| 1. |
- Bendtsen, Preben, et al.
(författare)
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Measuring health-related quality of life in patients with chronic obstructive pulmonary disease in a routine hospital setting : Feasibility and perceived value
- 2003
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Ingår i: Health and Quality of Life Outcomes. - : Springer Science and Business Media LLC. - 1477-7525 .- 1477-7525. ; 1:5
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAssessment of health-related quality of life is so far mainly used in specific research settings and not widely accepted in the routine care of patients. Lack of trust in accuracy and reliability and lack of knowledge concerning the questionnaires used, methods, terminology, are just some of the perceived barriers for a more widespread dissemination of these instruments into routine health care. The present study was undertaken in order to test the feasibility of a computerised system for collecting and analysing health-related quality of life in a routine clinical setting and to examine the thoughts and attitudes among physicians concerning the value of these measurements.MethodsSeventy-four patients with chronic pulmonary lung disease were asked to assess their health-related quality of life with a computerised version of the SF-36 questionnaire before a regular the visit to a physician. The results were immediately available for the physician during the consultation for comparison of information given by the patients and the physician's evaluation of the patients overall health status. A focus group interview with the physicians was performed before and after the implementation of routine measurements of health-related quality of life.ResultsThe systematic assessment concept worked satisfactorily. All patients approached agreed to participate and completed the assessment on the touch screen computer. A weak correlation was found between patients' self-rated health and pulmonary function and between physicians' evaluation and pulmonary function. The physicians appreciated the SF-36 assessments and the value of the patients' perspective although only a few could pinpoint new clinical decisions based upon this new information.ConclusionPhysicians' clinical evaluation and patients' self-rating of health status offer unique and important information that are complementary.
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| 2. |
- Andersen, Pia, et al.
(författare)
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Physical Activity on Prescription with Counsellor Support : A 4-Year Registry-Based Study in Routine Health Care in Sweden
- 2018
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Ingår i: Healthcare. - : MDPI. - 2227-9032. ; 6:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Public health gains from physical activity on prescription (PAP) depend on uptake in routine care. We performed an evaluation of the implementation, in a Swedish county council, of counsellors who give personalized support to PAP recipients aimed at facilitating PAP delivery. The aim was to compare characteristics between PAP recipients and the health care population as well as between PAP recipients who used and did not use counsellor support. We also investigated professional belonging and health care setting of health care professionals who prescribed PAP. Methods: All patients' >= 18 years who received PAP during 2009-2012 in primary and secondary care in the County Council of Kronoberg were included (n = 4879). Data were retrieved from electronic medical records. Main outcome measures were patient and professional characteristics. Results: A third of the PAP recipients had diseases in >= 5 diagnostic groups and more than half had >= 11 office visits the year before receiving PAP. Counsellor support was used by one-third and PAP recipients who used counsellor support had more multiple diagnoses and office visits compared with non-users. Physicians issued 44% of prescriptions and primary care was the predominant setting. The amount of PAP did not change over time, but the proportion of physicians' prescriptions decreased while the proportion of nurses' prescriptions increased. Conclusions: PAP recipients had high morbidity and were frequent health care attenders, indicating that PAP was predominantly used for secondary or tertiary prevention. PAP rates did not increase as intended after the implementation of counsellor support.
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| 3. |
- Andréasson, Sven, et al.
(författare)
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Att förebygga sjukdom - en ledarskapsfråga
- 2010
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Ingår i: Läkartidningen. - : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 107:48, s. 3070-3071
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 4. |
- Balldin, J, et al.
(författare)
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A 6-month controlled naltrexone study: Combined effect with cognitive behavioral therapy in outpatient treatment of alcohol dependence
- 2003
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Ingår i: Alcoholism: Clinical and Experimental Research. - 0145-6008 .- 1530-0277. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background: In several studies, patients with alcohol dependence treated with the opioid antagonist naltrexone have shown fewer relapses to heavy drinking than those receiving placebo. An interaction between the naltrexone effect and the type of psychological therapy has been observed. Methods: A 6-month, double-blind, placebo-controlled, parallel-group study was performed at 10 different investigation sites. After a placebo run-in period of 1 week, 118 patients were randomized into 4 treatment groups—50 mg of naltrexone daily or placebo in combination with either cognitive behavioral therapy (CBT) or supportive therapy. The CBT was performed over nine sessions according to the manual of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity). The supportive therapy was defined as "the treatment as usual." Alcohol consumption, craving, carbohydrate-deficient transferrin, medication compliance by tablet count, and adverse clinical events were assessed at all visits. Other liver enzymes and psychiatric symptoms were also determined. Results: Ninety-one (77%) patients completed the study, and 92 (78%) were 80% compliant with the medication regimen. A lower percentage of heavy-drinking days was shown in the naltrexone group (p = 0.045) compared with the placebo group, as was a lower craving score (p = 0.029). These results are supported by the lower levels of liver enzyme activities (p < 0.010 for aspartate aminotransferase, alanine aminotransferase, and γ-glutamyltransferase), but not by the carbohydrate-deficient transferrin levels, in the naltrexone group. The mean time period before the first day of heavy drinking was longer for the group treated with CBT (p = 0.010), especially in combination with naltrexone (p = 0.007). Naltrexone was well tolerated, and no patients discontinued the study due to side effects. Conclusions: This study supports the effect of naltrexone in outpatient treatment of alcohol dependence and suggests that a beneficial interaction effect with CBT can be expected.
