| 1. |
- Zielinski, Andrzej, et al.
(författare)
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Impact of comorbidity on the individual's choice of primary health care provider.
- 2011
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 29, s. 104-109
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective. This study examined whether age, gender, and comorbidity were of importance for an individual's choice of listing with either a public or a private primary health care (PHC) practice. Design and setting. The study was a register-based closed cohort study in one private and one public PHC practice in Blekinge County in southern Sweden. Subjects. A cohort (12 696 individuals) was studied comprising all those listed with the public or private PHC practice on 1 October 2005 who were also listed with the public PHC practice on 1 October 2004. Main outcome measures. The listing/re-listing behaviour of the population in this cohort was studied at two points in time, 1 October 2005 and 1 October 2006, with respect to age, gender, and comorbidity level as measured by the ACG Case-Mix system. Results. Individuals listed with the public practice both on 1 October 2005 and one year later were significantly older, were more often females, and had a higher comorbidity level than individuals listed with the private practice. Individuals with a higher comorbidity level were more likely to re-list or to stay listed with the public practice. Conclusions. This study shows that the probability of choosing a public instead of private PHC provider increased with higher age and comorbidity level of the individuals. It is suggested that using a measure of comorbidity can help us understand more about the chronically ill individual's choice of health care provider. This would be of importance when health care policy-makers decide on reimbursement system or organization of PHC.
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| 2. |
- Ahrné, Karin, et al.
(författare)
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Tillstånd och trender för arter och deras livsmiljöer – rödlistade arter i Sverige 2015
- 2015
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- 2015 års upplaga av den svenska rödlistan är den fjärde i ordningen. Den är baserad på IUCN:s rödlistningskriterier och revideras vart femte år. I rödlistan bedöms risken som enskilda arter av djur, växter och svampar löper att försvinna från Sverige. Bedömningen utförs av ArtDatabankens medarbetare i samverkan med över 100 externa experter, indelade i 14 expertkommittéer för olika organismgrupper. Under arbetet med 2015 års rödlista har tillstånd och trender bedömts för 21 600 arter och 1 318 lägre taxa (apomiktiska arter, underarter och varieteter), sammanlagt ca 22 900 taxa. Av de bedömda arterna klassificerades 2 029 som hotade (kategorierna CR, EN och VU) och 4 273 som rödlistade (inkluderar även kategorierna NT, RE och DD). Förhållandet mellan antalet rödlistade och antalet bedömda arter ar 19,8 %, vilket är ungefär samma värde som 2010 och 2005. I denna rapport jämförs antalet och andelen rödlistade arter mellan olika organismgrupper, biotoper, substrat och påverkansfaktorer. Texten ar indelad i en allmän del och åtta kapitel inriktade på olika landskapstyper. Landskapstyperna utgör en grov indelning av landets miljöer enligt följande kategorier: Skog, Jordbrukslandskap, Urbana miljöer, Fjäll, Våtmarker, Sötvatten, Havsstränder och Havsmiljöer. Skogen och jordbrukslandskapet är de artrikaste landskapstyperna med 1 800 respektive 1 400 arter som har en stark anknytning dit, och ytterligare flera hundra arter som förekommer där mer sporadiskt. De faktorer som påverkar flest rödlistade arter i Sverige är skogsavverkning och igenväxning, som båda utgör ett hot mot vardera ca 30 % av de rödlistade arterna. Avverkning minskar arealen av skog där naturliga strukturer och naturlig dynamik upprätthålls, och den orsakar därmed förlust av livsmiljöer. Igenväxning orsakas av ett antal faktorer, bland annat upphörande hävd (bete och slåtter), gödsling, trädplantering och brist på naturliga störningsregimer som t.ex. regelbundna översvämningar kring vattendrag och sjöar. Andra viktiga påverkansfaktorer är fiske, torrläggning av våtmarker, tillbakagång hos värdarter (främst alm och ask som drabbats av invasiva svampsjukdomar), klimatförändringar och konkurrens från invasiva arter. IUCN:s rödlisteindex beräknas för ett urval av de bedömda organismgrupperna. Rödlisteindex visar att skillnaderna mellan rödlistorna från 2000, 2005, 2010 och 2015 är små. Ett par undantag finns dock. Groddjur och stora däggdjur har fått en något förbättrad situation sedan 2000. Totalt förefaller det ändå som att trycket mot Sveriges artstock har förblivit relativt konstant under de senaste 15 åren.
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| 3. |
- Berg Skoog, Jessica, et al.
