| 1. |
- Neves, Ana Luisa, et al.
(författare)
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Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma : Secondary Analysis of Observational Studies
- 2021
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 23:9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients' daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. Objective: This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. Methods: A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. Results: A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were <= 40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). Conclusions: A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users' general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use.
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| 2. |
- Amaral, Rita, et al.
(författare)
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Profiling Persistent Asthma Phenotypes in Adolescents : A Longitudinal Diagnostic Evaluation from the INSPIRERS Studies
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 18:3
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Tidskriftsartikel (refereegranskat)abstract
- We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13-17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.
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| 3. |
- Fernandez-Cruz, Maria Luisa, et al.
(författare)
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Quality evaluation of human and environmental toxicity studies performed with nanomaterials – the GUIDEnano approach
- 2018
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Ingår i: Environmental Science: Nano. ; 5:2, s. 381-397
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Tidskriftsartikel (refereegranskat)abstract
- The European Union FP-7 project GUIDEnano developed a web-based guidance tool, which guides users to assess human and environmental risks of nanomaterial-enabled products throughout their life cycle. One of the aims in the GUIDEnano hazard assessment strategy is to derive safety limit values based on existing human toxicity and ecotoxicological studies. Clear criteria needed to be established to select studies that could be used for such purpose. In the present paper, we present an approach for a systematical and quantitative evaluation of the quality of environmental and human toxicity studies performed with nanomaterials. The approach builds upon previous initiatives and includes refinements to facilitate its application by users with limited toxicological expertise. It covers in vivo and in vitro human toxicity studies as well as ecotoxicological studies addressing the toxicity to all environmental compartments. A scoring system related to test design and reporting considerations was developed following the principles of the Klimisch score (K score). In addition, the approach includes a scoring system based on the physicochemical properties that have been characterized and reported for the nanomaterial, including properties characterized in the exposure medium (S score). These two scores (K and S) are combined to obtain an overall quality score (Q score) that can be used to select studies, to weight different studies, and/or to introduce uncertainty factors in the risk assessment process. During its development, the approach has been tested and refined with 137 peer-reviewed articles. The final quality assessment approach and the results of its evaluation are presented here.
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| 4. |
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| 5. |
- Ferraz-Nunes, Jose, 1947
(författare)
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Cost-effective prevention of hip fractures
- 2005
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Ingår i: International Advances in Economic Research. - 1083-0898 .- 1573-966X. ; 11:1, s. 49-67
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Tidskriftsartikel (refereegranskat)abstract
- The main objective of the analysis in this article is to do a health economic study of a preventive program that may influence the risk of hip fractures for people age 65 and older. The analysis of health promoting measures aimed at the prevention of hip fractures shows that there is a large potential for reducing costs and achieving significant health benefits within the older groups of the population. Prevention of hip fractures in the "best cities" seems to be cost-effective because it dominates a situation without any prevention. This implies a reduction in the total costs for society and an improvement in the quality of life and life expectancy.
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| 7. |
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| 8. |
- Ferraz-Nunes, José, 1947-
(författare)
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The importance of health capital in an ageing population : a QALY approach
- 2012
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Ingår i: International journal of behavioural and healthcare research. - London : InderScience Publishers. - 1755-3539 .- 1755-3547. ; 3:2, s. 106-134
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Tidskriftsartikel (refereegranskat)abstract
- The importance of health capital, especially in relation to an aged population, is discussed. The value of health as a stock is important because it may contribute to the well-being and individual independence that influences the expectations and desires of humans for activities. Expected depreciation of health capital between two points in time may imply a demand for investments in health, which corresponds to flows of health services and activities performed by individuals. An efficient allocation of resources in this area demands measurement of health that is connected with analysis of activities that promote health in different age groups and activities. This paper presents the use of QALY in several empirical studies that have dealt with different ways to increase health capital. All of the cases illustrate the importance of new technologies to improve cost efficiency in services used by aged people.
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| 9. |
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| 10. |
- Persson, Josefine, 1981, et al.
