| 1. |
- Sundström, Johan, Professor, 1971-, et al.
(författare)
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Risk factors for subarachnoid haemorrhage : a nationwide cohort of 950 000 adults
- 2019
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Ingår i: International Journal of Epidemiology. - : Oxford University Press. - 0300-5771 .- 1464-3685. ; 48:6, s. 2018-2025
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Subarachnoid haemorrhage (SAH) is a devastating disease, with high mortality rate and substantial disability among survivors. Its causes are poorly understood. We aimed to investigate risk factors for SAH using a novel nationwide cohort consortium.METHODS: We obtained individual participant data of 949 683 persons (330 334 women) between 25 and 90 years old, with no history of SAH at baseline, from 21 population-based cohorts. Outcomes were obtained from the Swedish Patient and Causes of Death Registries.RESULTS: During 13 704 959 person-years of follow-up, 2659 cases of first-ever fatal or non-fatal SAH occurred, with an age-standardized incidence rate of 9.0 [95% confidence interval (CI) (7.4-10.6)/100 000 person-years] in men and 13.8 [(11.4-16.2)/100 000 person-years] in women. The incidence rate increased exponentially with higher age. In multivariable-adjusted Poisson models, marked sex interactions for current smoking and body mass index (BMI) were observed. Current smoking conferred a rate ratio (RR) of 2.24 (95% CI 1.95-2.57) in women and 1.62 (1.47-1.79) in men. One standard deviation higher BMI was associated with an RR of 0.86 (0.81-0.92) in women and 1.02 (0.96-1.08) in men. Higher blood pressure and lower education level were also associated with higher risk of SAH.CONCLUSIONS: The risk of SAH is 45% higher in women than in men, with substantial sex differences in risk factor strengths. In particular, a markedly stronger adverse effect of smoking in women may motivate targeted public health initiatives.
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| 2. |
- Alänge, Sverker, 1951, et al.
(författare)
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From job-less growth to growth-with-less-jobs: Employment and equity impact of technical and organisational change
- 1996
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Ingår i: Science and Public Policy. - 1471-5430 .- 0302-3427. ; 23:1, s. 27-38
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Tidskriftsartikel (refereegranskat)abstract
- New technical innovations in the form of new production technologies are known to affect productivity, but organisational innovations and new ways of designing products have now been found to have a profound influence on productivity. These innovations have moved the industrialised countries into a stage in which industrial growth is accompanied by the continuous reduction in industrial employment. This development will greatly influence our society and put stringent demands on our political decision-making apparatus to avoid a growth in the 'wealth of nations' going hand-in-hand with a growth in poverty.
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| 3. |
- Carlfjord, Siw, 1959-
(författare)
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The Challenge of Changing Practice : Applying Theory in the Implementation of an Innovation in Swedish Primary Health Care
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The translation of new knowledge, such as research findings, new tools or methods into health care practice has gained increased interest in recent years. Important factors that determine implementation outcome have been identified, and models and checklists to be followed in planning as well as in carrying out an implementation process have been produced. However, there are still knowledge gaps regarding what approach should be used in which setting and for which problems. Primary health care (PHC) in Sweden is an area where there is a paucity of research regarding implementation of new methods into practice. The aim of the thesis was to apply theory in the study of the implementation of an innovation in Swedish PHC, and identify factors that influenced outcome.Methods: The study was performed using a quasi-experimental design, and included six PHC units, two from each one of three county councils in the southeast part of Sweden. A computer-based lifestyle intervention tool (CLT) developed to facilitate addressing lifestyle issues, was introduced at the units. Two different strategies were used for the introduction, both aiming to facilitate the process: a theory-based explicit strategy and an implicit strategy requiring a minimum of effort. Data collection was performed at baseline, and after six, nine and 24 months. Questionnaires were distributed to staff and managers, and data was also collected from the CLT database and county council registers. Implementation outcome was defined as the proportion of eligible patients being referred to the CLT, and was also measured in terms of Reach, Effectiveness, Adoption, Implementation and Maintenance according to the RE-AIM framework. Interviews were performed in order to explore experiences of the implementation process as perceived by staff and managers.Results: A positive organizational climate seemed to promote implementation. Organizational changes or staff shortages coinciding with the implementation process had a negative influence on outcome. The explicit implementation strategy seemed to be more effective than the implicit strategy in the short term, but the differences levelled out over time. The adopters’ perceptions of the implementation seemed to be influenced by the existing professional sub-cultures. Successful implementation was associated with positive expectations, perceptions of the innovation being compatible with existing routines and perceptions of relative advantage.Conclusions: The general conclusion is that when theory was applied in the implementation of a lifestyle intervention tool in Swedish PHC, factors related to the adopters and to the innovation seemed to be more important over time than the strategy used. Staff expectations, perceptions of the innovation’s relative advantage and potential compatibility with existing routines were found to be positively associated with implementation outcome, and other major organizational changes concurrent with implementation seemed to affect the outcome in a negative way. Values, beliefs and behaviour associated with the existing sub-cultures in PHC appeared to influence how the implementation of an innovation was perceived by managers and the different professionals.
