| 1. |
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| 2. |
- Adolfsson, Peter, 1963, et al.
(författare)
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Continuous glucose monitoring system during physical exercise in adolescents with type 1 diabetes
- 2011
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 100:12, s. 1603-1609
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Continuous glucose monitoring system (CGMS) provides detailed information on glucose fluctuations. The aim was to establish whether CGMS could be used during physical exercise and whether it detects more episodes of hypoglycaemia and hyperglycaemia than frequent blood glucose measurements. Methods: Adolescents with type 1 diabetes (12 girls and 47 boys) participated in three annual sports camps that lasted for 3-4 days and included different types of exercise: soccer, floorball + cross-country skiing and golf. During the study, blood glucose values, mean 8.7 +/- 3.3 per day, were obtained with Hemocue in parallel with the CGMS. Results: Ninety-eight per cent of the participants used the sensor at all times during the camps. Eighty-seven per cent of the sensors gave adequate signals for 24 h and 66% for 48 h. Median durations of hypoglycaemia and hyperglycaemia were 1.7 h per day and 3.8 h per day, respectively. The CGMS identified significantly more episodes of hypoglycaemia (p < 0.005) and hyperglycaemia (p < 0.005) during the day and night than frequent blood glucose tests. Conclusion: We demonstrate that, even during days that included episodic strenuous physical exercise, CGMS could provide useful information on glucose fluctuations during day and night, albeit with significant failure rates.
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| 3. |
- Adolfsson, Peter, 1963, et al.
(författare)
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Hormonal response during physical exercise of different intensities in adolescents with type 1 diabetes and healthy controls.
- 2012
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Ingår i: Pediatric Diabetes. - : Hindawi Limited. - 1399-543X .- 1399-5448. ; 13:8, s. 587-96
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Tidskriftsartikel (refereegranskat)abstract
- Background Physical activity is a critical component in the care of diabetes. Although it offers health benefits it presents challenges. Objective To investigate differences between adolescent boys and girls with type 1 diabetes and healthy controls in terms of maximal work capacity (VO2 max) and hormonal response to physical exercise of different intensities. Subjects Twelve individuals (six boys and six girls; age 1419 yr, pubertal stage 45) with type 1 diabetes (duration, 6.3 +/- 4.4 yr; hemoglobin A1c, 63 +/- 10 mmol/mol) were compared with 12 healthy controls matched for age, sex, pubertal stage, body mass index standard deviation score, and amount of regular physical activity. Methods During consecutive days, three different workloads; maximal, endurance, and interval, were performed on an Ergometer cycle. During the tests, levels of lactate, glucose, insulin, and regulatory hormones [glucagon, cortisol, growth hormone (GH), adrenaline, and noradrenaline] were measured in blood. Subcutaneous glucose was measured continuously. Results VO2 max did not differ between the groups, diabetes 49.8 +/- 9.9 vs. control 50.7 +/- 12.0 mL/min/kg. Hormonal responses did not differ between the groups except for mean peak GH level during the interval test, diabetes 63.2 +/- 27.0 vs. control 33.8 +/- 20.9 mU/L, p
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| 4. |
- af Klint, Erik, et al.
(författare)
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Evaluation of arthroscopy and macroscopic scoring.
- 2009
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Ingår i: Arthritis Research & Therapy. - : Springer Science and Business Media LLC. - 1478-6362 .- 1478-6354. ; 11:3
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Arthroscopy is a minimally invasive technique for retrieving synovial biopsies in rheumatology during the past 20 years. Vital for its use is continual evaluation of its safety and efficacy. Important for sampling is the fact of intraarticular variation for synovial markers. For microscopic measurements scoring systems have been developed and validated, but for macroscopic evaluations there is a need for further comprehensive description and validation of equivalent scoring systems.METHODS: We studied the complication rate and yield of arthroscopies performed at our clinic between 1998 and 2005. We also created and evaluated a macroscopic score set of instructions for synovitis.RESULTS: Of 408 procedures, we had two major and one minor complication; two haemarthrosis and one wound infection, respectively. Pain was most often not a problem, but 12 procedures had to be prematurely ended due to pain. Yield of biopsies adequate for histology were 83% over all, 94% for knee joints and 34% for smaller joints. Video printer photographs of synovium taken during arthroscopy were jointly and individually reviewed by seven raters in several settings, and intra and inter rater variation was calculated. A macroscopic synovial scoring system for arthroscopy was created (Macro-score), based upon hypertrophy, vascularity and global synovitis. These written instructions were evaluated by five control-raters, and when evaluated individual parameters were without greater intra or inter rater variability, indicating that the score is reliable and easy to use.CONCLUSIONS: In our hands rheumatologic arthroscopy is a safe method with very few complications. For knee joints it is a reliable method to retrieve representative tissue in clinical longitudinal studies. We also created an easy to use macroscopic score, that needs to be validated against other methodologies. We hope it will be of value in further developing international standards in this area.
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| 5. |
- Aronsson, Håkan, 1961-, et al.
(författare)
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Managing health care decisions and improvement through simulation modeling
- 2011
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Ingår i: Quality Management in Health Care. - : Wolters Kluwer. - 1063-8628 .- 1550-5154. ; 20:1, s. 15-29
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Tidskriftsartikel (refereegranskat)abstract
- Simulation modeling is a way to test changes in a computerized environment to give ideas for improvements before implementation. This article reviews research literature on simulation modeling as support for health care decision making. The aim is to investigate the experience and potential value of such decision support and quality of articles retrieved. A literature search was conducted, and the selection criteria yielded 59 articles derived from diverse applications and methods. Most met the stated research-quality criteria. This review identified how simulation can facilitate decision making and that it may induce learning. Furthermore, simulation offers immediate feedback about proposed changes, allows analysis of scenarios, and promotes communication on building a shared system view and understanding of how a complex system works. However, only 14 of the 59 articles reported on implementation experiences, including how decision making was supported. On the basis of these articles, we proposed steps essential for the success of simulation projects, not just in the computer, but also in clinical reality. We also presented a novel concept combining simulation modeling with the established plan-do-study-act cycle for improvement. Future scientific inquiries concerning implementation, impact, and the value for health care management are needed to realize the full potential of simulation modeling.