(författare)
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Economic burden of stroke in a large county in Sweden
- 2012
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 12:341, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- Stroke remains to be a major burden of disease, often causing death or physical impairment or disability. This paper estimates the economic burden of stroke in a large county of 1.5 million inhabitants in western Sweden. Methods: The economic burden of stroke was estimated from a societal perspective with an incidence approach. Data were collected from clinical registries and 3,074 patients were included. In the cost calculations, both direct and indirect costs were estimated and were based on costs for 12 months after a first-ever stroke. Results: The total excess costs in the first 12 months after the first-ever stroke for a population of 1.5 million was 629 million SEK (€69 million). Men consumed more acute care in hospitals, whereas women consumed more rehabilitation and long-term care provided by the municipalities. Younger patients brought a significantly higher burden on society compared with older patients due to the loss of productivity and the increased use of resources in health care. Conclusions: The results of this cost-of-illness study were based on an improved calculation process in a number of fields and are consistent with previous studies. In essence, 50% of costs for stroke care fall on acute care hospital, 40% on rehabilitation and long-time care and informal care and productivity loss explains 10% of total cost for the stroke disease. The result of this study can be used for further development of the methods for economic analyses as well as for analysis of improvements and investments in health care.
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| 11. |
- Persson, Josefine, 1981, et al.
(författare)
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Hälsoekonomi - Begrepp och tillämpningar
- 2019
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Detta är tredje upplagan av läroboken i hälsoekonomi avsedd för utbildningar inom alla grenar av hälso- och sjukvården. Hälsoekonomi utgår från olika välfärdsteorier, vilket innebär att frågorna om samhällets ansvar för hälsa står i fokus. Det centrala temat är därför bästa möjliga användning av samhällets gemensamma och begränsade resurser för förebyggande och botande behandlingar. Boken ger kunskap om hur resursfördelning och hälsopolitik samspelar samt hur nyttan av hälso- och sjukvårdens insatser kan värderas. Liksom tidigare förklaras begreppen BNP, pris- och kostnadselasticitet, alternativkostnad, marginalkostnad och kostnadseffektivitet med aktuella exempel. I denna upplaga har den teoretiska och praktiska bakgrunden till hälsoekonomiska analyser utvidgats med ett större avsnitt om metoder för värdering av relationerna mellan kostnader och effekter. Den särskilda lagstiftningen som finns för prioriteringar i vården redovisas och dess konsekvenser diskuteras. Boken vänder sig till studerande inom hälso- och sjukvård, folkhälsa, samhällsvetenskap och närliggande områden. Även beslutsfattare på politisk och administrativ nivå, praktiker med direkt patientkontakt och ledningsuppdrag samt andra med intresse för uppföljning, utvärdering och analys av hälso- och sjukvård kan ha glädje av boken.
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| 12. |
- Razavi-Shearer, Devin M., et al.
(författare)
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Adjusted estimate of the prevalence of hepatitis delta virus in 25 countries and territories
- 2024
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Ingår i: JOURNAL OF HEPATOLOGY. - 0168-8278 .- 1600-0641. ; 80:2, s. 232-242
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Tidskriftsartikel (refereegranskat)abstract
- Background & Aims: Hepatitis delta virus (HDV) is a satellite RNA virus that requires the hepatitis B virus (HBV) for assembly and propagation. Individuals infected with HDV progress to advanced liver disease faster than HBV-monoinfected individuals. Recent studies have estimated the global prevalence of anti-HDV antibodies among the HBV-infected population to be 5-15%. This study aimed to better understand HDV prevalence at the population level in 25 countries/territories. Methods: We conducted a literature review to determine the prevalence of anti-HDV and HDV RNA in hepatitis B surface antigen (HBsAg)-positive individuals in 25 countries/territories. Virtual meetings were held with experts from each setting to discuss the findings and collect unpublished data. Data were weighted for patient segments and regional heterogeneity to estimate the prevalence in the HBV-infected population. The findings were then combined with The Polaris Observatory HBV data to estimate the anti-HDV and HDV RNA prevalence in each country/territory at the population level. Results: After adjusting for geographical distribution, disease stage and special populations, the anti-HDV prevalence among the HBsAg+ population changed from the literature estimate in 19 countries. The highest anti-HDV prevalence was 60.1% in Mongolia. Once adjusted for the size of the HBsAg+ population and HDV RNA positivity rate, China had the highest absolute number of HDV RNA+ cases. Conclusions: We found substantially lower HDV prevalence than previously reported, as prior meta-analyses primarily focused on studies conducted in groups/regions that have a higher probability of HBV infection: tertiary care centers, specific risk groups or geographical regions. There is large uncertainty in HDV prevalence estimates. The implementation of reflex testing would improve estimates, while also allowing earlier linkage to care for HDV RNA+ individuals. The logistical and economic burden of reflex testing on the health system would be limited, as only HBsAg+ cases would be screened.
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