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| 2. |
- Baroudi, Mazen, et al.
(författare)
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Preteen children’s health related quality of life in Sweden: changes over time and disparities between different sociodemographic groups
- 2019
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- Background: Assessing disparities in health-related quality of Life (HRQoL) is important as a part of health-related disparities in the society. The aim of this study was to explore HRQoL among 12-year-olds in Sweden in terms of differences between years 2005 and 2009 and disparities related to sociodemographic background.Methods: During the school years 2005 and 2009, a total of 18,325 sixth grade students in Sweden were invited to a celiac disease screening study; 13,279 agreed to participate. Jointly with the celiac screening, the children answered a questionnaire that included EuroQol 5 Dimensions-youth (EQ-5D-Y) and their parents responded to separate questionnaires about their own and their child’s country of birth, family structure, their employment status, occupation, and education. In total 11,009 child-parent questionnaires were collected. Logistic regression was used to study differences in HRQoL between 2005 and 2009, and between various sociodemographic subgroups.Results: Compared with 2005, children in 2009 reported more pain (OR: 1.20, 95% CI: 1.1–1.3) and more mood problems (OR: 1.35, 95% CI: 1.2–1.5). In general, girls reported more pain and mood problems and had more disparities than boys. There were no significant differences based on parents’ occupation, however, children of parents with low or medium education levels reported less “mood problems” than those of parents with high education levels (OR: 0.65, 95% CI: 0.46–0.92) and (OR: 0.84, 95% CI: 0.73–0.96), respectively. A slight variation was seen in HRQoL between children with different migration background. Girls living in small municipalities reported more pain (OR: 1.51, 95% CI: 1.14–2.01), and problems performing usual activities (OR: 3.77, 95% CI: 2.08–6.84), compared to girls living in large municipalities. In addition, children living with two parents had less mood problems than children living in other family constellations.Conclusion: More children reported pain and mood problems in 2009 compared with 2005. To study future trends, health outcomes among children in Sweden should continue to be reported periodically. More efforts should be invested to increase the awareness of health-related disparities as highlighted in this study especially for girls living in small municipalities and children of parents with high education level.
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| 3. |
- Bybrant, Mara Cerqueiro, et al.
(författare)
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The prevalence of having coeliac disease in children with type 1 diabetes was not significantly higher during the Swedish coeliac epidemic
- 2023
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 112:10, s. 2175-2181
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Tidskriftsartikel (refereegranskat)abstract
- Aim: From 1986 to 1996, there was a four-fold increase in coeliac disease among young Swedish children, known as the Swedish coeliac epidemic. Children with type 1 diabetes have an increased risk of developing coeliac disease. We studied whether the prevalence of coeliac disease differed in children with type 1 diabetes born during and after this epidemic.Methods: We compared national birth cohorts of 240 844 children born in 1992–1993 during the coeliac disease epidemic and 179 530 children born in 1997–1998 after the epidemic. Children diagnosed with both type 1 diabetes and coeliac disease were identified by merging information from five national registers.Results: There was no statistically significant difference in the prevalence of coeliac disease among children with type 1 diabetes between the two cohorts: 176/1642 (10.7%, 95% confidence interval 9.2%–12.2%) in the cohort born during the coeliac disease epidemic versus 161/1380 (11.7%, 95% confidence interval 10.0%–13.5%) in the post-epidemic cohort.Conclusion: The prevalence of having both coeliac disease and type 1 diabetes was not significantly higher in children born during, than after, the Swedish coeliac epidemic. This may support a stronger genetic disposition in children who develop both conditions.
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| 4. |
- Cameron, David, et al.