(författare)
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Drugs prescribed by general practitioners according to age, gender and socioeconomic status after adjustment for multimorbidity level
- 2014
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Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Age, gender and socioeconomic status have been shown to be associated with the use of prescription drugs, even after adjustment for multimorbidity. General practitioners have a holistic and patient-centred perspective and our hypothesis is that this may reflect on the prescription of drugs. In Sweden the patient may seek secondary care without a letter of referral and the liability of the prescription of drugs accompanies the patient, which makes it suitable for this type of research. In this study we examine the odds of having prescription drug use in the population and the rates of prescription drugs among patients, issued in primary health care, according to age, gender and socioeconomic status after adjustment for multimorbidity level. Method: Data were collected on all individuals above 20 years of age in Ostergotland county with about 400 000 inhabitants in year 2006. The John Hopkins ACG Case-mix was used as a proxy for multimorbidity level. Odds ratio (OR) of having prescription drugs issued in primary health care in the population and rates of prescription drug use among patients in primary health care, stated as incidence rate ratio (IRR), according to age, gender and socioeconomic status were calculated and adjusted for multimorbidity. Results: After adjustment for multimorbidity, individuals 80 years or older had higher odds ratio (OR 3.37 (CI 95% 3.22-3.52)) and incidence rate ratio (IRR 6.24 (CI 95% 5.79-6.72)) for prescription drug use. Male individuals had a lower odds ratio of having prescription drugs (OR 0.66 (CI 95% 0.64-0.69)), but among patients males had a slightly higher incidence rate of drug use (IRR 1.06 (CI 95% 1.04-1.09)). Individuals with the highest income had the lowest odds ratio of having prescription drugs and individuals with the second lowest income had the highest odds ratio of having prescription drugs (OR 1.10 (CI 95% 1.07-1.13)). Individuals with the highest education had the lowest odds ratio of having prescription drugs (OR 0.61 (CI 95% 0.54-0.67)). Conclusion: Age, gender and socioeconomic status are associated with large differences in the use of prescribed drugs in primary health care, even after adjustment for multimorbidity level.
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| 4. |
- Berg Skoog, Jessica, et al.
(författare)
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Indication for pharmacological treatment is often lacking: a cross-sectional study on the quality of drug therapy among the elderly.
- 2015
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Although the elderly have a substantially higher drug use than younger patients, even after adjustment for multimorbidity, there is limited knowledge about the elderly's indication for treatment. It is essential for elderly patients to have a well-planned drug therapy. The first step towards a correct and safe drug therapy is to ensure that the patient's drugs have an indication, i.e. correct diagnoses are linked to all of the prescription drugs. The aim of this study was to examine to what extent elderly patients have indication for a number of their prescribed drugs and, furthermore, if there are any differences in indication for treatment depending on gender, age, level of multimorbidity and income.
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| 5. |
- Halling, Anders, et al.
(författare)
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General health and tobacco habits among middle-aged Swedes
- 2007
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Ingår i: European Journal of Public Health. - 1101-1262 .- 1464-360X. - 1101-1262 ; 17:2, s. 151-154
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Tidskriftsartikel (refereegranskat)abstract
- Background: Convincing scientific evidence exists that smoking has devastating effects on health. The use of smokeless tobacco (snuff) as a tobacco habit has been reported to be considerably less harmful, and has been suggested as an aid to smoking cessation, among other things. Methods: Cross-sectional data on general health and tobacco habits were obtained through a self-administered mail questionnaire in 2002 representing 50-year-old (n = 6236) and 60-year-old (n = 6232) Swedes in two counties. Participation rates were 70.2 and 75.7% in the both age cohorts, respectively. Of all participants 46.2% were male and 53.8% female. A general health index encompassing five items (score 0-5) was designed, with the best general health attributed to those scoring 5. Results: Male daily smokers accounted for 15.6% of the 50-year-olds and 18.7% of the 60-years-olds compared with 21.1 and 16.6%, respectively, for females. Corresponding figures for daily snuffing were 21.1 and 11.9% for men and 1.7 and 0.4% for women. When adjusting for age, sex, place of living, social network, education, and marital status, and related to subjects who never used tobacco, 'best general health' score 5, significant differences were found for ex-smokers (OR 0.82; 95% CI 0.74-0.90; P < 0.001) and ex-snuffers (OR 0.74; 95% CI 0.61-0.90; P < 0.01). Conclusion: Those who have stopped smoking or snuffing seem to be in a vulnerable condition with respect to general health and in need of extra support and health-promoting activities.
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| 6. |
- Halling, Anders, et al.
