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| 2. |
- Bhatt, Deepak L., et al.
(författare)
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Rationale, design and baseline characteristics of the effect of ticagrelor on health outcomes in diabetes mellitus patients Intervention study
- 2019
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Ingår i: Clinical Cardiology. - : Wiley. - 0160-9289 .- 1932-8737. ; 42:5, s. 498-505
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Tidskriftsartikel (refereegranskat)abstract
- In the setting of prior myocardial infarction, the oral antiplatelet ticagrelor added to aspirin reduced the risk of recurrent ischemic events, especially, in those with diabetes mellitus. Patients with stable coronary disease and diabetes are also at elevated risk and might benefit from dual antiplatelet therapy. The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS, NCT01991795) is a Phase 3b randomized, double-blinded, placebo-controlled trial of ticagrelor vs placebo, on top of low dose aspirin. Patients >= 50 years with type 2 diabetes receiving anti-diabetic medications for at least 6 months with stable coronary artery disease as determined by a history of previous percutaneous coronary intervention, bypass grafting, or angiographic stenosis of >= 50% of at least one coronary artery were enrolled. Patients with known prior myocardial infarction (MI) or stroke were excluded. The primary efficacy endpoint is a composite of cardiovascular death, myocardial infarction, or stroke. The primary safety endpoint is Thrombolysis in Myocardial Infarction major bleeding. A total of 19 220 patients worldwide have been randomized and at least 1385 adjudicated primary efficacy endpoint events are expected to be available for analysis, with an expected average follow-up of 40 months (maximum 58 months). Most of the exposure is on a 60 mg twice daily dose, as the dose was lowered from 90 mg twice daily partway into the study. The results may revise the boundaries of efficacy for dual antiplatelet therapy and whether it has a role outside acute coronary syndromes, prior myocardial infarction, or percutaneous coronary intervention.
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- Bjerkeli, Pernilla J., et al.
(författare)
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Does early identification of high work related stress affect pharmacological treatment of primary care patients?-analysis of Swedish pharmacy dispensing data in a randomised control study
- 2020
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Ingår i: Bmc Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background The study is part of a randomised controlled trial with the overall aim to evaluate if use of the Work Stress Questionnaire (WSQ), combined with feedback at consultation, can be used by healthcare professionals in primary health care to prevent sickness absence. The specific aim of the present study was to investigate whether there were differences in pharmacy dispensing of prescription medications between the intervention group and the control group. Methods The study was a randomized controlled trial. Non-sick-listed employed women and men, aged 18 to 64 years, seeking care at primary health care centres (PHCCs) were eligible participants. The intervention included early identification of work-related stress by the WSQ, general practitioner (GP) training and GP feedback at consultation. Pharmacy dispensing data from the Swedish Prescription Drug Register for a period of 12 months following the intervention was used. Primary outcomes were the number of different medications used, type of medication and number of prescribing clinics. Data was analysed using Mann Whitney U tests and chi-square tests. Results The study population included 271 individuals (132 in the intervention group and 139 in the control group). The number of different medications used per individual did not differ significantly between the control group (median 4.0) and the intervention group (median 4.0, p-value 0.076). The proportion of individuals who collected more than 10 different medications was higher in the control group than in the intervention group (15.8% versus 4.5%, p = 0.002). In addition, the proportion of individuals filling prescriptions issued from more than three different clinics was higher in the control group than in the intervention group (17.3% versus 6.8%, p = 0.007). Conclusion Systematic use of the WSQ combined with training of GPs and feedback at consultation may affect certain aspects of pharmacological treatment in primary health care patients. In this randomised control trial, analysis of pharmacy dispensing data show that patients in the intervention group had less polypharmacy and filled prescriptions issued from a smaller number of different clinics.
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- Holmgren, Johan, 1977-, et al.
(författare)
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Making headway towards a better understanding of service frequency valuations : a study of how the relative valuation of train service frequency and in-vehicle time vary with traveller characteristics
- 2014
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Ingår i: International Journal of Transport Economics. - Pisa, Italy : Fabrizio Serra Editore. - 0303-5247 .- 1724-2185. ; 41:1, s. 109-129
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Tidskriftsartikel (refereegranskat)abstract
- On-going urbanization has led to greater distances between homes and workplaces and more long-distance commuting, increasing the need for efficient inter-urban transport infrastructure. For sustainability, trains are preferred to private cars.Two key variables affecting door-to-door train travel time are in-vehicle time (IVT) and headway ; however, there is often a trade-off between speed and frequency in a system. If different categories of travellers value IVT and headway differently, their proportions on a route should affect traffic planning. Optimal system design might differ between routes carrying many commuters and routes carrying mainly passengers on single private or business trips. Knowledge of differences in relative valuations of headway versus IVT should therefore affect railway system design.We investigate whether the relative values of headway versus IVT differ between inter- urban commuting by train and single inter-urban trips by train, whilst also examining differences between socioeconomic groups. Stated choice (SC) data from 580 Swedish respondents are used in estimation. Individuals actually commuting and individuals not commuting but imagining that they are when answering the SC questions are asked about their preferences for headway versus IVT.Commuters are estimated to value increased headway 19 percentage points more than do non-commuters. Young people (under age 21 years) value headway more than do older people while people with children value headway less than do the childless.