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| 6. |
- Askling, Johan, et al.
(författare)
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Anti-TNF therapy in RA and risk of malignant lymphomas Relative risks and time-trends in the Swedish Biologics Register
- 2008
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 68:5, s. 648-653
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Tidskriftsartikel (refereegranskat)abstract
- Background: Tumour necrosis factor (TNF) antagonists have proved effective as treatment against rheumatoid arthritis (RA), but the unresolved issue of whether the use of anti-TNF therapy increases the already elevated risk of lymphoma in RA remains a concern.Methods: Using the Swedish Biologics Register (ARTIS), the Swedish Cancer Register, pre-existing RA cohorts and cross-linkage with other national health and census registers, a national RA cohort (n = 67 743) was assembled and patients who started anti-TNF therapy between 1998 and July 2006 (n = 6604) were identified. A general population comparator (n = 471 024) was also assembled and the incidence of lymphomas from 1999 to 31 December 2006 was assessed and compared in these individuals.Results: Among the 6604 anti-TNF-treated RA patients, 26 malignant lymphomas were observed during 26 981 person-years of follow-up, which corresponded to a relative risk (RR) of 1.35 (95% CI 0.82 to 2.11) versus anti-TNF-naive RA patients (336 lymphomas during 365 026 person-years) and 2.72 (95% CI 1.82 to 4.08) versus the general population comparator (1568 lymphomas during 3 355 849 person-years). RA patients starting anti-TNF therapy in 1998–2001 accounted for the entire increase in lymphoma risk versus the two comparators. By contrast, RR did not vary significantly by time since start of first treatment or with the accumulated duration of treatment, nor with the type of anti-TNF agent.Conclusion: Overall and as used in routine care against RA, TNF antagonists are not associated with any major further increase in the already elevated lymphoma occurrence in RA. Changes in the selection of patients for treatment may influence the observed risk.
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| 7. |
- Askling, Johan, et al.
(författare)
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Cancer risk in patients with rheumatoid arthritis treated with anti-tumor necrosis factor alpha therapies : does the risk change with the time since start of treatment?
- 2009
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Ingår i: Arthritis and Rheumatism. - : Wiley. - 0004-3591 .- 1529-0131. ; 60:11, s. 3180-3189
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:To determine the short-term and medium-term risks of cancer in patients receiving anti-tumor necrosis factor alpha (anti-TNFalpha) therapies that have proven effective in the treatment of chronic inflammatory conditions.METHODS:By linking together data from the Swedish Biologics Register, Swedish registers of RA, and the Swedish Cancer Register, we identified and analyzed for cancer occurrence a national cohort of 6,366 patients with RA who first started anti-TNF therapy between January 1999 and July 2006. As comparators, we used a national biologics-naive RA cohort (n = 61,160), a cohort of RA patients newly starting methotrexate (n = 5,989), a cohort of RA patients newly starting disease-modifying antirheumatic drug combination therapy (n = 1,838), and the general population of Sweden. Relative risks (RRs) were estimated using Cox regression analyses, examining overall RR as well as RR by time since the first start of anti-TNF therapy, by the duration of active anti-TNF therapy, and by the anti-TNF agent received.RESULTS:During 25,693 person-years of followup in 6,366 patients newly starting anti-TNF, 240 first cancers occurred, yielding an RR of 1.00 (95% confidence interval 0.86-1.15) versus the biologics-naive RA cohort, and similar RRs versus the other 2 RA comparators. RRs did not increase with increasing time since the start of anti-TNF therapy, nor with the cumulative duration of active anti-TNF therapy. During the first year following the first treatment start, but not thereafter, dissimilar cancer risks for adalimumab, etanercept, and infliximab were observed.CONCLUSION:During the first 6 years after the start of anti-TNF therapy in routine care, no overall elevation of cancer risk and no increase with followup time were observed.
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| 8. |
- Askling, Johan, et al.
(författare)
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Risk and case characteristics of tuberculosis in rheumatoid arthritis associated with tumor necrosis factor antagonists in Sweden
- 2005
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Ingår i: Arthritis and Rheumatism. - : Wiley. - 0004-3591 .- 1529-0131. ; 52:7, s. 1986-1992
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:Because treatment with tumor necrosis factor (TNF) antagonists may increase the risk of tuberculosis (TB), and because knowledge of the risk of TB in rheumatoid arthritis (RA) not treated with biologics is scarce and of uncertain generalizability to low-risk populations, this study sought to determine the risk of TB among Swedish patients with RA.METHODS:Using data from Swedish nationwide and population-based registers and data from an ongoing monitoring program of TNF antagonists, the relative risks of TB in patients with RA (versus the general population) and of TB associated with TNF antagonists (versus RA patients not treated with biologics) were determined by comparing the incidence of hospitalization for TB in 3 RA cohorts and 2 general population cohorts from 1999 to 2001. We also reviewed the characteristics of all reported cases of TB in RA patients treated with TNF antagonists in Sweden and calculated the incidence of TB per type of TNF antagonist between 1999 and 2004.RESULTS:During 1999-2001, RA patients who were not treated with TNF antagonists were at increased risk of TB versus the general population (relative risk 2.0, 95% confidence interval [95% CI] 1.2-3.4). RA patients treated with TNF antagonists had a 4-fold increased risk of TB (relative risk 4.0, 95% CI 1.3-12) versus RA patients not treated with TNF antagonists. The reported TB cases during 1999-2004 in RA patients exposed to TNF antagonists (9 infliximab, 4 etanercept, 2 both) were predominantly pulmonary. TB occurred up to 3 years following the start of treatment.CONCLUSION:Irrespective of whether TNF antagonists are administered, Swedish patients with RA are at increased risk of TB. During 1999-2001, TNF antagonists were associated with an increased risk of TB, up to 4-fold in magnitude. This increased risk may persist over time during treatment and is related to both infliximab and etanercept.