(författare)
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On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data : a systematic review
- 2018
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Ingår i: Global Health Action. - Abingdon : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 11:1
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: The amount a government should be willing to invest in adopting new medical treatments has long been under debate. With many countries using formal cost-effectiveness (C/E) thresholds when examining potential new treatments and ever-growing medical costs, accurately setting the level of a C/E threshold can be essential for an efficient healthcare system.OBJECTIVES: The aim of this systematic review is to describe the prominent approaches to setting a C/E threshold, compile available national-level C/E threshold data and willingness-to-pay (WTP) data, and to discern whether associations exist between these values, gross domestic product (GDP) and health-adjusted life expectancy (HALE). This review further examines current obstacles faced with the presently available data.METHODS: A systematic review was performed to collect articles which have studied national C/E thresholds and willingness-to-pay (WTP) per quality-adjusted life year (QALY) in the general population. Associations between GDP, HALE, WTP, and C/E thresholds were analyzed with correlations.RESULTS: Seventeen countries were identified from nine unique sources to have formal C/E thresholds within our inclusion criteria. Thirteen countries from nine sources were identified to have WTP per QALY data within our inclusion criteria. Two possible associations were identified: C/E thresholds with HALE (quadratic correlation of 0.63), and C/E thresholds with GDP per capita (polynomial correlation of 0.84). However, these results are based on few observations and therefore firm conclusions cannot be made.CONCLUSIONS: Most national C/E thresholds identified in our review fall within the WHO's recommended range of one-to-three times GDP per capita. However, the quality and quantity of data available regarding national average WTP per QALY, opportunity costs, and C/E thresholds is poor in comparison to the importance of adequate investment in healthcare. There exists an obvious risk that countries might either over- or underinvest in healthcare if they base their decision-making process on erroneous presumptions or non-evidence-based methodologies. The commonly referred to value of 100,000$ USD per QALY may potentially have some basis.
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| 5. |
- Degerlund Maldi, Kinza, et al.
(författare)
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Cost-utility analysis of esketamine and electroconvulsive therapy in adults with treatment-resistant depression
- 2021
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Ingår i: BMC Psychiatry. - : BioMed Central. - 1471-244X. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Electroconvulsive therapy (ECT) has long been used for treating individuals with treatment-resistant depression (TRD). Esketamine has recently emerged as a new treatment for TRD due to its rapid antidepressant effects. To further inform the decision regarding choice of treatment, this paper aims to evaluate whether ECT or esketamine is the more cost-effective option.METHODS: The cost-effectiveness was derived as cost per quality-adjusted life-year (QALY) using a Markov model from a societal and life-time perspective. The incremental cost-effectiveness ratio (ICER) was calculated. Health states included different depression and remission states and death. Data to populate the model was derived from randomised controlled trials and other research. Various sensitivity analyses were carried out to test the robustness of the model.RESULTS: The base case scenario shows that ECT is cost-effective compared to esketamine and yields more QALYs at a lower cost. The sensitivity analysis shows that ECT is cost-effective in all scenarios and ECT dominates esketamine in 12 scenarios.CONCLUSIONS: This study found that, from a cost-effectiveness point of view, ECT should be the first-hand option for individuals with TRD, when other first line treatments have failed. Considering the lack of economic evaluation of ECT and esketamine, this study is of great value to decision makers.
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| 6. |
- Ekman, M J, et al.
(författare)
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6-minute walk test before and after a weight reduction program in obese subjects.
- 2013
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Ingår i: Obesity. - : Wiley. - 1930-739X .- 1930-7381. ; 21:3, s. 236-243
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Tidskriftsartikel (refereegranskat)abstract
- Weight loss and physical activity have shown favorable effects on risks associated with obesity. It is therefore of interest to evaluate exercise capacity and related co-morbidities in obese patients. We present data from obese subjects evaluated by the 6-minute walk test (6MWT) before and after a 7.3 (6.1-8.2) month weight reduction program. 251 subjects completed the test at baseline (BMI 40.6 [36.9-44.6] kg/m(2) ) and 129 (51.4 %) repeated the test after intervention (BMI 35.6 [31.2-38.5] kg/m(2) ). The six minute walking distance (6MWD) at baseline (535 [480-580] m) and at follow up (599 [522-640] m) correlated to several cardiovascular risk markers. Age, weight, height, resting heart rate, smoking status, fP-glucose and use of ß-blockers explained 43 % of the variance in predicted 6MWD at baseline. The effect of smoking status, fP-glucose, ß-blockers and resting heart rate lost significance at follow up. Presence of diabetes and the metabolic syndrome had a negative influence on 6MWD but did not affect the impact of intervention based on percentage increase in walking distance. Gender had no impact on 6MWD. Reported pain during the test was common but decreased after intervention (57.0 % vs. 28.7 %, p<0.001). In conclusion, the 6MWT may be used to evaluate intervention success beyond kilogram weight loss in obese subjects. We present formulas to predict 6MWD and the effect of weight loss on walking distance in clinical practice. Pain is a common problem which has to be considered when giving advice on exercise as a part of weight loss intervention.