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| 5. |
- Holmgren, Johan, et al.
(författare)
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Mode choice in home-to-work travel in mid-size towns : The competitiveness of public transport when bicycling and walking are viable options
- 2020
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Ingår i: Transportation Research Procedia. - : Taylor & Francis. - 2352-1465.
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Konferensbidrag (refereegranskat)abstract
- It is widely recognized that the transport system contributes significantly to current environmental problems such as global warming, as well as to health issues caused by emissions and lack of exercise. For the transport system to contribute to sustainable development, the link between economic growth and growth in motorized transport must be broken. Since high population densities and shorter distances provide greater potential for efficient public transport as well as for walking and biking, the highest potential for change is in urban areas. As a large proportion of urban travel consists of home-to-work travel, such travel will be our focus in this paper. More specifically, this paper aims to analyze the factors that determine mode choice in situations where bicycle and walking are competitive options and to contribute to the knowledge of the conditions under which public transport can be a competitive alternative to the private car. The results of this study could be used to devise policies for reducing car dependency in urban areas. The results show that even if it is possible to attract new passengers to public transport through changes in the public transport system (i.e., reduced fares or reduced travel time) few of these new passengers will be shifting from private car use. To achieve a shift from private car to walking, bicycling or bus riding, such policies must be combined with restrictions (and/or cost increases) on car use.
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- Hultén, Anna-Maria, et al.
(författare)
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Self-reported sick leave following a brief preventive intervention on work-related stress : A randomised controlled trial in primary health care
- 2021
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:3
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To evaluate the effectiveness of a brief intervention about early identification of work-related stress combined with feedback at consultation with a general practitioner (GP) on the number of self-reported sick leave days. Design Randomised controlled trial. Prospective analyses of self-reported sick leave data collected between November 2015 and January 2017. Setting Seven primary healthcare centres in western Sweden. Participants The study included 271 employed, non-sick-listed patients aged 18-64 years seeking care for mental and/or physical health complaints. Of these, 132 patients were allocated to intervention and 139 patients to control. Interventions The intervention group received a brief intervention about work-related stress, including training for GPs, screening of patients' work-related stress, feedback to patients on screening results and discussion of measures at GP consultation. The control group received treatment as usual. Outcome measures The number of self-reported gross sick leave days and the number of self-reported net sick leave days, thereby also considering part-time sick leave. Results At 6 months' follow-up, 220/271 (81%) participants were assessed, while at 12 months' follow-up, 241/271 (89%) participants were assessed. At 6-month follow-up, 59/105 (56%) in the intervention group and 61/115 (53%) in the control group reported no sick leave. At 12-month follow-up, the corresponding numbers were 61/119 (51%) and 57/122 (47%), respectively. There were no statistically significant differences between the intervention group and the control group in the median number of self-reported gross sick leave days and the median number of self-reported net sick leave days. Conclusions The brief intervention showed no effect on the numbers of self-reported sick leave days for patients seeking care at the primary healthcare centres. Other actions and new types of interventions need to be explored to address patients' perceiving of ill health due to work-related stress.
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| 8. |
- Hultén, Anna-Maria, et al.
