Introduction The prevalence of depressive symptoms in persons with heart failure is higher than in age- and gender-matched populations not suffering from heart failure. Heart failure in itself is associated with an unpredictable trajectory of symptoms, a poor prognosis, high mortality and morbidity, and low health-related quality of life (HrQoL). With the addition of depressive symptoms to heart failure the negative health effects increase further. Though the negative consequences of depressive symptoms in heart failure are well known, there is a knowledge gap about the course of depressive symptoms in heart failure and about how to effectively manage these symptoms. Pharmacological treatment with serotonin reuptake inhibitors has not been able to demonstrate efficacy in persons with heart failure. In a few studies, cognitive behavioural therapy (CBT) delivered face-to-face, has demonstrated effects on depressive symptoms in persons with heart failure. However, currently there are barriers in delivering face-to-face CBT as there is a lack of therapists with the required training. As a solution to this, the use of Internet-based CBT (ICBT) has been proposed. ICBT has been shown to be effective in treatment of mild and moderate depression but has not been evaluated in persons with heart failure. Aim The overall aim of this thesis was to describe depressive symptoms over time and to develop and evaluate an ICBT intervention to treat depressive symptoms in persons with heart failure. Design and Methods The studies in this thesis employ both quantitative (Studies I, II and III) and qualitative (Studies II and IV) research methods. The sample in Study I (n=611) were recruited in the Netherlands. The participants (n=7) in Study II were recruited via advertisements in Swedish newspapers. Studies III and IV used the same cohort of participants (Study III n=50, Study IV n=13). These participants were recruited via an invitation letter sent to all persons who had made contact with healthcare services in relation to heart failure during the previous year, at the clinics of cardiology or medicine in four hospitals in southeast Sweden. Study I had a quantitative longitudinal design. Data on depressive symptoms was collected at baseline (discharge from hospital) and after 18 months. Data on mortality and hospitalisation was collected at 18 and 36 months after discharge from hospital. Study II employed three differentBehind the Screen2patterns of design, as follows: I) The development and context adaptation of the ICBT program was based on research, literature and clinical experience and performed within a multi-professional team. II) The feasibility of the program from the perspective of limited efficacy and function was investigated with a quantitative pre-post design. III) Participants’ experience of the ICBT program was investigated with a qualitative content analysis. Data on depressive symptoms was collected pre and post intervention. The time used for support and feedback was logged during the intervention, and qualitative interviews were performed with the participants after the end of the intervention. Study III was designed as a randomised controlled trial. A nine-week ICBT program adapted to persons with heart failure and depressive symptoms was tested against an online moderated discussion forum. Data on depressive symptoms, HrQoL and cardiac anxiety was collected at baseline (before the intervention started) and after the end of the intervention (approximately 10 weeks after the start of the intervention). Study IV had a qualitative design to explore and describe participants’ experiences of ICBT. The participants were recruited from within the sample in Study III and all had experience of ICBT. Data collection occurred after the ICBT program ended and was carried out using qualitative interviews by telephone. Results The mean age of the samples used in this thesis varied between 62 and 69 years of age. Concerning the symptom severity of heart failure, most persons reported New York Heart Association (NYHA) class II (40-57%) followed by NYHA class III (36-41%). Ischaemic heart disease was the most common comorbidity (36-43%). The vast majority had pharmacological treatment for their heart failure. Six percent of the persons in Study I used pharmacological antidepressants. In Studies II and III, the corresponding numbers were 43% and 18% respectively. Among persons hospitalised due to heart failure symptoms, 38% reported depressive symptoms. After 18 months, 26% reported depressive symptoms. Four different courses of depressive symptoms were identified: 1) Non-depressed 2) Remitted depressive symptoms. 3) Ongoing depressive symptoms. 4) New depressive symptoms. The highest risk for readmission to hospital and mortality was found among persons in the groups with ongoing and new depressive symptoms. A nine-week ICBT program consisting of seven modules including homework assignments on depressive symptoms for persons with heart failure was developed and tested. The RCT study (Study III) showed no significant difference in depressive symptoms between ICBT and a moderated discussion forum. Within-group analysis of depressive symptoms demonstrated a significant decrease of depressive symptoms in the ICBT group but not in the discussion forum group. The participants’ experience of ICBT was described in one theme: ICBT- an effective, but also challenging tool for self-management of health problems. This theme was constructed based on six categories: Something other than usual healthcare; Relevance and recognition; Flexible, understandable and safe; Technical problems; Improvements by live contact; Managing my life better. Conclusion After discharge from hospital, depressive symptoms decrease spontaneously among a large proportion of persons with heart failure, though depressive symptoms are still common in persons with heart failure that are community dwelling. Depressive symptoms in persons with heart failure are associated with increased risk of death and hospitalisation. The highest risks are found among persons with long-term ongoing depressive symptoms and those developing depressive symptoms while not hospitalised. ICBT for depressive symptoms in heart failure is feasible. An intervention with a nine-week guided self-help program with emphasis on behavioural activation and problem-solving skills appears to contribute to a decrease in depressive symptoms and improvement of HrQoL. When ICBT is delivered to persons with heart failure and depressive symptoms the participants requests that the ICBT is contextually adapted to health problems related to both heart failure and depressive symptoms. ICBT is experienced as a useful tool for self-care and something other than usual healthcare. ICBT also requires active participation by the persons receiving the intervention, something that was sometimes experienced as challenging.