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| 4. |
- Emilson, Christina, et al.
(författare)
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A 10-year follow-up of tailored behavioural treatment and exercise-based physiotherapy for persistent musculoskeletal pain
- 2017
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Ingår i: Clinical Rehabilitation. - London : Sage Publications. - 0269-2155 .- 1477-0873. ; 31:2, s. 186-196
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the long-term outcomes of two interventions targeting patients with sub-acute and persistent pain in a primary care physiotherapy setting.DESIGN: A 10-year follow-up of a two-armed randomised controlled trial, initially including 97 participants.INTERVENTIONS: Tailored behavioural medicine treatment, applied in a physiotherapy context (experimental condition), and exercise-based physiotherapy (control condition).MAIN MEASURES: Pain-related disability was the primary outcome. The maximum pain intensity, pain control, fear of movement, sickness-related absence (register data) and perceived benefit and confidence in coping with future pain problems were the secondary outcomes.RESULTS: Forty-three (44%) participants responded to the follow-up survey, 20 in the tailored behavioural medicine treatment group and 23 in the exercise-based physiotherapy group. The groups did not differ in terms of the change in the scores for the primary outcome (p=0.17) of pain-related disability between the experimental group (median: 2.5, Q1-Q3: -2.5-14.25), and the control group (median: 0, Q1-Q3: -5-6). Further, there were also no significant differences found for the secondary outcomes except for sickness-related absence, where the exercise-based physiotherapy group had more days of sickness-related absence three months before treatment (p= 0.02), and at the 10-year follow-up (p=0.03).DISCUSSION: The beneficial effects favouring tailored behavioural medicine treatment that observed post-treatment and at the two-year follow-up were not maintained 10 years after treatment. © The Author(s) 2016
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| 5. |
- Jonsson, Magnus, et al.
(författare)
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Nationwide Outcome Analysis of Primary Carotid Endarterectomy in Symptomatic Patients Depending on Closure Technique and Patch Type
- 2023
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Saunders Elsevier. - 1078-5884 .- 1532-2165. ; 65:4, s. 467-473
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Current European guidelines recommend both eversion carotid endarterectomy (CEA) and conventional CEA with routine patch closure, rather than routine primary closure. Polyester and polytetrafluoroethylene (PTFE) have been used as patch material for a long time. More recently, bovine pericardium has been used; however, there are few studies comparing long term results between bovine pericardium and other patch types. The aim of this study was to investigate the short and long term results after CEA depending on surgical technique and patch material.Methods: A registry based study on all primary CEAs (n = 9 205) performed for symptomatic carotid artery stenosis in Sweden from July 2008 to December 2019, cross linked with data from the Swedish stroke registry, Riksstroke, and chart review for evaluation of any events occurring during follow up. The primary endpoint was ipsilateral stroke < 30 days. Secondary endpoints included re-operations due to neck haematoma and < 30 day ipsilateral stroke, > 30 day ipsilateral stroke, all stroke > 30 days, and all cause mortality.Results: 2 495 patients underwent eversion CEA and 6 710 conventional CEA for symptomatic carotid stenosis. The most commonly used patch material was Dacron (n = 3 921), followed by PTFE (n = 588) and bovine pericardium (n = 413). A total of 1 788 patients underwent conventional CEA with primary closure. Two hundred and seventy-three patients (3.0%) had a stroke < 30 days. Primary closure was associated with an increased risk of ipsilateral stroke and stroke or death <30 days: odds ratio 1.7 (95% confidence interval [CI] 1.2 -2.4, p = .002); and 1.5 (95% CI 1.2 -2.0), respectively. During follow up (median 4.2 years), 592 patients had any form of stroke and 1 492 died. There was no significant difference in long term risk of ipsilateral stroke, all stroke, or death depending on surgical technique or patch material.Conclusion: There was an increased risk of ipsilateral stroke < 30 days in patients operated on with primary closure compared with eversion CEA and patch angioplasty. There was no difference between primary closure, different patch types, or eversion after the peri-operative phase.