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| 9. |
- Askling, Johan, et al.
(författare)
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Time-dependent increase in risk of hospitalisation with infection among Swedish RA patients treated with TNF antagonists
- 2007
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 0003-4967 .- 1468-2060. ; 66:10, s. 1339-1344
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:The degree to which treatment with tumour necrosis factor (TNF) antagonists may be associated with increased risks for serious infections is unclear. An observational cohort study was performed using prospectively collected data from the Swedish Biologics Register (ARTIS) and other national Swedish registers.METHODS:First, in the ARTIS, all 4167 rheumatoid arthritis (RA) patients starting TNF antagonist treatment between 1999 and 2003 were identified. Secondly, in the Swedish Inpatient Register, all individuals hospitalised for any reason and who also carried a diagnosis of RA, between 1964 and 2003 (n = 44 946 of whom 2692 also occurred in ARTIS), were identified. Thirdly, in the Swedish Inpatient Register, all hospitalisations listing an infection between 1999 and 2003 were identified. By cross-referencing these three data sets, RRs for hospitalisation with infection associated with TNF antagonist treatment were calculated within the cohort of 44 946 RA patients, using Cox regression taking sex, age, geography, co-morbidity and use of inpatient care into account.RESULTS:Among the 4167 patients treated with TNF antagonists, 367 hospitalisations with infections occurred during 7776 person-years. Within the cohort of 44 496 RA patients, the RR for infection associated with TNF antagonists was 1.43 (95% CI 1.18 to 1.73) during the first year of treatment, 1.15 (95% CI 0.88 to 1.51) during the second year of treatment, and 0.82 (95% CI 0.62 to 1.08) for subjects remaining on their first TNF antagonist treatment after 2 years.CONCLUSION:Treatment with TNF antagonists may be associated with a small to moderate increase in risk of hospitalisation with infection, which disappears with increasing treatment duration.
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| 10. |
- Assarsson, Liselott, 1969-, et al.
(författare)
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Iscensättande av identiteter i vuxenstudier
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The focus of this thesis is how identities are construed in adult education. According to the theoretical framework inspiring the study, identities are viewed as discursive constructions that are negotiated in social arenas. Hence, identities are considered versatile, plural and contradictory. The study has an ethnographic case study design and the field work was conducted 1998–2001. Various sources of data collection, such as interviews and participant observations were utilised. Every day practice at three different institutions of adult education in the case study municipality ”Nystad” were studied: Folk high school, Komvux and Liber Hermods flexgymnasium. Participants (27) were studied extensively, and a follow-up containing biographical interviews with the participants was also done 18 months after the main study.The result will show how the discourse of life long learning produce different technologies applying to different institutions of adult education defining what counts as knowledge, the relationships between actors and the demands participants will be posed with. Although the institutions of education are different, there are also similarities. The differences, however, are important in the recruitment of participants. The requirements of the education as to who you are supposed to be as a participant in adult education show a similar pattern, irrespective of the institution of education; the student with an interest in studying, prone to change, independent and well-behaved.Different strategies are detected when focusing the staging of participants’ identities, adaptive and defiant. An adaptive strategy means the adults meet the requirements of the education and a defiant strategy that they resist. The strategies may be applied by one and the same participant depending on the situation. Biographies show how different interpretative repertoires are used to stage different identities. The participants use four repertoires relevant to the subject: that of making a living, learning, earning credits and self realization. The repertoires applicable to the forms of teaching are teacher oriented, selfdirected and conversational. The repertoires used in relation to the teachers in adult education are expert, person, supervisor and administrator. The repertoires used by the adults in order to describe other participants are adult student, study mate and friend. The result of the study inspires the discussion of adult education in terms of social inclusion and exclusion.
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| 11. |
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| 12. |
- Bergström, Staffan, et al.
(författare)
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Utred självvalt livsslut
- 2016
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Ingår i: Läkartidningen. - 0023-7205. ; 113:34-35
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 13. |
- Cornelissen, Johannes H C, et al.
(författare)
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Global negative vegetation feedback to climate warming responses of leaf litter decomposition rates in cold biomes
- 2007
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Ingår i: Ecology Letters. - : Wiley. - 1461-023X .- 1461-0248. ; 10:7, s. 619-627
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Tidskriftsartikel (refereegranskat)abstract
- Whether climate change will turn cold biomes from large long-term carbon sinks into sources is hotly debated because of the great potential for ecosystem-mediated feedbacks to global climate. Critical are the direction, magnitude and generality of climate responses of plant litter decomposition. Here, we present the first quantitative analysis of the major climate-change-related drivers of litter decomposition rates in cold northern biomes worldwide.Leaf litters collected from the predominant species in 33 global change manipulation experiments in circum-arctic-alpine ecosystems were incubated simultaneously in two contrasting arctic life zones. We demonstrate that longer-term, large-scale changes to leaf litter decomposition will be driven primarily by both direct warming effects and concomitant shifts in plant growth form composition, with a much smaller role for changes in litter quality within species. Specifically, the ongoing warming-induced expansion of shrubs with recalcitrant leaf litter across cold biomes would constitute a negative feedback to global warming. Depending on the strength of other (previously reported) positive feedbacks of shrub expansion on soil carbon turnover, this may partly counteract direct warming enhancement of litter decomposition.
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| 14. |
- Edenius, Mats, 1960-, et al.