Intended for any business or marketing manager who wants to increase the speed with which they can demonstrate a return on their marketing spend, it is also an insightful and provoking text for any student of marketing.
I am unaware of any textbook which provides such comprehensive coverage of the field and doubt that this work will be surpassed in the foreseeable future, if ever!' From the foreword by Robert C. Moellering, Jr., M.D, Shields Warren-Mallinckrodt Professor of Medical Research, Harvard Medical School, USA Kucers' The Use of Antibiotics is the leading major reference work in this vast and rapidly developing field. More than doubled in length compared to the fifth edition, the sixth edition comprises 3000 pages over 2-volumes in order to cover all new and existing therapies, and emerging drugs not yet fully licensed. Concentrating on the treatment of infectious diseases, the content is divided into 4 sections: antibiotics, anti-fungal drugs, anti-parasitic drugs and anti-viral drugs, and is highly structured for ease of reference.Within each section, each chapter is structured to cover susceptibility, formulations and dosing (adult and paediatric), pharmacokinetics and pharmacodynamics, toxicity and drug distribution, detailed discussion regarding clinical uses, a feature unique to this title. Compiled by an expanded team of internationally renowned and respected editors, with a vast number of contributors spanning Europe, Africa, Asia, Australia, South America, the US and Canada, the sixth edition adopts a truly global approach. It will remain invaluable for anyone using antimicrobial agents in their clinical practice and provides in a systematic and concise manner all the information required when treating infections requiring antimicrobial therapy. Kucers' The Use of Antibiotics is available free to purchasers of the books as an electronic version on line or on your desktop: It provides access to the entire 2-volume print material It is fully searchable, so you can find the relevant information you need quickly Live references are linked to PubMed referring you to the latest journal material Customise the contents - you can highlight sections and make notes Comments can be shared with colleagues/tutors for discussion, teaching and learning The text can also be reflowed for ease of reading Text and illustrations copied will be automatically referenced to Kucers' The Use of Antibiotics
This book analyses a peculiar phase in the history of Stockholm which has not previously been systematically investigated. Between 1750 and 1850 the Swedish capital experienced long-term stagnation, characterized by de-industrialization and slow population growth. In this study various aspects of the economic and social history of the period are examined in detail, including the decline of manufacturing, the causes of the extremely high rates of mortality and extra-marital fertility, and the distribution of economic resources. Social and spatial patterns of poverty are described and the trends and fluctuations in prices and real wages charted and compared with other European towns and cities.
This thesis presents valuable contributions to several aspects of the rapidly growing field of gravitational wave astrophysics. The potential sources of gravitational waves in globular clusters are analyzed using sophisticated dynamics simulations involving intermediate mass black holes and including, for the first time, high-order post-Newtonian corrections to the equations of motion. The thesis further demonstrates our ability to accurately measure the parameters of the sources involved in intermediate-mass-ratio inspirals of stellar-mass compact objects into hundred-solar-mass black holes. Lastly, it proposes new techniques for the computationally efficient inference on gravitational waves. On 14 September 2015, the LIGO observatory reported the first direct detection of gravitational waves from the merger of a pair of black holes. For a brief fraction of a second, the power emitted by this merger exceeded the combined output of all stars in the visible universe. This has since been followed by another confirmed detection and a third candidate binary black hole merger. These detections heralded the birth of an exciting new field: gravitational-wave astrophysics.