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| 6. |
- Lindberg, Catharina, et al.
(författare)
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Registered nurses' efforts to ensure safety for home-dwelling older patients
- 2023
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 37:2, s. 571-581
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Tidskriftsartikel (refereegranskat)abstract
- Background The international development of health care, an ageing population and rapid technical development mean that more care is being performed in patient homes. This care environment is often unpredictable and involves both formal and informal caregivers, making it potentially unsafe. There is sparse knowledge about how patient safety is protected in home health care in Sweden and how registered nurses work to prevent risks and promote safe care. Aim The aim of the study was to explore registered nurses' efforts to reduce perceived risks for home-dwelling older patients and ensure safe home health care. Method We used a qualitative design with individual interviews with 13 registered nurses working in municipalities in southeast Sweden. The narratives were analysed with inductive content analysis. Findings The findings showed that the registered nurses tried to secure a safe care environment and took an active role in care, striving to stay one step ahead of the patient. These three types of efforts are likely interdependent, suggesting they are all needed to reduce perceived risks for home-dwelling older patients and ensure patient safety in home health care. Conclusions It is a challenge for registered nurses to maintain patient safety when performing care in patient homes. Continuity of care is required and must be based not only on self-reliance among registered nurses but also on trusting relationships with patients, next of kin, colleagues and other personnel, as well as on the development of organisational conditions adapted to patient needs.
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| 7. |
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| 8. |
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| 9. |
- Lymeus, Freddie, et al.
(författare)
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A natural meditation setting improves compliance with mindfulness training
- 2019
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Ingår i: Journal of Environmental Psychology. - : Elsevier. - 0272-4944 .- 1522-9610. ; 64, s. 98-106
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Tidskriftsartikel (refereegranskat)abstract
- The setting matters in meditation, but most research has neglected it. Many mindfulness-based health interventions emphasize effortful attention training exercises in sparsely furnished indoor settings. However, many beginners with attention regulation problems struggle with the exercises and drop out. In contrast, restoration skills training (ReST) – a five-week course set in a garden environment – builds on mindfulness practices adapted to draw on restorative processes stimulated effortlessly in nature contacts. Expecting that the ReST approach will facilitate the introduction to mindfulness, we compared drop-out and homework completion records from four rounds of ReST vs. conventional mindfulness training (N = 139). Randomly assigned ReST participants had lower drop-out and more sustained homework completion over the course weeks. Supporting the theoretical assumptions, higher restorative environmental qualities and state mindfulness mediated the compliance differences. The improved acceptability with ReST means that more people can enjoy the long-term benefits of establishing a meditation practice.
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| 10. |
- Lymeus, Freddie, et al.
(författare)
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Building mindfulness bottom-up : Meditation in natural settings supports open monitoring and attention restoration
- 2018
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Ingår i: Consciousness and Cognition. - : Elsevier BV. - 1053-8100 .- 1090-2376. ; 59, s. 40-56
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Tidskriftsartikel (refereegranskat)abstract
- Mindfulness courses conventionally use effortful, focused meditation to train attention. In contrast, natural settings can effortlessly support state mindfulness and restore depleted attention resources, which could facilitate meditation. We performed two studies that compared conventional training with restoration skills training (ReST) that taught low-effort open monitoring meditation in a garden over five weeks. Assessments before and after meditation on multiple occasions showed that ReST meditation increasingly enhanced attention performance. Conventional meditation enhanced attention initially but increasingly incurred effort, reflected in performance decrements toward the course end. With both courses, attentional improvements generalized in the first weeks of training. Against established accounts, the generalized improvements thus occurred before any effort was incurred by the conventional exercises. We propose that restoration rather than attention training can account for early attentional improvements with meditation. ReST holds promise as an undemanding introduction to mindfulness and as a method to enhance restoration in nature contacts.
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