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Sandlund, Mikael
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Fischer Grönlund, C., Söderberg, A., Dahlqvist, V., Sandlund, M. & Zingmark, K. (2019). Communicative and organizational aspects of clinical ethics support. Journal of Interprofessional Care, 33(16), 724-733
Öppna denna publikation i ny flik eller fönster >>Communicative and organizational aspects of clinical ethics support
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2019 (Engelska)Ingår i: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 33, nr 16, s. 724-733Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Studies show that healthcare professionals need inter-professional clinical ethics support (CES) in order to communicate and reflect on ethically difficult care situations that they experience in their clinical practice. Internationally, various CES interventions have been performed, but the communication processes and organisation of these interventions are rarely described in detail. The aim of this study was to explore communicative and organisational conditions of a CES intervention with the intention of promoting inter-professional communication about ethically difficult care situations. Eight audio- and video-recorded inter-professional CES sessions, inspired by Habermas' theory of communicative actions, were conducted. The observations were transcribed, sorted, and analysed using concept- and data-driven content analysis methods. The findings show three approaches to promoting communicative agreement, which include the CES facilitators' and participants' approaches to promoting a permissive communication, extended views, and mutual understanding. The CES sessions had organizational aspects for facilitating communicative agreement with both a given structure and openness for variation. The dynamic structure of the organization, promoted both safety and stability as well as a creativity and responsiveness, which in turn opened up for a free and dynamic inter-professional dialogue concerning ethically difficult care situations. The findings constitute a step towards a theory-based CES method inspired by Habermas' theory of communicative action. Further research is needed in order to fully develop the method and obtain increased knowledge about how to promote an inter-professional dialogue about ethically difficulties.

Ort, förlag, år, upplaga, sidor
Taylor & Francis, 2019
Nyckelord
Clinical ethics support, care ethics, ethically difficult situations, healthcare professionals, inter-professional communication
Nationell ämneskategori
Omvårdnad
Identifikatorer
urn:nbn:se:umu:diva-155309 (URN)10.1080/13561820.2018.1551862 (DOI)000493764900015 ()30497309 (PubMedID)
Tillgänglig från: 2019-01-11 Skapad: 2019-01-11 Senast uppdaterad: 2019-12-03Bibliografiskt granskad
Lundgren, L., Padyab, M., Lucero, N. M., Blom-Nilsson, M., Nyström, S., Carver-Roberts, T. & Sandlund, M. (2019). Immigration Status and Substance Use Disorder-related Mortality in Sweden. Journal of addiction medicine
Öppna denna publikation i ny flik eller fönster >>Immigration Status and Substance Use Disorder-related Mortality in Sweden
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2019 (Engelska)Ingår i: Journal of addiction medicine, ISSN 1932-0620, E-ISSN 1935-3227Artikel i tidskrift (Refereegranskat) Epub ahead of print
Abstract [en]

Objectives: First-generation immigrants, in many countries, are healthier than their native counterparts. This study examined the association between first- and second-generation immigrant status and alcohol- or drugs other than alcohol-related (primarily opioids) mortality for those with risky substance use.

Methods: A Swedish longitudinal, 2003 to 2017, registry study combined Addiction Severity Index (ASI) assessment data with mortality data (n = 15 601). Due to missing data, the analysis sample for this study was 15 012. Multivariate models tested the relationship between immigration status and drugs other than alcohol or alcohol-related mortality, controlling for demographics and the 7 ASI composite scores (CS).

Results: Age, a higher ASI CS for alcohol, a lower ASI CS family and social relationship, a lower ASI CS for drug use and a higher ASI CS for health significantly predicted mortality because of alcohol-related causes. Higher ASI CS for drugs other than alcohol, employment, and health, age, male sex, and immigration status predicted drugs other than alcohol, related mortality. Individuals born in Nordic countries, excluding Sweden, were 1.76 times more likely to die of drugs other than alcohol compared with their Swedish counterparts. Individuals born outside a Nordic country (most common countries: Iran, Somalia, Iraq, Chile) were 61% less likely to die of drugs other than alcohol compared with their Swedish counterparts. Those with parents born outside Nordic countries were 54% less likely to die of drugs other than alcohol.

