desdobramentos
para pesquisas futuras propõe-se aplicar nas áreas de ECMM
em SCM e SM visando a uni-las em um tema: gestão da cadeia
de suprimento de serviços. / [en] The understanding of the present productive processes is
essential at this moment when knowledge became an important
value creator. A holistic vision of the pieces of knowledge
that are spread out and dispersed among practitioners,
consultants and academics is necessary for the synthesis of
new theories of production. Operations management
researchers often use causal mapping as a key tool for
building and communicating theory, particularly in support
of empirical research. The widely accepted approaches for
capturing cognitive data for a causal map are informal
brainstorming and interviews, which require a time-
consuming and significant cost of implementation. This
dissertation aims at creating a methodology (Evocative
Causal Mapping Methodology - ECMM) intended for use in
operations management research for collecting and
structuring dispersed data spread out as practical and
research knowledge, and experience contained in the
opinions of a large number of specialists demographically
and geographically scattered. This is accomplished by
evoking opinions, encoding them into variables and reducing
the resulting set to concepts and relationships. A special
concern is to achieve this goal in a feasible time and cost-
efficient way. ECMM consists of two or three round, Delphi-
like, Internet-based asynchronous data collection, and a
data analysis that uses a coding panel of experts,
hierarchical cluster analysis and multidimensional scaling
for identifying concepts on cognitive map formats.
Applications illustrate ECMM and demonstrate its
feasibility. They were developed on supply chain management
(SCM) and service management (SM) involving about 1,300
respondents of companies and universities of about 100
countries. Among possible unfolding future studies, this
dissertation proposes to apply ECMM in SCM and SM aiming at
unifying them into a single topic: service supply chain
management.
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