(författare)
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Managing knowledge across boundaries in healthcare when innovation is desired
- 2010
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Ingår i: Knowledge Management & E-Learning: An International Journal. - Hong Kong : The University of Hong Kong. - 2073-7904 .- 2309-5008. ; 2:2, s. 134-151
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study is to explore how knowledge can be managed across boundaries when implementing innovations in the healthcare sector is desired, in this specific case a healthcare quality register. The research is based on a qualitative, case study approach and comprises methodologies such as semi-structured interviews and document analysis. Critical incidents analysis is used to discern significant events in the course of innovation implementation. The findings of this study describe knowledge transferred across boundaries on a syntactic, semantic, and pragmatic level. On the syntactic level, knowledge of the innovation was transferred by training sessions for healthcare staff and through information to patients. On the semantic level, knowledge was transferred by knowledge brokering in the professional community of rheumatologists, and by creating collective stories and encouraging rheumatologists to “try” the innovation to find added value. Moreover, allowing the innovation process to take time and realising that knowledge to some extent is tacit, were solutions to some of the challenges on the semantic level. On the pragmatic level, there were explicit conflict of interest between physicians and healthcare authorities as well as resistance from some rheumatologists to share knowledge of patients and treatment. These challenges were met by encouraging the use of the register to improve health status of patients instead of control and further stressing the common goal of healthier patients given the right treatment. The paper is concluded with implications for innovation practice in healthcare drawn from the study and ends with remarks about challenges ahead.
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| 15. |
- Essén, Anna, et al.
(författare)
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Innovation as emergence in healthcare : Unpacking change from within
- 2013
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 93, s. 203-211
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Tidskriftsartikel (refereegranskat)abstract
- The contemporary healthcare literature suffers from a disproportionate focus on 'given' externally created innovations, and belief in ordered, planned and well-funded implementation processes. As an alternative, the present paper highlights the potential of emergent change processes, using the continuous invention and re-invention of the Rheumatology Quality Registry in Sweden as an example. This 19 year long process, which is still ongoing, does not exhibit the sequential steps that are allegedly determinants of success in the innovation and implementation literature. Yet, it has produced system-wide improvements. We draw on more than 100 informal and formal meetings with practitioners involved in the process studied, observations, documentation analysis and quantitative registry-data. A total of 67 interviews with registry-users and external stakeholders were also performed. The dissipative structures model (complexity theory) was used to analyze the data. The studied process illustrates an ongoing, practice-driven improvement process, which was sparked by abstract and indirect energies that interacted with more concrete innovations such as new drugs. For example, participants tapped new information technologies, changing perspectives and governmental priorities to challenge current ways of working and introduce new ideas. Ideas were realized and spread through various self-organized processes that involved the re-arrangement of existing resources rather than acquisition of new resources. Taken together, these processes brought Swedish rheumatology to new levels of functioning 1992-2011. An important implication of our work is that incremental and practice-driven change processes can significantly transform care systems in the long run. Policy makers need to acknowledge and foster such ongoing innovation processes at micro-level, rather than focusing exclusively on innovations as externally created 'things' that await 'implementation'.
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| 16. |
- Eurenius, Eva, et al.
(författare)
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Predicting physical activity and general health perception among patients with rheumatoid arthritis
- 2007
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Ingår i: Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 34:1, s. 10-15
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe changes over one year in physical activity, body functions, and disease activity in patients with rheumatoid arthritis (RA) and to identify predictors for physical activity and general health perception. METHODS: One hundred two patients with RA were recruited for the study (median age 57 yrs, range 19-84; median disease duration 15 mo, range 4-78; 76% women). Self-reported data on physical activity and health locus of control, tests of lower extremity function, grip force, joint range of motion, balance, and measures of disease activity, including pain, general health perception, Health Assessment Questionnaire (HAQ), and Disease Activity Score (DAS28), were collected on 2 occasions, one year apart. Each variable was dichotomized to fit logistic regression models, performed to identify which variables predicted physical activity and general health perception over one year. RESULTS: Physical activity was stable, while lower extremity function, grip force, and range of motion improved and DAS28 decreased significantly over one year. A high physical activity level at baseline was the only predictor of high physical activity (odds ratio 3.85, 95% confidence interval 1.67-9.09) one year later. Low pain (OR 8.47, 95% CI 2.97-24.39), high physical activity (OR 3.72, 95% CI 1.39-10.10), and good lower extremity function (OR 2.94, 95% CI 1.04-8.33) were identified as predictors of good general health perception. CONCLUSION: While pain is a well known predictor of general health perception, to our knowledge, this is the first study to identify predictive factors related to physical activity and lower extremity function as important for perceived health among patients with RA.
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| 17. |
- Frostegard, Johan, et al.
(författare)
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Atheroprotective natural anti-phosphorylcholine antibodies of IgM subclass are decreased in Swedish controls as compared to non-westernized individuals from New Guinea
- 2007
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Ingår i: Nutrition & Metabolism. - : Springer Science and Business Media LLC. - 1743-7075. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To determine the importance of IgM antibodies against phosphorylcholine ( aPC), a novel protective factor for cardiovascular disease ( CVD), in a population with a non-western life style as compared with a Swedish control group. Methods and results: Risk factors for cardiovascular disease were determined in a group of 108 individuals aged 40-86 years from New Guinea and 108 age-and sex-matched individuals from a population based study in Sweden. Antibodies were tested by ELISA. aPC IgM levels were significantly higher among New Guineans than among Swedish controls ( p < 0.0001). This difference remained significant among both men and women when controlled for LDL and blood pressure which were lower and smoking which was more prevalent in New Guineans as compared to Swedish controls ( p < 0.0001). aPC IgM was significantly and negatively associated with age and systolic blood pressure among Swedish controls and with waist circumference among New Guineans. aPC IgM levels were significantly higher among women than men in both groups. The proportion of the saturated fatty acid ( FA) myristic acid in serum cholesterol esters was negatively but polyunsaturated eicosapentaenoic acid and also lipoprotein ( a) were positively associated with aPC IgM levels. Conclusion: IgM-antibodies against PC, which have atheroprotective properties, are higher in a population from Kitava, New Guinea with a traditional lifestyle, than in Swedish Controls, and higher among women than men in both populations tested. Such antibodies could contribute to the low incidence of cardiovascular disease reported from Kitava and could also provide an explanation as to why women have a later onset of CVD than men.