Discussion: Research is needed on why people with risky substance use from Nordic countries (not Sweden) residing in Sweden, have higher mortality rates because of drugs other than alcohol (primarily opioids drugs other than alcohol compared with the other population groups in our study). Findings indicate that ASI CSs are strong predictors of future health problems including mortality due to alcohol and other drug-related causes.

Ort, förlag, år, upplaga, sidor
Wolters Kluwer, 2019
Nyckelord
alcohol-related mortality, Addiction Severity Index, drugs other than alcohol-related mortality, immigration status, opioid-related mortality
Nationell ämneskategori
Socialt arbete
Identifikatorer
urn:nbn:se:umu:diva-157873 (URN)10.1097/ADM.0000000000000524 (DOI)30889058 (PubMedID)
Projekt
STANCE
Tillgänglig från: 2019-04-04 Skapad: 2019-04-04 Senast uppdaterad: 2019-05-21
Lieber, I., Ott, M., Öhlund, L., Lundqvist, R., Eliasson, M., Sandlund, M. & Werneke, U. (2019). Lithium-associated hypothyroidism and potential for reversibility after lithium discontinuation: Findings from the LiSIE retrospective cohort study. Journal of Psychopharmacology, Article ID UNSP 0269881119882858.
Öppna denna publikation i ny flik eller fönster >>Lithium-associated hypothyroidism and potential for reversibility after lithium discontinuation: Findings from the LiSIE retrospective cohort study
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2019 (Engelska)Ingår i: Journal of Psychopharmacology, ISSN 0269-8811, E-ISSN 1461-7285, artikel-id UNSP 0269881119882858Artikel i tidskrift (Refereegranskat) Epub ahead of print
Abstract [en]

Background: The association between lithium and thyroid dysfunction has long been known. However, it remains unknown if lithium-associated hypothyroidism is reversible once lithium treatment has been stopped.

Aims: To determine whether lithium-associated hypothyroidism was reversible in patients who subsequently discontinued lithium.

Methods: A retrospective cohort study in the Swedish region of Norrbotten into the effects and side- effects of lithium treatment and other drugs for relapse prevention (Lithium – Study into Effects and Side Effects). For this particular study, we reviewed medical records between 1997 and 2015 of patients with lithium-associated hypothyroidism who had discontinued lithium.

Results: Of 1340 patients screened, 90 were included. Of these, 27% had overt hypothyroidism at the start of thyroid replacement therapy. The mean delay from starting lithium to starting thyroid replacement therapy was 2.3 years (SD 4.7). In total, 50% of patients received thyroid replacement therapy within 10 months of starting lithium. Of 85 patients available for follow-up, 41% stopped thyroid replacement therapy after lithium discontinuation. Only six patients reinstated thyroid replacement therapy subsequently. Of these, only one had overt hypothyroidism.

Conclusions: Lithium-associated hypothyroidism seems reversible in most patients once lithium has been discontinued. In such cases, thyroid replacement therapy discontinuation could be attempted much more often than currently done. Based on the limited evidence of our study, we can expect hypothyroidism to recur early after thyroid replacement therapy discontinuation, if at all.

Ort, förlag, år, upplaga, sidor
Sage Publications, 2019
Nyckelord
Bipolar disorder, lithium, hypothyroidism, thyroxine, adverse effect
Nationell ämneskategori
Farmakologi och toxikologi
Identifikatorer
urn:nbn:se:umu:diva-165328 (URN)10.1177/0269881119882858 (DOI)000495170900001 ()31670617 (PubMedID)
Forskningsfinansiär
Region NorrbottenAstraZeneca
Tillgänglig från: 2019-12-02 Skapad: 2019-12-02 Senast uppdaterad: 2019-12-02
Renberg, F. E. & Sandlund, M. (2019). Microdecisions instead of coercion: patient participation and self-perceived discrimination in a psychiatric ward. Nordic Journal of Psychiatry, 73(8), 532-538
Öppna denna publikation i ny flik eller fönster >>Microdecisions instead of coercion: patient participation and self-perceived discrimination in a psychiatric ward
2019 (Engelska)Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 73, nr 8, s. 532-538Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Aims: Patients may experience unfair reception when in contact with psychiatric services. The aims are to illuminate these perceptions, and the extent of inpatients' involvement in their care, and if degree of involvement depends on compulsory or voluntary care. Furthermore, we sought to determine if an educational intervention for staff members, including systematic listening and offering the inpatients involvement using microdecisions, affects the inpatients' experiences and the use of coercion.