Balancing Water for Humans and Nature, authored by two of the world's leading experts on water management, examines water flows - the 'blood stream' of both nature and society - in terms of the crucial links, balances, conflicts and trade-offs between human and environmental needs. The authors argue that a sustainable future depends fundamentally on our ability to manage these trade-offs and encourage long-term resilience. They advocate an ecohydrological approach to land/water/environmental problems and advance a strong, reasoned argument for viewing precipitation as the gross fresh water resource, ultimately responsible for sustaining all terrestrial and aquatic ecosystem services. This book makes the most coherent and holistic argument to date for a new ecological approach to understanding and managing water resources for the benefit of all. Basing their analysis on per capita needs for an acceptable nutritional diet, the authors analyse predictions of the amounts of water needed for global food production by 2050 and identify potential sources. Drawing on small-scale experiences in Africa and Asia, they also cover the vulnerability of the semi-arid tropics through a simplified model of green and blue water scarcity components.
As a nominally neutral power during the Second World War, Sweden in the early postwar era has received comparatively little attention from historians. Nonetheless, as this definitive study shows, the war—and particularly the specter of Nazism—changed Swedish society profoundly. Prior to 1939, many Swedes shared an unmistakable affinity for German culture, and even after the outbreak of hostilities there remained prominent apologists for the Third Reich. After the Allied victory, however, Swedish intellectuals reframed Nazism as a discredited, distinctively German phenomenon rooted in militarism and Romanticism. Accordingly, Swedes’ self-conception underwent a dramatic reformulation. From this interplay of suppressed traditions and bright dreams for the future, postwar Sweden emerged.
We have just experienced the worst financial crash the world has seen since the Great Depression of the 1930s. While real economies in general did not crash as they did in the 1930s, the financial parts of the economy certainly did, or, at least, came very close to doing so. Hundreds of banks in the United States and Europe have been closed by their supervisory authorities, forcibly merged with stronger partners, nationalized or recapitalized with the tax payers' money. Banks and insurance companies had, by mid 2010, already written off some 2000 billion dollars in credit write-downs on loans and securities. In this book, Johan Lybeck draws on his experience as both an academic economist and a professional banker to present a detailed yet non-technical analysis of the crash. He describes how the crisis began in early 2007, explains why it happened and shows how it compares to earlier financial crises.
Psychotherapy research has shifted from mainly focusing on the average effects of different treatments to concentrating more on questions related to the individual patient. When research attention shifts, it can give rise to the implementation of new statistical methods that, in turn, can illuminate new challenges that must be addressed. The aim of the thesis was to study how traditional methods for predicting certain psychotherapy outcomes have been conducted in the past, and how more advanced statistical methods might be used to enhance knowledge of how to predict these outcomes today. Three studies were performed: Paper I focused on how Multi Level Modeling (MLM) can be used to study certain aspects of the relationship between working alliance and treatment outcome. In Paper II, Latent Profile Analysis (LPA) and item-level analysis were used to give nuance to the relationship between psychological distress at baseline and change rate during treatment. Finally, in Paper III, Machine Learning (ML) was used to detect dropout patients in the early phase of treatment by exploring complex patterns of symptom distress during the early phase of treatment. The thesis showed how different goals of scientific exploration can be studied in the context of routine care with the use of these statistical frameworks and discussed some of the challenges and opportunities worth noting when entering this line of research. Psykoterapiforskning har på senare tid gått från att fokusera på genomsnittliga effekter av olika behandlingsinriktningar, till att inrikta sig mer mot den enskilda patienten. När fokus förflyttas på det här sättet kan det leda till att nya statistiska metoder behöver tillämpas vilket i sin tur kan leda till nya utmaningar för psykoterapiforskaren. Syftet med avhandlingen var att undersöka hur traditionella statistiska metoder har använts för att studera olika typer av psykoterapiutfall i rutinmässig vård, och hur mer avancerade statistiska metoder kan tillämpas för att öka kunskapen om hur dessa utfall kan prediceras. Tre studier genomfördes. Studie I fokuserade på hur flernivåanalys kan användas för att studera relationen mellan arbetsallians och behandlingsutfall. I studie II användes latent profilanalys för att studera sambandet mellan psykologiska besvär vid det första besöket och symptomförändring under behandlingens gång. Slutligen, I studie III, tillämpades maskininlärning för att upptäcka patienter med risk att hoppa av behandlingen i förtid. Sammanfattningsvis belystes i avhandlingen hur olika typer av vetenskapliga frågeställningar kan studeras i en klinisk kontext med hjälp av dessa statistiska ramverk samt några av de fördelar och begräsningar som är viktiga att notera när de tillämpas.