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| 5. |
- Bobak, M, et al.
(författare)
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Life span and disability : a cross sectional comparison of Russian and Swedish community based data
- 2004
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Ingår i: The BMJ. - : BMJ. - 1756-1833. ; 329:7469, s. 767-770
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To compare levels of disability (in terms of physical function and self rated health) among middle aged and elderly people in Russia and Sweden, a country with high life expectancy. Design Cross sectional study. Setting General population of the Russian Federation and of two counties in southern Sweden. Participants Randomly selected men and women in Sweden (n = 9489) and Russia (n = 1599). Main outcome measures Official life table data, self rated health and physical functioning (subscale of the SF-36). Results The official life table data showed large differences in mortality-for example, 36% of Russian men aged 45-49 years would survive the next 25 years compared with 75% of Swedish men. The survey data showed, for both sexes, similar levels of self rated health and physical functioning in the two countries up to the age of about 45 years, but after that, the age related decline in both outcomes was much faster in Russia than in Sweden. By combining the national life tables with survey data on physical functioning we estimated that in the age group 45-49 years, 99% of Russian and 97% of Swedish men would be free of disability, of these, if these data were for a cohort, only 17% of Russians would be alive and free of disability 25 years later compared with 65% of Swedes. The difference in survival was similar in women. Conclusions Large differences exist in survival without disability between elderly Russians and Swedes. The short life span in Russia reflects high levels of ill health and disability and is associated with a rapid age related decline in physical functioning.
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| 6. |
- Carlfjord, Siw, et al.
(författare)
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Experiences of Working with the Tobacco Issue in the Context of Health Promoting Hospitals and Health Services: A Qualitative Study
- 2011
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Ingår i: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH. - : MDPI AG. - 1660-4601. ; 8:2, s. 498-513
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Tidskriftsartikel (refereegranskat)abstract
- The worldwide Health Promoting Hospital and Health Services (HPH) network was initiated by the World Health Organizations in the late 1980s. The goal of the network is to change the focus of health services from curing patients to also embrace disease prevention and health promotion. In Sweden the network started in 1996, and involves mainly hospitals and primary care. The network members collaborate in task forces, one of which is working on the tobacco issue. There is limited evidence on the value of working within an HPH organization. The aim of this study was to investigate the experiences of members of the Swedish HPH network tobacco task force. Focus group interviews with task force members were analyzed using implementation theory. Three themes, overall experiences of working with tobacco issues, experiences of working with. free from tobacco in connection with surgery., and experiences of work in the HPH tobacco task force, emerged from the interviews. The results show that working with the tobacco issue in the context of health-promoting hospitals and health services met with difficulties involving the following important factors: evidence, context, facilitation and adopter characteristics. Leadership, one contextual factor, at national and local level, seems to be crucial if the work is going to succeed. The tobacco task force of the HPH network is an important facilitator supporting the task.
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| 7. |
- Dyar, Oliver J., et al.
(författare)
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Rainbows over the world's public health : determinants of health models in the past, present, and future
- 2022
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Ingår i: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 50:7, s. 1047-1058
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Tidskriftsartikel (refereegranskat)abstract
- The need to visualise the complexity of the determinants of population health and their interactions inspired the development of the rainbow model. In this commentary we chronicle how variations of this model have emerged, including the initial models of Haglund and Svanström (1982), Dahlgren and Whitehead (1991), and the Östgöta model (2014), and we illustrate how these models have been influential in both public health and beyond. All these models have strong Nordic connections and are thus an important Nordic contribution to public health. Further, these models have underpinned and facilitated other examples of Nordic leadership in public health, including practical efforts to address health inequalities and design new health policy approaches.Apart from documenting the emergence of rainbow models and their wide range of contemporary uses, we examine a range of criticisms levelled at these models – including limitations in methodological development and in scope. We propose the time is ripe for an updated generic determinants of health model, one that elucidates and preserves the core value in older models, while recognising the developments that have occurred over the past decades in our understanding of the determinants of health. We conclude with an example of a generic model that fulfills the general purposes of a determinants of health model while maintaining the necessary scope for further adjustments to be made in the future, as well as adjustments to location or context-specific purposes, in education, research, health promotion and beyond.
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| 8. |
- Elwing, B, et al.