Materials and methods: We used a naturalistic setting case control design in two psychiatric wards for one year, including all inpatients (n = 685) of which 458 took part of the microdecision intervention. Structured direct interviews were carried out with inpatients based on the Discrimination and Stigma Scale (DISC), Dyadic OPTION, and CollaboRATE instruments before (n = 19) and after (n = 46) the intervention. Frequencies of coercive measures before and after the intervention were compared (n = 685).

Results: Respondents subjected to the intervention experienced less discrimination related to psychiatric care compared to responders not subjected. Tendencies of improvements post intervention were found for some aspects of involvement, as attention to concerns and possibilities to ask questions. A decrease in the use of coercive measures at three and six months after the start of the intervention was observed.

Conclusion: Results suggest that the intervention could decrease the inpatients' experiences of discrimination during psychiatric care as well as the use of coercion in the service. The Dyadic OPTION instrument showed a mixed picture with results implying improvements in some areas and impairments in others.

Ort, förlag, år, upplaga, sidor
Taylor & Francis, 2019
Nyckelord
Mental illness, stigma, discrimination, DISC, patients' participation
Nationell ämneskategori
Psykiatri
Identifikatorer
urn:nbn:se:umu:diva-164403 (URN)10.1080/08039488.2019.1664629 (DOI)000486799200001 ()31524552 (PubMedID)
Tillgänglig från: 2019-11-05 Skapad: 2019-11-05 Senast uppdaterad: 2019-11-05Bibliografiskt granskad
Öhlund, L., Ott, M., Oja, S., Bergqvist, M., Lundqvist, R., Sandlund, M., . . . Werneke, U. (2018). Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study. BMC Psychiatry, 18, Article ID 37.
Öppna denna publikation i ny flik eller fönster >>Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study
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2018 (Engelska)Ingår i: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 18, artikel-id 37Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Lithium remains first choice as maintenance treatment for bipolar affective disorder. Yet, about half of all individuals may stop their treatment at some point, despite lithium’s proven benefits concerning the prevention of severe affective episodes and suicide.

Methods: Retrospective cohort study in the Swedish region of Norrbotten into the causes of lithium discontinuation. The study was set up to (1) test whether patients with bipolar affective disorder or schizoaffective disorder, treated with lithium maintenance therapy, were more likely to discontinue lithium because of adverse effects than lack of therapeutic effectiveness, (2) explore gender differences, (3) understand the role of diagnosis and (4) identify who, patient or doctor, took the initiative to stop lithium. Review of medical records for all episodes of lithium discontinuation that had occurred between 1997 and 2013 with the intent to stop lithium for good.

Results: Of 873 patients treated with lithium, 54% discontinued lithium, corresponding to 561 episodes of lithium discontinuation. In 62% of episodes, lithium was discontinued due to adverse effects, in 44% due to psychiatric reasons, and in 12% due to physical reasons interfering with lithium treatment. The five single most common adverse effects leading to lithium discontinuation were diarrhoea (13%), tremor (11%), polyuria/polydipsia/diabetes insipidus (9%), creatinine increase (9%) and weight gain (7%). Women were as likely as men to take the initiative to stop lithium, but twice as likely to consult a doctor before taking action (p < 0.01). Patients with type 1 BPAD or SZD were more likely to discontinue lithium than patients with type 2 or unspecified BPAD (p < 0.01). Patients with type 1 BPAD or SZD were more likely to refuse medication (p < 0.01). Conversely, patients with type 2 or unspecified BPAD were three times as likely to discontinue lithium for lack or perceived lack of effectiveness (p < 0.001).

Conclusions: Stopping lithium treatment is common and occurs mostly due to adverse effects. It is important to discuss potential adverse effects with patients before initiation and continuously during lithium treatment, to reduce the frequency of potentially unnecessary discontinuations.