This Element provides a pedagogical overview of the history of knowledge, including its main currents, distinguishing ideas, and key concepts. However, it is not primarily a state-of-the-art overview but rather an argumentative contribution that seeks to push the field in a certain direction – towards studying knowledge in society and knowledge in people's lives. Hence, the history of knowledge envisioned by the authors is not a rebranding of the history of science and intellectual history, but rather a reinvigoration of social and cultural history. This implies that many different forms of knowledge should be objects of study. By drawing on ongoing research from all across the world dealing with different time periods and problems, the authors demonstrate that the history of knowledge can enrich our understanding of past societies. This title is also available as Open Access on Cambridge Core.
This book identifies fear of movement and injury as a primary issue in chronic pain management. It provides a detailed treatment manual on exposure-based techniques for the reduction of pain-related fear and disability in chronic pain.
WINNER OF SWEDEN’S BEST CRIME NOVEL AWARD On the idyllic island of Öland, off the coast of northern Sweden, a young couple from Stockholm tries to start life afresh. For Joakim and Katrine Westin, reclaiming a long-neglected family manor will be a labor of love, as they slowly bring the sprawling home back to life and introduce their two children to the island’s woodlands, glens, and beaches. But in the Westins’ new home, there are things that cannot be repaired, lives that have gone wrong, and secrets that have followed them. When the family is struck by tragedy, it’s up to grief-stricken Joakim to put together a puzzle of inexplicable loss, unbearable suspicion, and tangled lives. In this powerhouse of suspense–at once a crime novel and a searing family drama–a home built as a shelter from the sea becomes a human storm of murder.
This open access book examines the challenges and issues caused by a move to a marketized education system in Sweden. Observing the introduction of the school voucher system and a postmodern social constructivist view of knowledge, the move away from objective knowledge is identified as the core reason for Sweden’s current education crisis. The impact of declining education standards on the labor market is also discussed. This book highlights the issues seen in Sweden and suggests policies that can improve education in the rest of the Western world as well. It will be relevant to students and researchers interested in education and labor economics.
On Songwriting in Northern Sami Literature on songwriting in Northern Sami have been scarce. Thanks to kind support from the Sami Parliament and the Norrbotten County Council the first book in the Black Belt book series, Songwriting, Get Your Black Belt in Music & Lyrics, by Swedish authors Johan Wahlander and Jan Sparby, is now present in a translation by Miliana Baer. The Book The first book in the Black Belt series deals with basic songwriting knowledge that makes a big difference for most songwriters: where to start your writing process, top down vs. bottom up songwriting, how to craft melodies, the various voicings of power chords, how you can extend the chords content of blues harmony, get the most out of your diatonic chords, how to work well together with other people, and much more. Also, the book features interviews with songwriters and people from the business, and gives you loads of practical songwriting tips. It exemplifies from a broad range of genres. The Authors People all around the world are wondering what is in the Swedish drinking water. Swedish songwriters are so influential that music magazines and bloggers talk about them as the new rulers of the pop charts. The authors are writing their book series from a vantage point. Not only have they interviewed their songwriting colleagues from all over the world, they are also teaching songwriting and music theory at college level themselves, and have degrees in composition, music theory and music production from the Royal College of Music in Stockholm, Sweden. They have experience, deep knowledge and a wonderful ability to explain, and make things easy to understand. Take your craftsmanship and artistry serious, and bring out the very best in your own creativeness and ideas for songs. Rise from your current level in songwriting to black belt mastery.
Raoul Wallenberg, the courageous Swedish financier and trade executive turned diplomat who saved thousands of Jews in Hungary in 1944, was arrested in January 1945 by the Soviet military counterintelligence, incarcerated in the Lubianka prison in Moscow, and later executed for reasons that remain obscure to this day. Drawing on recently declassified Soviet encrypted cables and a wide array of Soviet, Swedish, and U.S. archival sources, Stalin’s Double-Edged Game: Soviet Bureaucracy and the Raoul Wallenberg Case, 1945–1952 offers the first comprehensive analysis of the inner workings and interdepartmental communication of the Soviet foreign and state security ministries in relation to Wallenberg’s case. The way these branches of the Soviet apparatus reacted to Swedish diplomatic approaches because of Wallenberg in the years 1945 through 1948 indicate that Stalin never had any plan for Wallenberg other than to have him murdered and to make the Swedes believe that he died in Hungary shortly after the fall of Budapest. This book thereby challenges prevailing hypotheses about the Soviet leader’s motives in regard to Wallenberg.
This will help us customize your experience to showcase the most relevant content to your age group
Please select from below
Login
Not registered?
Sign up
Already registered?
Success – Your message will goes here
We'd love to hear from you!
Thank you for visiting our website. Would you like to provide feedback on how we could improve your experience?
This site does not use any third party cookies with one exception — it uses cookies from Google to deliver its services and to analyze traffic.Learn More.