(författare)
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A comparative study of food intake between Lithuanian and Swedish middle-aged men : The LiVicordia study
- 2001
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Ingår i: Scandinavian Journal of Nutrition/Næringsforskning. - 1102-6480 .- 1651-2359. ; 45:3, s. 126-130
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Background: In 1994, the mortality in coronary heart disease was four times higher among Lithuanian middle-aged men than among Swedish men. Over the period 1993-1995, the LiVicordia study investigated possible causes for this difference. We have earlier reported lower serum levels of cholesterol and higher susceptibility of low-density lipoprotein cholesterol for oxidation among Lithuanian men. Objective: In this part of the study, the aim was to compare mean estimates of food intake. Design: Cross-sectional study of random samples of 50-year-old men from each of the cities of Link÷ping, Sweden and Vilnius, Lithuania (n=150). The volunteers were interviewed about their food intake with the 24-hour recall method. Results: We found no differences in total energy intake, but Vilnius men had a higher energy intake from fat. Vilnius men consumed more fat from meat and less vegetable fat, while fat intake from dairy products was almost the same. Also, Vilnius men had a higher intake of vegetables, while Link÷ping men had a higher intake of fruit and berries. Conclusion: The observed differences in food consumption and dietary composition are partly consistent with the higher CHD mortality among Lithuanian men. However, data on biomarkers indicate that other dietary and lifestyle factors play a role.
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| 9. |
- Engström, Sevek, 1954-
(författare)
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Dental Health Care Cooperating with Primary Health Care as a Resource in Early Case Finding of Patients with Diabetes or Hypertension
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives To investigate if there is an association between dental health status and high blood pressure, to test the effectiveness of screening for high blood pressure and high blood glucose performed by the dental health care in collaboration with primary health care and to investigate the direct costs for this type of screening organisation. Study population and methods In Paper I 54 subjects with known hypertension and 141 with a high blood pressure in the dental office were compared with matched controls. In Paper II 1,149 subjects were screened for hypertension and in Paper III 1,568 subjects were screened for diabetes in dental care. Follow up was performed in co-operating primary health care centres. In paper IV the direct costs for screening and follow-up were calculated. Results There was a significant association between deep periodontal pockets and high blood pressure, even when the influence of age, sex, smoking and number of teeth was taken into account. Among those being screened for high blood pressure and high blood glucose 20.6% and 9.9% respectively were referred to primary health care, and a hypertension or a diabetes diagnosis was found in 32.1% and 5.8% of those screening positive. For every 18th subject screened a hypertension case was found (“numbers needed to screen” (NNS)), and for every 196th a diabetes case. NNS for combined hypertension and diabetes screening was 15. The total direct costs for screening and follow up per diagnosis found were 5,298 SEK for hypertension, 19,100 SEK for diabetes, and 4,116 SEK for combined blood pressure and blood glucose screening. Conclusions There was an association between dental health and hypertension. Screening for hypertension was highly efficient, while screening for diabetes was less so, because it is a less prevalent condition. Screening for both conditions appears to be the most efficient type of screening.
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| 10. |
- Festin, Karin, et al.
(författare)
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Choice of measure matters: A study of the relationship between socioeconomic status and psychosocial resources in a middle-aged normal population
- 2017
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Ingår i: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 12:8
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Tidskriftsartikel (refereegranskat)abstract
- Psychosocial resources may serve as an important link to explain socioeconomic differences in health. Earlier studies have demonstrated that education, income and occupational status cannot be used interchangeably as indicators of a hypothetical latent social dimension. In the same manner, it is important to disentangle the effect of measuring different constructs of psychosocial resources. The aim of this study was therefore to analyse if associations between socioeconomic status (SES) and psychosocial resources differ depending on the measures used. A cross-sectional population-based study of a random sample (n = 1007) of middle-aged individuals (45-69 years old, 50% women) in Sweden was performed using questionnaire and register data. SES was measured as education, occupation, household income and self-rated economy. Psychosocial resources were measured as social integration, social support, mastery, self-esteem, sense of coherence (SOC) and trust. Logistic regression models were applied to analyse the relationships controlling for the effects of possible confounders. The measures of SES were low or moderately correlated to each other as were the measures of psychosocial resources. After controlling for age, sex, country of birth and employment status, household income and self-rated economy were associated with all six psychosocial resources; occupation was associated with three (social integration, self-esteem and trust) and education with two (social integration and self-esteem). Social integration and self-esteem showed a significant and graded relationship with all SES measures; trust was associated with all SES measures except education, whereas SOC and mastery were only associated with household income and self-rated economy. After controlling for other SES measures, no associations with psychosocial resources remained for education or occupation. In conclusion, associations between SES and psychosocial resources did differ depending on the measures used. The findings illustrate the importance of the choice of measure when investigating SES as well as psychosocial resources.
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