(författare)
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Work-related stress and future sick leave in a working population seeking care at primary health care centres : a prospective longitudinal study using the WSQ
- 2022
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Studying the relationship between work-related stress and sick leave is valuable in identifying and assessing employees at risk of sick leave, but also in developing interventions and taking actions for workers’ health. The overall aim of this study was to analyse the association between work-related stress, measured with the work stress questionnaire (WSQ), and registered sick leave in a working population seeking care at primary health care centres in Sweden. Methods: A prospective longitudinal study was performed with 232 employed patients aged 18–64 years seeking care for mental and/or physical health complaints at seven primary health care centres. Bivariate logistic regression analysis adjusted for educational level, occupational class and marital status was performed using questionnaire data on work-related stress and sociodemographic factors collected between May 2015 until January 2016 together with registered sick leave data from a national database. Results: High stress due to indistinct organization and conflicts was reported by 21% (n = 49), while 45% (n = 105) reported high stress due to individual demands and commitment. Thirty-six percent were on sick leave for 15 days or more during 12 months after baseline. The odds of being on registered sick leave during this period was approximately twice as high for patients perceiving high stress due to indistinct organization and conflicts (OR 2.25, 95% CI 1.18;4.26), high stress due to individual demands and commitment (OR 2.21, 95% CI 1.28;3.82), low influence at work (OR 2.07, 95% CI 1.20;3.57), or high interference between work and leisure time (OR 2.19, 95% CI 1.27;3.80). Perceiving high stress due to both indistinct organization and conflicts as well as individual demands and commitment quadrupled the odds of sick leave, OR 4.15 (95% CI 1.84; 9.38). Conclusions: Work-related stress and sick leave were prevalent among the patients. Perceiving one or more of the work-related stressors and stress increased the odds of registered sick leave between two to four times. Hence, to capture the dynamic interaction between the individual and the work environment, a wide spectrum of factors must be considered. In addition, primary health care could be a suitable arena for preventing sick leave due to work-related stress. Trial registration: ClinicalTrials.gov. Identifier: NCT02480855. Registered 20 May 2015.
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| 9. |
- Hultén, Anna-Maria, et al.
(författare)
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Work-related stress, reason for consultation and diagnosis-specific sick leave : How do they add up?
- 2023
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 18:7
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Tidskriftsartikel (refereegranskat)abstract
- Work-related stress is common in Western society and disorders associated with stress are often managed in primary health care. This study was set to increase the understanding of the relationship between reason for consultation, work-related stress and diagnosis-specific sick leave for primary health care patients. The longitudinal observational study included 232 employed non-sick listed patients at seven primary health care centres in Sweden. Of these patients, 102 reported high work-related stress, as measured with the Work Stress Questionnaire, and 84 were on registered sick leave within one year after inclusion. The study showed that, compared to those who did not report high work-related stress, highly stressed patients more often sought care for mental symptoms (60/102 versus 24/130), sleep disturbance (37/102 versus 22/130) and fatigue (41/102 versus 34/130). The risk for sick leave with a mental diagnosis within a year after base-line was higher among patients reporting high work-related stress than among those who did not (RR 2.97, 95% CI 1.59;5.55). No such association was however found for the risk of sick leave with a musculoskeletal diagnosis (RR 0.55, 95% CI 0.22;1.37). Seeking care for mental symptoms, sleep disturbance and fatigue were associated with having a future mental sick leave diagnosis (p-values < 0.001), while seeking care for musculoskeletal symptoms was associated with having a future musculoskeletal sick leave diagnosis (p-value 0.009). In summary, compared to those who did not report high work-related stress, patients with high work-related stress more often sought care for mental symptoms, sleep disturbance and fatigue which lead to a mental sick leave diagnosis. Reporting high work-related stress was, however, not linked to having sought care for musculoskeletal symptoms nor future sick leave due to a musculoskeletal diagnosis. Hence, both patients and general practitioners seem to characterize work-related stress as a mental complaint.
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| 10. |
- Hultqvist, Jenny, 1966, et al.
(författare)
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Does a brief work-stress intervention prevent sick-leave during the following 24 months? : A randomized controlled trial in Swedish primary care
- 2021
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Ingår i: Work. - : IOS Press. - 1051-9815 .- 1875-9270. ; 70:4, s. 1141-1150
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Work-related stress (WRS) presents a risk for sick leave. However, effective methods to identify people at risk for sick leave due to WRS at an early stage are lacking in primary health care.OBJECTIVE: To evaluate whether a systematic early identification of WRS can prevent sick leave over 24 months after the intervention.METHODS: Study participants (n = 132 intervention; n = 139 control) were employed, non-sick-listed persons seeking care at primary health care centres. The intervention included early identification of WRS by a validated instrument, general practitioner (GP) awareness supported by a brief training session, patients' self-reflection by instrument completion, GP giving the patient feedback at consultation and GP identifying preventive measures. The control group received treatment as usual. Outcome data were retrieved from the Swedish Social Insurance Agency.RESULTS: The intervention group had less registered median sick leave days (n = 56) than the control group (n = 65) but the difference was not statistically significant.CONCLUSIONS: The brief intervention was not proven effective in preventing sick leave in the following 24 months compared to treatment as usual. Further research on how to identify, advice and treat those at high risk for sick leave in primary health care is needed.
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