Nyckelord
Lithium, Bipolar disorder, Physical health, Compliance, Side effects
Nationell ämneskategori
Psykiatri
Identifikatorer
urn:nbn:se:umu:diva-145594 (URN)10.1186/s12888-018-1622-1 (DOI)000424707200003 ()29415689 (PubMedID)
Anmärkning

Correction: Louise Öhlund, Michael Ott, Sofia Oja, Malin Bergqvist, Robert Lundqvist, Mikael Sandlund, Ellinor Salander Renberg and Ursula Werneke. Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study. BMC Psychiatry, 2018;18. DOI: 10.1186/s12888-018-1895-4

Tillgänglig från: 2018-04-04 Skapad: 2018-04-04 Senast uppdaterad: 2019-05-06Bibliografiskt granskad
Eklund, M., Tjörnstrand, C., Sandlund, M. & Argentzell, E. (2017). Effectiveness of Balancing Everyday Life (BEL) versus standard occupational therapy for activity engagement and functioning among people with mental illness - a cluster RCT study. BMC Psychiatry, 17, Article ID 363.
Öppna denna publikation i ny flik eller fönster >>Effectiveness of Balancing Everyday Life (BEL) versus standard occupational therapy for activity engagement and functioning among people with mental illness - a cluster RCT study
2017 (Engelska)Ingår i: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 17, artikel-id 363Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Many with a mental illness have an impoverished everyday life with few meaningful activities and a sedentary lifestyle. The study aim was to evaluate the effectiveness of the 16-week Balancing Everyday Life (BEL) program, compared to care as usual (CAU), for people with mental illness in specialized and community-based psychiatric services. The main outcomes concerned different aspects of subjectively evaluated everyday activities, in terms of the engagement and satisfaction they bring, balance among activities, and activity level. Secondary outcomes pertained to various facets of well-being and functioning. It was hypothesized that those who received the BEL intervention would improve more than the comparison group regarding activity, well-being and functioning outcomes.

Methods: BEL is a group and activity-based lifestyle intervention. CAU entailed active support, mainly standard occupational therapy. The BEL group included 133 participants and the CAU group 93. They completed self-report questionnaires targeting activity and well-being on three occasions – at baseline, after completed intervention (at 16 weeks) and at a six-month follow-up. A research assistant rated the participants’ level of functioning and symptom severity on the same occasions. Non-parametric statistics were used since these instruments produced ordinal data.

Results: The BEL group improved more than the CAU group from baseline to 16 weeks on primary outcomes in terms of activity engagement (p < 0.001), activity level (p = 0.036) and activity balance (p < 0.042). The BEL group also improved more on the secondary outcomes of symptom severity (p < 0.018) and level of functioning (p < 0.046) from baseline to 16 weeks, but not on well-being. High intra-class correlations (0.12–0.22) indicated clustering effects for symptom severity and level of functioning. The group differences on activity engagement (p = 0.001) and activity level (p = 0.007) remained at the follow-up. The BEL group also improved their well-being (quality of life) more than the CAU group from baseline to the follow-up (p = 0.049). No differences were found at that time for activity balance, level of functioning and symptom severity.

Conclusion: The BEL program was effective compared to CAU in terms of activity engagement. Their improvements were not, however, greater concerning other subjective perceptions, such as satisfaction with daily activities and self-rated health, and clustering effects lowered the dependability regarding findings of improvements on symptoms and functioning. Although the CAU group had “caught up” at the follow-up, the BEL group had improved more on general quality of life. BEL appeared to be important in shortening the time required for participants to develop their engagement in activity and in attaining improved quality of life in a follow-up perspective.