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| 18. |
- Frostegård, Johan, et al.
(författare)
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Antibodies against Phosphorylcholine among New Guineans Compared to Swedes: An Aspect of the Hygiene/Missing Old Friends Hypothesis.
- 2017
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Ingår i: Immunological investigations. - : Informa UK Limited. - 1532-4311 .- 0882-0139. ; 46:1, s. 59-69
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Tidskriftsartikel (refereegranskat)abstract
- We here study antibodies against phosphorylcholine (anti-PC) which we reported to be inversely associated with atherosclerosis, cardiovascular disease (CVD), and autoimmune conditions. In previous studies, we determined that this inverse association is more pronounced at low levels with high risk and at high levels, with decreased risk. We compare individuals from Kitava, New Guinea (with low risk of these conditions), with Swedish controls.We studied a group of 178 individuals from Kitava (age 20-86), and compared those above age 40 (n = 108) with a group of age- and sex-matched individuals from a population based cohort in Sweden (n = 108). Traditional risk factors for CVD and fatty acids were determined. IgM, IgG, and IgA anti-PC were tested by enzyme-linked immunosorbent assay (ELISA).All anti-PC measures were significantly lower among Swedish controls as compared to Kitavans (p < 0.001), independent of traditional risk factors. Having low levels of anti-PC, defined as below 25th percentile of values among Swedish controls, was associated with this cohort after adjustment for other risk factors (OR 5.7, 95% CI 2.2-14.7 for IgM; OR 31.7, 95% CI 3.9-252 for IgA; and OR 11.1, 95% CI 2.4-51 for IgG).PC is highly exposed on microorganisms and helminths (common on Kitava) exposing much PC which humans and hominids may have been exposed to for millions of years. We propose that low anti-PC levels in the developed world could be a new aspect of the hygiene hypothesis, generating a pro-inflammatory and pro-atherosclerotic state.
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| 19. |
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| 20. |
- Ivarsson, Malena, 1962-
(författare)
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Psycho-physiological reactions to violent video gaming : Experimental studies of heart rate variability, cortisol, sleep and emotional reactions in teenage boys
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Playing violent video games may provoke aggression. Psycho-physiological methods may provide knowledge about the underlying psychological processes. Most previous studies have been performed in laboratory settings at daytime with adults. Thus the aim of this thesis was to investigate psycho-physiological (autonomic and HPA related reactions), sleep-related and emotional responses in teenage boys to playing a violent and a non-violent video game at home before going to sleep. In Study I the autonomic responses differed between the violent and the non-violent game during playing and more distinctly during sleep. In Study II the HPA axis was not affected by video gaming at all. In Study III, the effect of habits of playing violent games was assessed (≤ 1h/day and ≥ 3h/day). High versus low experience of violent gaming were related to different autonomic, sleep-related and emotional processes at exposure to a violent and a non-violent game, during playing and during sleep. The present thesis demonstrated that violent and non-violent games induce different autonomic responses during playing and – more distinctly – during sleep. Frequent gaming seems to influence physiological, sleep-related and emotional reactions, possibly as an expression of desensitization processes.
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| 21. |
- Keller, Christina, 1961-, et al.
(författare)
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Adopting proactive knowledge use as an innovation : The case of a knowledge management system in rheumatology
- 2009
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Ingår i: Proceedings of the International Conference on Information Systems (ICIS) 2009. - 9780615335032 ; , s. 96-
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Konferensbidrag (refereegranskat)abstract
- The aim of the study is to present a tentative framework to explore and investigate the drivers and barriers of adoption of the innovation of proactive knowledge use in connection to a knowledge management system (KMS) in health care. Semi-structured interviews were performed with champion implementers and physicians using the KMS along with a document analysis depicting significant events of the implementation process. The findings from the study suggested that drivers of the innovation were the characteristics of change agents, quality improvement, budget control and knowledge brought to the physician-patient dialogue by the KMS. In particular, there were indications of the KMS facilitating the process of making tacit knowledge explicit in the physician-patient dialogue. Identified barriers towards the innovation were resistance from clinical management, lack of motivation to share knowledge, lack of time and perceived flaws in the interface and compilation of data in the KMS.
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| 22. |
- Keller, Christina, 1961-, et al.
(författare)
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Designing for Complex Innovations in Health Care : Design Theory and Realist Evaluation Combined
- 2009
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Ingår i: Proceedings of DESRIST '09 the 4th International Conference on Design Science Research in Information Systems and Technology 2009 in Malvern, PA, USA. - : ACM.
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Konferensbidrag (refereegranskat)abstract
- Innovations in health care are often characterized by complexity and fuzzy boundaries, involving both the elements of the innovation and the organizational structure required for a full implementation. Evaluation in health care is traditionally based on the collection and dissemination of evidence-based knowledge stating the randomized controlled trial, and the quasi-experimental study design as the most rigorous and ideal approaches. These evaluation approaches capture neither the complexity of innovations in health care, nor the characteristics of the organizational structure of the innovation. As a result, the reasons for innovations in health care not being disseminated are not fully explained. The aim of the paper is to present a design – evaluation framework for complex innovations in health care in order to understand what works for whom under what circumstances by combining design theory and realist evaluation. The framework is based on research findings of a case study of a complex innovation, a health care quality register, in order to understand underlying assumptions behind the design of the innovation, as well as the characteristics of the implementation process. The design - evaluation cycle is hypothesized to improve the design and implementation of complex innovation by using program/kernel theories to develop design propositions, which are evaluated by realistic evaluation, resulting in further refinement of program/kernel theories. The goal of the design – evaluation cycle is to provide support to implementers and practitioners in designing and implementing complex innovations in health care. As a result, the design – evaluation cycle could provide opportunities of improving dissemination of complex innovations in health care.
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| 23. |
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| 24. |
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| 25. |
- Keller, Christina, 1961-, et al.