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| 8. |
- Forsner, Maria, 1954-, et al.
(författare)
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Relaxation and guided imagery used with 12-year-olds during venipuncture in a school-based screening study
- 2014
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Ingår i: Journal of Child Health Care. - : Sage Publications. - 1367-4935 .- 1741-2889. ; 18:3, s. 241-252
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Tidskriftsartikel (refereegranskat)abstract
- Needle-related procedures are reported to be problematic for children. In a school-based celiac disease screening, 12-year-olds' experiences with relaxation and guided imagery (R-GI) during venipuncture were investigated. One group tried nurse-led R-GI (n = 60) and another group received standard care (SC; n = 49). A mixed method design was applied using short written narratives, facial affective scale (FAS), and visual analog scale (VAS) for pain intensity. Qualitative content analysis highlighted that diversity and contradictions when facing blood tests. FAS scores were significantly lower in the SC group before (p = 0.01), during (p = 0.01), and after (p = 0.01) venipuncture. VAS scores did not differ between the groups. The blood test was mostly experienced as unproblematic, and GI during venipuncture did not decrease pain or affect. However, the fact that a number of children scored high FAS indicates a need for effective methods to help children cope with needle-related school-based procedures.
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| 9. |
- Hambraeus, Johan, et al.
(författare)
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Cost-effectiveness of radiofrequency neurotomy to treat zygapophysial joint pain compared with pain rehabilitation programs
- 2022
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Ingår i: Interventional Pain Medicine. - : Elsevier. - 2772-5944. ; 1:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic pain is a widespread condition that causes much suffering and significant cost to society. Pain rehabilitation programs (REH) have dominated the treatment of chronic pain in Sweden in recent decades. Although radiofrequency neurotomy (RFN) was cost-effective in recent studies, the long-term health and economic effects of REH have not been comprehensively evaluated.Design: Observational study with propensity score weighting to compare RFN and REH.Methods: Patients assessed and treated between 2010 and 2016 were eligible; 15,357 underwent REH and 254 underwent RFN. Patient data were combined with linked data from national registers. We used propensity score weighting to mimic a randomized controlled trial using baseline gender, age, and baseline health-related quality of life as covariates.Results: Health-related quality of life improved significantly in both groups, by 0.164 and 0.352 quality-adjusted life years (QALYs) at 1 and 2 years after REH, and by 0.186 and 0.448 QALYs after RFN. The assessment and diagnostic procedures were slightly more expensive for RFN, but the treatment costs were greater for REH. Sick leave decreased after treatment in both groups, particularly after RFN. The cost per QALY gained 1 year after REH was ∼121,633 USD, which is considered "very expensive" according to the Swedish National Board of Health and Welfare. By comparison, the cost of RFN was ∼13,715 USD, in the "moderate" range. After 2 years the cost per QALY gained was in the "moderate" range for REH and "low" for RFN.Conclusions: RFN and REH improved health-related quality of life, with significantly greater improvement with RFN. The treatments were comparable based on propensity score weighting, and RFN was cost-effective in the moderate to low range, whereas REH was considered very expensive to moderate. Expanding RFN from 2% currently to 25% of the treatments given in Sweden could save ∼21.2 million USD annually in healthcare expenditure.
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| 10. |
- Hu, Qitao, et al.
(författare)
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Current gain and low-frequency noise of symmetric lateral bipolar junction transistors on SOI
- 2018
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Ingår i: 2018 48th European Solid-State Device Research Conference (ESSDERC). - 9781538654019 - 9781538654002 - 9781538654026 ; , s. 258-261
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Konferensbidrag (refereegranskat)abstract
- This paper presents a comprehensive study of symmetric lateral bipolar junction transistors (LBJTs) fabricated on SOI substrate using a CMOS-compatible process; LBJTs find many applications including being a local signal amplifier for silicon-nanowire sensors. Our LBJTs are characterized by a peak gain (β) over 50 and low-frequency noise two orders of magnitude lower than what typically is of the SiO 2 /Si interface for a MOSFET. β is found to decrease at low base current due to recombination in the space charge region at the emitter-base junction and at the surrounding SiO 2 /Si interfaces. This decrease can be mitigated by properly biasing the substrate.
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