Ort, förlag, år, upplaga, sidor
BIOMED CENTRAL LTD, 2017
Nyckelord
Disability, Life style, Personal satisfaction, Occupational therapy, Recovery, Schizophrenia, Mood sorder
Nationell ämneskategori
Arbetsterapi
Identifikatorer
urn:nbn:se:umu:diva-142240 (URN)10.1186/s12888-017-1524-7 (DOI)000414864400002 ()
Forskningsfinansiär
Vetenskapsrådet, K2014-99X-20,067-09-4
Tillgänglig från: 2017-12-11 Skapad: 2017-12-11 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
Sallin, K., Ågård, A., Engström, I., Bremer, A. & Sandlund, M. (2017). Kontinuitet främjar personligt och professionellt ansvarstagande. Läkartidningen, 114, Article ID ETHI.
Öppna denna publikation i ny flik eller fönster >>Kontinuitet främjar personligt och professionellt ansvarstagande
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2017 (Svenska)Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, artikel-id ETHIArtikel i tidskrift (Refereegranskat) Published
Ort, förlag, år, upplaga, sidor
Sveriges läkarförbund, 2017
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:umu:diva-145102 (URN)29064519 (PubMedID)
Tillgänglig från: 2018-02-21 Skapad: 2018-02-21 Senast uppdaterad: 2018-10-16Bibliografiskt granskad
Lindgren, S., Petersson, G., Bergenbrant Glas, S. & Sandlund, M. (2017). Läkaresällskapet svarar Åke Thörn och medförfattare: E-hälsa kan vara bra ibland, men löser inte alla problem i vården. Läkartidningen, 114, Article ID EU3F.
Öppna denna publikation i ny flik eller fönster >>Läkaresällskapet svarar Åke Thörn och medförfattare: E-hälsa kan vara bra ibland, men löser inte alla problem i vården
2017 (Svenska)Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, artikel-id EU3FArtikel i tidskrift, Editorial material (Övrigt vetenskapligt) Published
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:umu:diva-146476 (URN)29039882 (PubMedID)
Tillgänglig från: 2018-04-10 Skapad: 2018-04-10 Senast uppdaterad: 2018-11-23Bibliografiskt granskad
Sandlund, M. (2017). Social psykiatri (1ed.). In: Magnus Englander, Karin Ingvarsdotter (Ed.), Socialpsykiatrins grunder: människans villkor (pp. 49-70). Gleerups Utbildning AB
Öppna denna publikation i ny flik eller fönster >>Social psykiatri
2017 (Svenska)Ingår i: Socialpsykiatrins grunder: människans villkor / [ed] Magnus Englander, Karin Ingvarsdotter, Gleerups Utbildning AB, 2017, 1, s. 49-70Kapitel i bok, del av antologi (Refereegranskat)
Ort, förlag, år, upplaga, sidor
Gleerups Utbildning AB, 2017 Upplaga: 1
Nationell ämneskategori
Psykiatri
Identifikatorer
urn:nbn:se:umu:diva-147397 (URN)9789140694546 (ISBN)
Tillgänglig från: 2018-05-03 Skapad: 2018-05-03 Senast uppdaterad: 2018-11-13Bibliografiskt granskad
Pihkala, H., Dimova-Branstrom, N. & Sandlund, M. (2017). Talking about parental substance abuse with children: eight families' experiences of Beardslee's family intervention. Nordic Journal of Psychiatry, 71(5), 395-401
Öppna denna publikation i ny flik eller fönster >>Talking about parental substance abuse with children: eight families' experiences of Beardslee's family intervention
2017 (Engelska)Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 71, nr 5, s. 395-401Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Many children are affected by parental substance use disorder. Beardslee's family intervention (BFI) is a family-based psycho-educative method for children of mentally ill parents, used in psychiatric practise in several Nordic countries. The method has also been used to some extent when a parent suffers from substance use disorder. Aims: The aim of the study was to explore the family members' experiences of the BFI when a parent has a diagnosis of substance use disorder, to gain new knowledge about the process of the BFI in this area. Methods: Ten children and 14 parents were interviewed about their experiences 6 months after a BFI. The interviews were analyzed by qualitative content analysis. The children's psychological symptoms were measured by the Strengths and Difficulties Questionnaire at baseline and after 6 months. Results: Increased openness about the substance use disorder in the families was a recurrent theme throughout the material and a central issue reported in the children's experiences. The children had a high level of psychological symptoms according to the SDQ at baseline, but the majority of them felt that the BFI made a positive difference in their families and for themselves. The parents reported improved wellbeing of their children. Conclusions and clinical implications: Positive experienced effects for children and parents are reported in families with parental substance use disorder, with possible connection to use of BFI. The present study suggests that Beardslee's family intervention is applicable as a preventive method for children in families with a parent suffering from substance use disorder.

Ort, förlag, år, upplaga, sidor
TAYLOR & FRANCIS LTD, 2017
Nyckelord
Parental substance abuse, prevention, intervention, children
Nationell ämneskategori
Psykiatri
Identifikatorer
urn:nbn:se:umu:diva-138228 (URN)10.1080/08039488.2017.1308009 (DOI)000406140700010 ()
Tillgänglig från: 2017-08-18 Skapad: 2017-08-18 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
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