(författare)
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General health and tobacco habits among middle-aged Swedes
- 2007
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Ingår i: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 17:2, s. 151-154
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Tidskriftsartikel (refereegranskat)abstract
- Background: Convincing scientific evidence exists that smoking has devastating effects on health. The use of smokeless tobacco (snuff) as a tobacco habit has been reported to be considerably less harmful, and has been suggested as an aid to smoking cessation, among other things. Methods: Cross-sectional data on general health and tobacco habits were obtained through a self-administered mail questionnaire in 2002 representing 50-year-old (n = 6236) and 60-year-old (n = 6232) Swedes in two counties. Participation rates were 70.2 and 75.7% in the both age cohorts, respectively. Of all participants 46.2% were male and 53.8% female. A general health index encompassing five items (score 0-5) was designed, with the best general health attributed to those scoring 5. Results: Male daily smokers accounted for 15.6% of the 50-year-olds and 18.7% of the 60-years-olds compared with 21.1 and 16.6%, respectively, for females. Corresponding figures for daily snuffing were 21.1 and 11.9% for men and 1.7 and 0.4% for women. When adjusting for age, sex, place of living, social network, education, and marital status, and related to subjects who never used tobacco, 'best general health' score 5, significant differences were found for ex-smokers (OR 0.82; 95% CI 0.74-0.90; P < 0.001) and ex-snuffers (OR 0.74; 95% CI 0.61-0.90; P < 0.01). Conclusion: Those who have stopped smoking or snuffing seem to be in a vulnerable condition with respect to general health and in need of extra support and health-promoting activities.
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| 7. |
- Larsen, Lars Bruun, et al.
(författare)
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Digital Recruitment and Acceptance of a Stepwise Model to Prevent Chronic Disease in the Danish Primary Care Sector : Cross-Sectional Study
- 2019
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: During recent years, stepwise approaches to health checks have been advanced as an alternative to general health checks. In 2013, we set up the Early Detection and Prevention project (Tidlig Opsporing og Forebyggelse, TOF) to develop a stepwise approach aimed at patients at high or moderate risk of a chronic disease. A novel feature was the use of a personal digital mailbox for recruiting participants. A personal digital mailbox is a secure digital mailbox provided by the Danish public authorities. Apart from being both safe and secure, it is a low-cost, quick, and easy way to reach Danish residents. OBJECTIVE: In this study we analyze the association between the rates of acceptance of 2 digital invitations sent to a personal digital mailbox and the sociodemographic determinants, medical treatment, and health care usage in a stepwise primary care model for the prevention of chronic diseases. METHODS: We conducted a cross-sectional analysis of the rates of acceptance of 2 digital invitations sent to randomly selected residents born between 1957 and 1986 and residing in 2 Danish municipalities. The outcome was acceptance of the 2 digital invitations. Statistical associations were determined by Poisson regression. Data-driven chi-square automatic interaction detection method was used to generate a decision tree analysis, predicting acceptance of the digital invitations. RESULTS: A total of 8814 patients received an invitation in their digital mailbox from 47 general practitioners. A total of 40.22% (3545/8814) accepted the first digital invitation, and 30.19 % (2661/8814) accepted both digital invitations. The rates of acceptance of both digital invitations were higher among women, older patients, patients of higher socioeconomic status, and patients not diagnosed with or being treated for diabetes mellitus, chronic obstructive pulmonary disease, or cardiovascular disease. CONCLUSIONS: To our knowledge, this is the first study to report on the rates of acceptance of digital invitations to participate in a stepwise model for prevention of chronic diseases. More studies of digital invitations are needed to determine if the acceptance rates seen in this study should be expected from future studies as well. Similarly, more research is needed to determine whether a multimodal recruitment approach, including digital invitations to personal digital mailboxes will reach hard-to-reach subpopulations more effectively than digital invitations only.
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| 8. |
- Larsen, Lars Bruun, et al.
(författare)
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Step-wise approach to prevention of chronic diseases in the Danish primary care sector with the use of a personal digital health profile and targeted follow-up- A n assessment of attendance
- 2019
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- Background: Current evidence on chronic disease prevention suggests that interventions targeted at high-risk individuals represents the best way forward. We implemented a step-wise approach in the Danish primary care sector, designed for the systematic and targeted prevention of chronic disease. The intervention centered on a personal digital health profile for all participants, followed by targeted preventive programs for high-risk patients. The present paper examines individual characteristics and health-care usage of patients who took up the targeted preventive programs in response to their personal digital health profile. Methods: A sample of patients born between 1957 and 1986 was randomly selected from the patient-list system of participating general practitioners in two Danish municipalities. The selected patients received a digital invitation to participate. Consenting patients received a second digital invitation for a personal digital health profile based on questionnaire and electronic patient record data. The personal digital health profile contained individualized information on risk profile and personalized recommendations on further actions. If at-risk or presenting with health-risk behaviour a patient would be advised to contact either their general practitioner or municipal health centre for targeted preventive programs. Attendance at the targeted preventive programs was examined using Poisson regression and chi-squared automatic interaction detection methods. Results: A total of 9400 patients were invited. Of those who participated (30%), 22% were advised to get a health check at their general practitioner. Of these, 19% did so. Another 23% were advised to schedule an appointment for behaviour-change counselling at their municipal health centre. A total of 21% took the advice. Patients who had fair or poor self-rated health, a body mass index above 30, low self-efficacy, were female, non-smokers, or lead a sedentary lifestyle, were most likely to attend the targeted preventive programs. Conclusions: A personal digital health profile shows some promise in a step-wise approach to prevention in the Danish primary care sector and seems to motivate people with low self-efficacy to attend targeted preventive programs.
