| 1. |
- Berlin, Johan, 1975-
(författare)
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Synchronous work - myth or reality? : a critical study of teams in health and medical care
- 2010
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Ingår i: Journal of Evaluation In Clinical Practice. - London : Blackwell Publishing Ltd. - 1356-1294 .- 1365-2753. ; 16:6, s. 1314-1321
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Rationale, aims and objectives In this article, ideal conceptions about teamwork are tested. The research question posed is: How are teams in psychiatry formed? Three theoretical concepts that distinguish groups from teams are presented: sequentiality, parallelism and synchronicity. The presumption is that groups cooperate sequentially and teams synchronously, while the parallel work mode is a transitional form between group and team. Methods Three psychiatric outpatient teams at a university hospital specialist clinic were studied. Data were collected through 25 personal interviews and 82 hours of observations. The data collection was carried out over 18 months (2008–2009). Results Results show: (1) that the three theoretical distinctions between group and team need to be supplemented with two intermediate forms, semiparallel and semisynchronous teamwork; and (2) that teamwork is not characterized by striving towards a synchronous ideal but instead is marked by an adaptive interaction between sequential, parallel and synchronous working modes. Conclusions The article points to a new intermediate stage between group and team. This intermediate stage is called semiparallel teamwork. The study shows that practical teamwork is not characterized by a synchronous ideal, but rather is about how to adaptively find acceptable solutions to a series of practical problems. The study emphasizes the importance of the team varying between different working modes, so-called semisystematics.
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| 2. |
- Gustavsson, Anders, et al.
(författare)
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Cost of disorders of the brain in Europe 2010.
- 2011
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Ingår i: European Neuropsychopharmacology. - Amsterdam : Elsevier BV. - 0924-977X .- 1873-7862. ; 21:10, s. 718-79
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The spectrum of disorders of the brain is large, covering hundreds of disorders that are listed in either the mental or neurological disorder chapters of the established international diagnostic classification systems. These disorders have a high prevalence as well as short- and long-term impairments and disabilities. Therefore they are an emotional, financial and social burden to the patients, their families and their social network. In a 2005 landmark study, we estimated for the first time the annual cost of 12 major groups of disorders of the brain in Europe and gave a conservative estimate of €386 billion for the year 2004. This estimate was limited in scope and conservative due to the lack of sufficiently comprehensive epidemiological and/or economic data on several important diagnostic groups. We are now in a position to substantially improve and revise the 2004 estimates. In the present report we cover 19 major groups of disorders, 7 more than previously, of an increased range of age groups and more cost items. We therefore present much improved cost estimates. Our revised estimates also now include the new EU member states, and hence a population of 514 million people.AIMS: To estimate the number of persons with defined disorders of the brain in Europe in 2010, the total cost per person related to each disease in terms of direct and indirect costs, and an estimate of the total cost per disorder and country.METHODS: The best available estimates of the prevalence and cost per person for 19 groups of disorders of the brain (covering well over 100 specific disorders) were identified via a systematic review of the published literature. Together with the twelve disorders included in 2004, the following range of mental and neurologic groups of disorders is covered: addictive disorders, affective disorders, anxiety disorders, brain tumor, childhood and adolescent disorders (developmental disorders), dementia, eating disorders, epilepsy, mental retardation, migraine, multiple sclerosis, neuromuscular disorders, Parkinson's disease, personality disorders, psychotic disorders, sleep disorders, somatoform disorders, stroke, and traumatic brain injury. Epidemiologic panels were charged to complete the literature review for each disorder in order to estimate the 12-month prevalence, and health economic panels were charged to estimate best cost-estimates. A cost model was developed to combine the epidemiologic and economic data and estimate the total cost of each disorder in each of 30 European countries (EU27+Iceland, Norway and Switzerland). The cost model was populated with national statistics from Eurostat to adjust all costs to 2010 values, converting all local currencies to Euro, imputing costs for countries where no data were available, and aggregating country estimates to purchasing power parity adjusted estimates for the total cost of disorders of the brain in Europe 2010.RESULTS: The total cost of disorders of the brain was estimated at €798 billion in 2010. Direct costs constitute the majority of costs (37% direct healthcare costs and 23% direct non-medical costs) whereas the remaining 40% were indirect costs associated with patients' production losses. On average, the estimated cost per person with a disorder of the brain in Europe ranged between €285 for headache and €30,000 for neuromuscular disorders. The European per capita cost of disorders of the brain was €1550 on average but varied by country. The cost (in billion €PPP 2010) of the disorders of the brain included in this study was as follows: addiction: €65.7; anxiety disorders: €74.4; brain tumor: €5.2; child/adolescent disorders: €21.3; dementia: €105.2; eating disorders: €0.8; epilepsy: €13.8; headache: €43.5; mental retardation: €43.3; mood disorders: €113.4; multiple sclerosis: €14.6; neuromuscular disorders: €7.7; Parkinson's disease: €13.9; personality disorders: €27.3; psychotic disorders: €93.9; sleep disorders: €35.4; somatoform disorder: €21.2; stroke: €64.1; traumatic brain injury: €33.0. It should be noted that the revised estimate of those disorders included in the previous 2004 report constituted €477 billion, by and large confirming our previous study results after considering the inflation and population increase since 2004. Further, our results were consistent with administrative data on the health care expenditure in Europe, and comparable to previous studies on the cost of specific disorders in Europe. Our estimates were lower than comparable estimates from the US.DISCUSSION: This study was based on the best