(författare)
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Improving health care services in rheumatology by open innovation : A qualitative pre-study
- 2011
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- IntroductionTraditions and organizational culture in health care has appointed the physician as the expert on the patient’s disease with full control of knowledge, treatment and services. In open service innovation, every patient is an expert on his or her disease and should be perceived as such by physicians and professions in health care. Patients with chronic diseases have access to knowledge about the disease from, for example, patient guides on the Internet or patient communities engaging in interaction via social media. Not only should evidence-based knowledge be valued in health care but also patients’ "subjective" experiences from health care services, and effects from treatment and lifestyle changes. Accordingly, the patient should be regarded as a co-designer and innovator of health care services, rather than a passive receiver of attention and care.MethodThe purpose of the study is to describe and discuss how principles from open innovation, which are primarily derived from commercial product development, could be applied to open service innovation in non-profit health care organizations. To evaluate the drivers, barriers and prerequisites of such innovation, interviews were performed with two rheumatologists, engaged in a Swedish research project on open innovation in rheumatology care. The data collected by the interviews were analyzed by content analysis.ResultsThe main driver was considered to be "the empowered patient", with a good knowledge of his or her disease. The barriers to open innovation were the lack of meeting places for patients, a strong local variation in how health care services are delivered, and an organizational culture which not promotes learning and innovations. It is necessary for health care organizations to change their current culture of closed innovation, in the sense that only physicians are regarded to have valid knowledge about patients’ diseases. Other necessary prerequisites for implementing open innovation principles are support from management and structures of financial control which encourage innovations.DiscussionIf open innovation principles were implemented today most things in medical practice would change. Hospital and clinic premises would be adapted for interacting with patients, instead of being tailored for performing administrative tasks. Patients would be allowed to speak their mind freely and take up more space than today. Open innovation principles in health care service development would free the power and knowledge of patients. It would also free the power and knowledge of other professions than physicians. It is quite probable that the nurse of the rheumatology clinic has more knowledge about the patient, than the senior professor who perhaps hasn’t met patients in years. Patients hold incredible amounts of specialist knowledge about their chronic disease, and are able to discover and understand things that physicians don’t notice or regard as important. To achieve this goal, the organizational culture of health care need to allow and respect learning about improvement of health care services in the same way as knowledge of biomedical research is allowed and respected. Support from hospital and clinical management, as well as financial incentives is needed promoting in open innovation initiatives.
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| 26. |
- Keller, Christina, 1961-, et al.
(författare)
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Innovations in health care : Design theory and realist evaluation combined
- 2010
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Innovations in health care are often characterized by complexity and fuzzy boundaries, involving both the elements of the innovation and the organizational structure required for a full implementation. Evaluation in health care is traditionally based on the collection and dissemination of evidence-based knowledge stating the randomized controlled trial, and the quasi-experimental study design as the most rigorous and ideal approaches. These evaluation approaches capture neither the complexity of innovations in health care, nor the characteristics of the organizational structure of the innovation. As a result, the reasons for innovations in health care not being disseminated are not fully explained. The aim of the paper is to present a design-evaluation framework for complex innovations in health care in order to understand what works for whom under what circumstances combining design theory and realist evaluation. The framework is based on research findings of a case study of a complex innovation, a health care quality register, in order to understand underlying assumptions behind the design of the innovation, as well as the characteristics of the implementation process. The design-evaluation cycle is hypothesized to improve the design and implementation of complex innovation by using program/kernel theories to develop design principles, which are evaluated by realistic evaluation, resulting in further refinement of program/kernel theories. The goal of the design-evaluation cycle is to provide support to implementers and practitioners designing and implementing complex innovations in health care, for improving dissemination of complex innovations.
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| 27. |
- Keller, Christina, 1961-, et al.
(författare)
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Open innovation in health care services : Challenges and opportunities
- 2011
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Konferensbidrag (refereegranskat)abstract
- In Chesbrough’s terminology, health care organisations are so-called “innovation missionaries”, not creating service innovations for profit, but to serve a cause. Traditions and organisational culture in health care has appointed the physician as the expert on the patient’s disease with almost full control of knowledge, treatment and services. In this sense, health care organisations clearly employ closed innovation principles. These principles have only recently been challenged by, for example, the patient empowerment movement, and approaches like evidence-based design and public display of treatment results. We argue that “classic” open innovation principles could be applied also to open service innovation in health care. In the paradigm of open service innovation, every patient is an expert on his or her disease and should be perceived as such by physicians and other professions in health care. Patients have access to knowledge about the disease from, for example, patient guides on the Internet or patient communities engaging in interaction via social media. Not only should evidence-based knowledge be valued in health care but also patients’ idiosyncratic experiences from health care services, and “subjective” effects of treatment and lifestyle changes. Accordingly, the patient should be regarded as a co-designer and innovator of health care services.The purpose of the study is to describe and discuss how principles from open innovation, which are primarily derived from commercial product development, could be applied to open service innovation in non-profit health care organisations. To evaluate the opportunities and challenges of such innovation, we conducted interviews with physicians from the medical specialty of rheumatology. The main opportunity of open innovation was considered to be the abilities of “the empowered patient”, with a good knowledge of his or her disease. Challenges to open innovation were the lack of meeting places for patients, inertia in local health care service delivery, and an organisational culture which not promotes learning and innovations. From now on, there is an opportunity for health care organisations to change their current culture of closed innovation, implying that only physicians have valid knowledge about patients’ diseases. However, necessary prerequisites for implementing open innovation principles are support from management and structures of financial control which encourage innovations.
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| 28. |
- Keller, Christina, 1961-, et al.
(författare)
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Open service innovation in health care : What can we learn from open innovation communities?