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| 9. |
- Larsen, Lars Bruun, et al.
(författare)
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Targeted prevention in primary care aimed at lifestyle-related diseases : A study protocol for a non-randomised pilot study
- 2018
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Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The consequences of lifestyle-related disease represent a major burden for the individual as well as for society at large. Individual preventive health checks to the general population have been suggested as a mean to reduce the burden of lifestyle-related diseases, though with mixed evidence on effectiveness. Several systematic reviews, on the other hand, suggest that health checks targeting people at high risk of chronic lifestyle-related diseases may be more effective. The evidence is however very limited. To effectively target people at high risk of lifestyle-related disease, there is a substantial need to advance and implement evidence-based health strategies and interventions that facilitate the identification and management of people at high risk. This paper reports on a non-randomized pilot study carried out to test the acceptability, feasibility and short-term effects of a healthcare intervention in primary care designed to systematically identify persons at risk of developing lifestyle-related disease or who engage in health-risk behavior, and provide targeted and coherent preventive services to these individuals. Methods: The intervention took place over a three-month period from September 2016 to December 2016. Taking a two-pronged approach, the design included both a joint and a targeted intervention. The former was directed at the entire population, while the latter specifically focused on patients at high risk of a lifestyle-related disease and/or who engage in health-risk behavior. The intervention was facilitated by a digital support system. The evaluation of the pilot will comprise both quantitative and qualitative research methods. All outcome measures are based on validated instruments and aim to provide results pertaining to intervention acceptability, feasibility, and short-term effects. Discussion: This pilot study will provide a solid empirical base from which to plan and implement a full-scale randomized study with the central aim of determining the efficacy of a preventive health intervention. Trial registration: Registered at Clinical Trial Gov (Unique Protocol ID: TOFpilot2016). Registered 29 April 2016. The study adheres to the SPIRIT guidelines.
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| 10. |
- Packness, Aake, et al.
(författare)
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Are perceived barriers to accessing mental healthcare associated with socioeconomic position among individuals with symptoms of depression? Questionnaire-results from the Lolland-Falster Health Study, a rural Danish population study
- 2019
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 9:3
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate if perceived barriers to accessing mental healthcare (MHC) among individuals with symptoms of depression are associated with their socio-economic position (SEP). Design: Cross-sectional questionnaire-based population survey from the Lolland-Falster Health Study (LOFUS) 2016-17 of 5076 participants. Participants: The study included 372 individuals, with positive scores for depression according to the Major Depression Inventory (MDI), participating in LOFUS. Interventions: A set of five questions on perceived barriers to accessing professional care for mental health problem was posed to individuals with symptoms of depression (MDI score >20). Outcomes: The association between SEP (as measured by educational attainment, employment status and financial strain) and five different types of barriers to accessing MHC were analysed in separate multivariable logistic regression models adjusted for gender and age. Results: A total of 314 out of 372 (84%) completed the survey questions and reported experiencing barriers to MHC access. Worry about expenses related to seeking or continuing MHC was a considerable barrier for 30% of the individuals responding and, as such, the greatest problem among the five types of barriers. 22% perceived Stigma as a barrier to accessing MHC, but there was no association between perceived Stigma and SEP. Transportation was not only the barrier of least concern for individuals in general but also the issue with the greatest and most consistent socio-economic disparity (OR 2.99, 95% CI 1.19 to 7.52) for the lowest vs highest educational groups and, likewise, concerning Expenses (OR 2.77, 95% CI 1.34 to 5.76) for the same groups. Conclusion: Issues associated with Expenses and Transport were more frequently perceived as barriers to accessing MHC for people in low SEP compared with people in high SEP. Stigma showed no association with SEP. Informed written consent was obtained. Region Zealand's Ethical Committee on Health Research (SJ-421) and the Danish Data Protection Agency (REG-24-2015) approved the study.
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