currently available data in Europe and our model enabled extrapolation to countries where no data could be found. Still, the scarcity of data is an important source of uncertainty in our estimates and may imply over- or underestimations in some disorders and countries. Even though this review included many disorders, diagnoses, age groups and cost items that were omitted in 2004, there are still remaining disorders that could not be included due to limitations in the available data. We therefore consider our estimate of the total cost of the disorders of the brain in Europe to be conservative. In terms of the health economic burden outlined in this report, disorders of the brain likely constitute the number one economic challenge for European health care, now and in the future. Data presented in this report should be considered by all stakeholder groups, including policy makers, industry and patient advocacy groups, to reconsider the current science, research and public health agenda and define a coordinated plan of action of various levels to address the associated challenges.RECOMMENDATIONS: Political action is required in light of the present high cost of disorders of the brain. Funding of brain research must be increased; care for patients with brain disorders as well as teaching at medical schools and other health related educations must be quantitatively and qualitatively improved, including psychological treatments. The current move of the pharmaceutical industry away from brain related indications must be halted and reversed. Continued research into the cost of the many disorders not included in the present study is warranted. It is essential that not only the EU but also the national governments forcefully support these initiatives.
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| 3. |
- Wittchen, H U, et al.
(författare)
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The size and burden of mental disorders and other disorders of the brain in Europe 2010.
- 2011
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Ingår i: European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology. - : Elsevier BV. - 1873-7862 .- 0924-977X. ; 21:9, s. 655-79
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Tidskriftsartikel (refereegranskat)abstract
- To provide 12-month prevalence and disability burden estimates of a broad range of mental and neurological disorders in the European Union (EU) and to compare these findings to previous estimates. Referring to our previous 2005 review, improved up-to-date data for the enlarged EU on a broader range of disorders than previously covered are needed for basic, clinical and public health research and policy decisions and to inform about the estimated number of persons affected in the EU.
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| 4. |
- Aronsson, Håkan, 1961-, et al.
(författare)
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Managing health care decisions and improvement through simulation modeling
- 2011
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Ingår i: Quality Management in Health Care. - : Wolters Kluwer. - 1063-8628 .- 1550-5154. ; 20:1, s. 15-29
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Tidskriftsartikel (refereegranskat)abstract
- Simulation modeling is a way to test changes in a computerized environment to give ideas for improvements before implementation. This article reviews research literature on simulation modeling as support for health care decision making. The aim is to investigate the experience and potential value of such decision support and quality of articles retrieved. A literature search was conducted, and the selection criteria yielded 59 articles derived from diverse applications and methods. Most met the stated research-quality criteria. This review identified how simulation can facilitate decision making and that it may induce learning. Furthermore, simulation offers immediate feedback about proposed changes, allows analysis of scenarios, and promotes communication on building a shared system view and understanding of how a complex system works. However, only 14 of the 59 articles reported on implementation experiences, including how decision making was supported. On the basis of these articles, we proposed steps essential for the success of simulation projects, not just in the computer, but also in clinical reality. We also presented a novel concept combining simulation modeling with the established plan-do-study-act cycle for improvement. Future scientific inquiries concerning implementation, impact, and the value for health care management are needed to realize the full potential of simulation modeling.
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| 5. |
- Svensson, Mikael, 1980, et al.
(författare)
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Adolescent alcohol and illicit drug use among first- and second-generation immigrants in Sweden.
- 2010
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Ingår i: Scandinavian journal of public health. - London : SAGE Publications. - 1651-1905 .- 1403-4948. ; 38:2, s. 184-91
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Tidskriftsartikel (refereegranskat)abstract
- This article compares adolescent alcohol and illicit drug use among first- and second-generation immigrants from Nordic, non-Nordic European and non-European countries with that of the native Swedish majority population.
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| 6. |
- Forslund, Johanna, et al.
(författare)
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Does remediation save lives? - on the cost of cleaning up arsenic-contaminated sites in Sweden.
- 2010
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Ingår i: The Science of the total environment. - : Elsevier BV. - 1879-1026 .- 0048-9697. ; 408:16, s. 3085-91
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Tidskriftsartikel (refereegranskat)abstract
- Sweden has only just begun remediation of its many contaminated sites, a process that will cost an estimated SEK 60,000 million (USD 9100 million). Although the risk assessment method, carried out by the Swedish EPA, is driven by health effects, it does not consider actual exposure. Instead, the sites are assessed based on divergence from guideline values. This paper uses an environmental medicine approach that takes exposure into account to analyse how cancer risks on and near arsenic-contaminated sites are implicitly valued in the remediation process. The results show that the level of ambition is high. At 23 contaminated sites, the cost per life saved varies from SEK 287 million to SEK 1,835,000 million, despite conservative calculations that in fact probably underestimate the costs. It is concluded that if environmental health risks are to be reduced, there are probably other areas where economic resources can be used more cost-effectively.
