| 1. |
- Wittchen, H U, et al.
(author)
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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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In: 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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Journal article (peer-reviewed)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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| 2. |
- Gustavsson, Anders, et al.
(author)
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Cost of disorders of the brain in Europe 2010.
- 2011
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In: European Neuropsychopharmacology. - Amsterdam : Elsevier BV. - 0924-977X .- 1873-7862. ; 21:10, s. 718-79
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Journal article (peer-reviewed)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. |
- Aronsson, Håkan, 1961-, et al.
(author)
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Managing health care decisions and improvement through simulation modeling
- 2011
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In: Quality Management in Health Care. - : Wolters Kluwer. - 1063-8628 .- 1550-5154. ; 20:1, s. 15-29
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Journal article (peer-reviewed)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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| 4. |
- Hasson, Henna, et al.
(author)
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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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In: International Journal of Older People Nursing. - : Wiley. - 1748-3735 .- 1748-3743. ; 5:1, s. 5-15
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Journal article (peer-reviewed)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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| 5. |
- Henningsson, Stefan, et al.
(author)
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Socio-technical IS design science research : developing design theory for IS integration management
- 2011
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In: Information Systems and E-Business Management. - : Springer Science and Business Media LLC. - 1617-9846 .- 1617-9854. ; 9:1, s. 109-131
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Journal article (peer-reviewed)abstract
- Design science research is an essential part of IS research since the field should not only try to understand how the world is, but also how to change it. We argue that the aim of IS design science research should be to develop practical knowledge not only for the design of novel information technology (IT), but also for IS governance and management. Whereas at least some methodological support exists for researchers engaged in IT-centric design science research, limited support is available for researchers who want to develop design knowledge and theory for IS governance and management. To overcome this shortcoming, we suggest a socio-technical IS design science research approach. The approach has four main activities: (1) identifying problem situations and desired outcomes, (2) reviewing extant theories, knowledge and data, (3) proposing/refining design theory and knowledge, and (4) testing design theory and knowledge. The applicability and usefulness of the proposed approach is shown by means of a design science research project concerning IS integration management in the context of mergers and acquisitions.
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| 6. |
- Nilsson, Anna S., et al.
(author)
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Transfer of Academic Research - Uncovering the Grey Zone
- 2010
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In: Journal of Technology Transfer. - : Springer Science and Business Media LLC. - 0892-9912 .- 1573-7047. ; 35:6, s. 617-636
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Journal article (peer-reviewed)abstract
- In this study, we respond to calls for further investigation on why and how scientists choose to commercialize their research. Mowery (University entrepreneurship and technology transfer: process design, and intellectual property, Elsevier, Oxford 2005), in his criticism of the US-system, emphasizes the need for multiple channels between university and industry. His argument makes the case of Sweden interesting, where the researchers own the intellectual property of their research. Sweden thus constitutes a unique case where data can be found on which choices researchers make in a setting where a variety of channels for transfer are available. Our empirical data, collected through case studies, allowed for the expansion of the typology for mechanisms for transfer of academic research as well as the development of a typology for determinants for researchers' choice to engage in transfer of research. Apart from those contributions to the theoretic discussion, the data also provided policy implications.
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| 7. |
- Cederberg, Christel, 1959, et al.
(author)
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Including Carbon Emissions from Deforestation in the Carbon Footprint of Brazilian Beef
- 2011
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In: Environmental Science and Technology. - : American Chemical Society (ACS). - 0013-936X .- 1520-5851. ; 45:5
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Journal article (peer-reviewed)abstract
- Effects of land use changes are starting to be included in estimates of life-cycle greenhouse gas (GHG) emissions, so-called carbon footprints (CFs), from food production. Their omission can lead to serious underestimates, particularly for meat. Here we estimate emissions from the conversion of forest to pasture in the Legal Amazon Region (LAR) of Brazil and present a model to distribute the emissions from deforestation over products and time subsequent to the land use change. Expansion of cattle ranching for beef production is a major cause of deforestation in the LAR. The carbon footprint of beef produced on newly deforested land is estimated at more than 700 kg CO2-equivalents per kg carcass weight if direct land use emissions are annualized over 20 years. This is orders of magnitude larger than the figure for beef production on established pasture on non-deforested land. While Brazilian beef exports have originated mainly from areas outside the LAR, i.e. from regions not subject to recent deforestation, we argue that increased production for export has been the key driver of the pasture expansion and deforestation in the LAR during the past decade and this should be reflected in the carbon footprint attributed to beef exports. We conclude that carbon footprint standards must include the more extended effects of land use changes to avoid giving misleading information to policy makers, retailers, and consumers.
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| 8. |
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| 9. |
- Choi, Soki, et al.
(author)
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Executive Management in Radical Change – The Case of Karolinska University Hospital Merger
- 2011
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In: Scandinavian Journal of Management. - : Elsevier BV. - 0956-5221 .- 1873-3387. ; 27:1, s. 11-23
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Journal article (peer-reviewed)abstract
- Based on the merger of two Swedish university hospitals, this paper examines top management's work in implementing radical change initiatives. Our case confirms the limitations of the classic top-down approach to radical change in professional organizations. We also identify an important paradox: contrary to contemporary change literature prescription, initial managerial success seems to impair the change process further down the organization. A key finding is that when mergers are used as tools to effect radical change in politically ambiguous environment, management appears to be limited to initiate change and to take the role of the scapegoat due to inherent factors in the change process. By elucidating management's difficult role vis-à-vis multiple stakeholders, this paper contributes to one aspect of managerial agency discourse that is rarely discussed in detail.
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| 10. |
- Gospic, Katarina, et al.
(author)
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Limbic Justice-Amygdala Involvement in Immediate Rejection in the Ultimatum Game
- 2011
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In: PLoS Biology. - : Public Library of Science. - 1545-7885 .- 1544-9173. ; 9:5
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Journal article (peer-reviewed)abstract
- Imaging studies have revealed a putative neural account of emotional bias in decision making. However, it has been difficult in previous studies to identify the causal role of the different sub-regions involved in decision making. The Ultimatum Game (UG) is a game to study the punishment of norm-violating behavior. In a previous influential paper on UG it was suggested that frontal insular cortex has a pivotal role in the rejection response. This view has not been reconciled with a vast literature that attributes a crucial role in emotional decision making to a subcortical structure (i.e., amygdala). In this study we propose an anatomy-informed model that may join these views. We also present a design that detects the functional anatomical response to unfair proposals in a subcortical network that mediates rapid reactive responses. We used a functional MRI paradigm to study the early components of decision making and challenged our paradigm with the introduction of a pharmacological intervention to perturb the elicited behavioral and neural response. Benzodiazepine treatment decreased the rejection rate (from 37.6% to 19.0%) concomitantly with a diminished amygdala response to unfair proposals, and this in spite of an unchanged feeling of unfairness and unchanged insular response. In the control group, rejection was directly linked to an increase in amygdala activity. These results allow a functional anatomical detection of the early neural components of rejection associated with the initial reactive emotional response. Thus, the act of immediate rejection seems to be mediated by the limbic system and is not solely driven by cortical processes, as previously suggested. Our results also prompt an ethical discussion as we demonstrated that a commonly used drug influences core functions in the human brain that underlie individual autonomy and economic decision making.
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