- 2012
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Ingår i: Managing open innovation technologies. - Berlin : Springer Berlin/Heidelberg. - 9783642316494 ; , s. 239-251
-
Bokkapitel (refereegranskat)abstract
- The purpose of the chapter is to describe and discuss how principles from open innovation, which are primarily derived from commercial product development, could be applied to open service innovation in non-profit health care organisations. To evaluate the drivers, barriers and prerequisites of such innovation, we performed an explorative study consisting of interviews with two rheumatologists, engaged in a Swedish research project on open innovation in health care. According to the interviews, the main driver was considered to be “the empowered patient”, holding a good knowledge of his or her disease. Barriers to open innovation were the lack of meeting places for patients, a strong local variation in how health care services are delivered, and an organisational culture which does not promote learning and innovations. It is necessary for health care organisations to change their current culture of closed innovation, implying that only physicians have valid knowledge about patients’ diseases. Other necessary prerequisites for implementing open innovation principles are support from management and structures of financial control which encourage innovations. This explorative study is, to the best of our knowledge, the first to combine principles of open innovation and health care services.
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| 29. |
- Lagerkvist, Anna-Lena, 1956, et al.
(författare)
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Immediate changes in blood-gas tensions during chest physiotherapy with positive expiratory pressure and oscillating positive expiratory pressure in patients with cystic fibrosis.
- 2006
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Ingår i: Respiratory care. - 0020-1324. ; 51:10, s. 1154-61
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess and compare immediate effects of chest physiotherapy with positive expiratory pressure (PEP) versus oscillating PEP on transcutaneously measured blood-gas tensions in patients with cystic fibrosis. METHODS: Fifteen patients (mean age 12.5 y, range 6.9-21.5 y) participated. The treatments were randomized and performed on 2 separate occasions, 8 weeks apart. Spirometry was conducted before and after each treatment. We transcutaneously measured oxygen tension (P(tO2). RESULTS: There were no changes in spirometry values. During PEP, different trends in blood-gas tension were seen, and there were no consistent changes. During oscillating PEP, P(tO2) increased and P(tCO2) decreased. During oscillating PEP, P(tCO2) was lower and the intra-individual change in P(tCO2) was more pronounced than during PEP. The results obtained immediately after oscillating PEP showed a higher P(tO2) and a lower P(tCO2) than with PEP. CONCLUSION: PEP and oscillating PEP can both cause transitory effects on blood gases in patients with cystic fibrosis. However, oscillating PEP alters blood-gas tensions more than does PEP, and hyperventilation during oscillating PEP may reduce treatment time.
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| 30. |
- Lekander, Ingrid, et al.
(författare)
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The cost-effectiveness of TNF-inhibitors for the treatment of rheumatoid arthritis in Swedish clinical practice
- 2013
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Ingår i: European Journal of Health Economics. - : Springer Science and Business Media LLC. - 1618-7601 .- 1618-7598. ; 14:6, s. 863-873
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Tidskriftsartikel (refereegranskat)abstract
- The objective was to estimate the cost-effectiveness of TNF-inhibitors for the treatment of rheumatoid arthritis in Swedish clinical practice, both as a first and second biological treatment, with or without the combination of conventional DMARDs. Further sub-group analysis of etanercept treatment was performed. Patient level data were obtained from three regions of the Swedish Rheumatology Registers. The dataset contained 2,558 patients who had started TNF-inhibitor treatment, 1,049 with etanercept as their first biological treatment. A total of 819 patients had switched to a second TNF-inhibitor, of which 425 to etanercept. A Markov cohort model was used in which health states of disease severity were classified according to HAQ and DAS28. Disease progression and discontinuation rates of TNF-inhibitors were based on the registry and for the comparator on published literature. Mortality, costs and utilities were based on Swedish data. The main analysis had a societal perspective over 20 years and efficacy was measured in quality-adjusted life-years (QALYs). TNF-inhibitor treatment was associated with an increase in QALYs and an incremental cost compared to no biological treatment. The cost per QALY gained with the three TNF-inhibitors ranged from a,not sign50,000 to a,not sign120,000, with lower estimates for TNF-inhibitors used in combination with MTX and as a first biologic. At a progression of 0.045 for the comparator, most values remain within the accepted range for cost-effectiveness. These results demonstrate that the cost per QALY for TNF-inhibitors was higher than in previous assessments based on registry data and that the results were sensitive to the HAQ progression of the comparator.
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| 31. |
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| 32. |
- Lööf, Helena, et al.
(författare)
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Body awareness in persons diagnosed with rheumatoid arthritis
- 2014
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Co-Action Publishing. - 1748-2623 .- 1748-2631. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Living with rheumatoid arthritis (RA) poses physiological and psychological demands on a person. RA is a autoimmune disease that can cause pain, disability, and suffering. The ability to notice bodily inner sensations and stimuli (body awareness, BA) is described in the literature in ways that could have either a positive or a negative impact on a person's health. The concept of BA is complex and a thorough understanding is needed about what BA means from the patient's perspective. This study was therefore conducted to acquire greater insight into this phenomenon. The study is grounded in a phenomenological life-world perspective. Eighteen narrative interviews were conducted in patients (age range 23-78 years) with RA. The interviews were analyzed using the Empirical Phenomenological Psychological method. General characteristics were found running through all 18 interviews, indicating that the disease resulted in a higher degree of negatively toned BA. BA was either a reactive process of searching or controlling after disease-related symptoms or a reactive process triggered by emotions. BA was an active process of taking an inventory of abilities. All participants had the ability to shift focus from BA to the outside world. Four typologies were identified: "A reactive process on symptoms," "A reactive process on emotional triggers," "An active process of taking an inventory of abilities," and "A shifting from BA to the outside world." In conclusion, because BA can be both positively and negatively toned, health care professionals must have a good understanding of when BA is positive and when it is negative in relation to the patient. RA had caused a higher degree of negatively toned BA. Thus, the ability to shift attention from BA to activity in the outside world could sometimes be beneficial for the patient's general health.
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| 33. |
- Lööf, Helena, et al.