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| 7. |
- Hasson, Henna, et al.
(författare)
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A comparative study of nursing staff, care recipients' and their relatives' perceptions of quality of older people care
- 2010
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Ingår i: International Journal of Older People Nursing. - : Wiley. - 1748-3735 .- 1748-3743. ; 5:1, s. 5-15
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Tidskriftsartikel (refereegranskat)abstract
- Background. Comparisons of different stakeholders’ ratings of the quality of older people care can help to drive quality improvement. Aim. The aim was to compare staff, older care recipients’ and their relatives’ quality of care ratings. Design. Cross-sectional questionnaire surveys in 2003 and 2004, using a repeated measures design on an organizational level. Methods. Nursing staff, care recipients and relatives in two older people care organizations were included. The ratings of an overall quality grade, information, activities, general care and staff skills were compared between the respondent groups. Results. Care recipients in both organizations rated the overall quality grade significantly higher than nursing staff and relatives. Staff ratings of the information given to care recipients were significantly more positive than care recipients’ and relatives’ ratings. All three groups gave lowest ratings to the quality of activities offered to care recipients, with lowest ratings from nursing staff. Conclusions. Concurrent measurements of staff, care recipients and relatives’ care quality perceptions can provide a broad evaluation of an organization’s strength and limitations. Relevance to clinical practice. Staff, care recipients’ and relatives’ perceptions can be useful for older people care organizations and decision makers in developing care processes and outcomes of care.
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| 8. |
- Nylinder, Pia, 1973-
(författare)
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Perception of budgetary control : a study of differences across managers in Swedish public primary healthcare related to professional background and sex
- 2011
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Ingår i: Journal of Nursing Management. - : Wiley-Blackwell. - 0966-0429 .- 1365-2834. ; 19:5, s. 664-672
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Tidskriftsartikel (refereegranskat)abstract
- Background The composition of managers in Swedish public primary care centres has changed since the mid-1990s, favouring nurses and female managers. In parallel, health-care professionals have become more involved in the management structure and many have experienced an increased demand for cost containment. There is limited empirical evidence about how managers with different professional backgrounds perceive tight budgetary control.Aim To examine whether perceptions of tight budgetary control across managers in Swedish public primary care are related to personal characteristics such as professional background and sex.Method A questionnaire measuring perception of tight budgetary control was administered to all (636) identified managers in Swedish public primary care centres (response rate was 59%). Differences between groups were analysed through logistic regression and factor analysis.Results Nurses and other non-physicians perceived the budgetary control to be tighter than did physicians and female physicians perceived the budgetary control to be tighter than did male physicians.Conclusions and implications for nursing management Results suggest that nurses were more committed to the budgetary control system and county council objectives than physicians. The impact of these differences are uncertain, however, nurses’ capacity to influence primary care services may be more limited compared with physicians because of their lower professional status.
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| 9. |
- de Jong, Kim, et al.
(författare)
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Area-aggregated assessments of perceived environmental attributes may overcome single-source bias in studies of green environments and health: results from a cross-sectional survey in southern Sweden
- 2011
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Ingår i: Environmental Health. - 1476-069X. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Most studies assessing health effects of neighborhood characteristics either use self-reports or objective assessments of the environment, the latter often based on Geographical Information Systems (GIS). While objective measures require detailed landscape data, self-assessments may yield confounded results. In this study we demonstrate how self-assessments of green neighborhood environments aggregated to narrow area units may serve as an appealing compromise between objective measures and individual self-assessments. Methods: The study uses cross-sectional data (N = 24,847) from a public health survey conducted in the county of Scania, southern Sweden, in 2008 and validates the Scania Green Score (SGS), a new index comprising five self-reported green neighborhood qualities (Culture, Lush, Serene, Spacious and Wild). The same qualities were also assessed objectively using landscape data and GIS. A multilevel (ecometric) model was used to aggregate individual self-reports to assessments of perceived green environmental attributes for areas of 1,000 square meters. We assessed convergent and concurrent validity for self-assessments of the five items separately and for the sum score, individually and area-aggregated. Results: Correlations between the index scores based on self-assessments and the corresponding objective assessments were clearly present, indicating convergent validity, but the agreement was low. The correlation was even more evident for the area-aggregated SGS. All three scores (individual SGS, area-aggregated SGS and GIS index score) were associated with neighborhood satisfaction, indicating concurrent validity. However, while individual SGS was associated with vitality, this association was not present for aggregated SGS and the GIS-index score, suggesting confounding (single-source bias) when individual SGS was used. Conclusions: Perceived and objectively assessed qualities of the green neighborhood environment correlate but do not agree. An index score based on self-reports but aggregated to narrow area units can be a valid approach to assess perceived green neighborhood qualities in settings where objective assessments are not possible or feasible.
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| 10. |
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