(författare)
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Development and psychometric testing of the Swedish version of the Body Awareness Questionnaire
- 2013
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 69:7, s. 1643-1651
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Tidskriftsartikel (refereegranskat)abstract
- Aim This paper is a report of the development and psychometric testing of the Swedish version of the Body Awareness Questionnaire to measure bodily focus of attention. Background The Body Awareness Questionnaire has been identified as an instrument with excellent psychometric properties within the concept of body awareness. It has been used in both research and clinical settings in different contexts. However, a validated Swedish version is not available. Method A cross-sectional design was applied for adaptation of the Body Awareness Questionnaire and psychometric validation. Data were collected between autumn 2009 and spring 2011 from 120 patients diagnosed with rheumatoid arthritis, and from 120 students. The concurrent think aloud' method was used in a pre-test to determine the usability of the questionnaire. Cronbach's alpha was used to test the internal consistency, and confirmatory factor analysis was performed to test the construct validity. Results According to the confirmatory factor analysis, neither the one-factor model nor the four-factor model tested in this study fulfilled the pre-specified criteria in accordance with the Comparative Fit Index, Standardized Root Mean Squared Residual and the Root Mean Square Error of Approximation. The value of Cronbach's alpha for the Swedish version of the Body Awareness Questionnaire was satisfactory. Conclusion Our results indicate that the two models tested in this study do not provide a good fit to the observed data. Further refinement and testing of the Swedish version of the Body Awareness Questionnaire is therefore required. The concept of body awareness may be useful in the management of chronic disease and can be addressed in nursing.
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| 34. |
- Lööf, Helena, et al.
(författare)
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Fear-avoidance beliefs about physical activity in adults with rheumatoid arthritis
- 2015
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Ingår i: Scandinavian Journal of Rheumatology. - : Taylor & Francis. - 0300-9742 .- 1502-7732. ; 44:2, s. 93-89
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of this study was to describe fear-avoidance beliefs about physical activity and explore how these beliefs correlate with sociodemographic, disease-specific, and psychosocial factors in adults with rheumatoid arthritis (RA).METHOD: This cross-sectional study is part of the Physical Activity in Rheumatoid Arthritis (PARA) 2010 study. The study participants (n = 2351) were identified through the Swedish Rheumatology Quality (SRQ) registries from six rheumatology clinics in Sweden. Univariate and backwards stepwise logistic regressions were performed.RESULTS: Stepwise logistic regressions showed that male gender [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.26-1.91] and having a below average income (OR 1.35, 95% CI 1.12-1.63) were associated with an increased risk of high scores on the modified Fear Avoidance-Belief Questionnaire (mFABQ). The two disease-specific factors most indicative of high mFABQ scores were high level of pain (OR 1.99, 95% CI 1.40-2.84) and poor health (OR 1.59, 95% CI 1.10-2.29). With regard to psychosocial factors, low health-related quality of life (HRQoL; OR 0.44, 95% CI 0.35-0.55) and a low score on the Exercise Self-Efficacy Scale (ESES; OR 0.66, 95% CI 0.52-0.82) were significantly associated with a high mFABQ score. The model fit was 0.27 (Nagelkerke's R(2)).CONCLUSIONS: High fear-avoidance beliefs about physical activity in patients with RA were found to be associated with being male and having a below average income, a high level of pain, poor health, a low HRQoL, and low ESES score. Additional research is warranted for adults with RA to capture the multiple potential correlates to fear-avoidance beliefs about physical activity.
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| 35. |
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| 36. |
- Lööf, Helena, et al.
(författare)
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Pain and fatigue in adult patients with rheumatoid arthritis : Association with body awareness, demographic, disease-related, emotional and psychosocial factors
- 2013
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Ingår i: Open Journal of Nursing. - : Scientific Research Publishing. - 2162-5336 .- 2162-5344. ; 3:2, s. 293-300
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients and clinicians report pain and fatigue as key outcome measures in rheumatoid arthritis. Fatigue and pain are a major concern to patients. Aim: The objective of this study was to examine fatigue and pain in adult patients with rheumatoid arthritis (RA) and to investigate the association between pain and fatigue with body awareness, demographic, disease-related, emotional and psychosocial factors.Method: Data were collected from a sample of patients with RA (n = 120) recruited from a Rheumatology clinic in a large university hospital in Stockholm, Sweden. Eligible for inclusion were patients between 20 - 80 years of age and with a confirmed diagnosis of RA. Fatigue was measured using the Multidimensional Assessment of Fatigue (MAF) scale, while the Visual Analogue Scale (VAS) was used to assess components of pain. A multiple stepwise regression analysis was performed to evaluate factors related to fatigue and pain. In the first step a univariate analysis of variance (ANOVA) was used for all relevant independent factors. In the next step backwards stepwise regression was applied.Result: Fatigue was significantly associated with the Disease Activity Score 28-joints (DAS 28) (p = 0.049), the Body Awareness Questionnaire (BAQ) (p = 0.006), the Positive Affect (PA) scale (p = 0.008) and no smoking (p = 0.021). Pain was significantly associated with the EuroQol EQ-5D (p = 0.008) and the DAS 28 (p = 0.001). The adjusted R-square was 28.6% for fatigue and 50.0% for pain. Conclusion: This study clearly demonstrates that fatigue and pain in patients with RA appear to be associated with disease-related factors. Furthermore, fatigue was related to body awareness and emotional factors, and pain was related to health related quality of life.
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| 37. |
- Lööf, Helena
(författare)
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Pain, fatigue and fear-avoidance beliefs in relation to physical activity and body awareness in persons diagnosed with rheumatoid arthritis
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Pain and fatigue are highly common and a major concern for persons diagnosed with rheumatoid arthritis (RA). Having physical limitations, which have a significant effect on daily life, is also described as a major problem for persons with RA. Research findings show that a minority of persons with RA perform maintained health-enhancing physical activity (HEPA), and that psychosocial factors seem to be the most salient and consistent factors to explain variations in HEPA. Furthermore, fear of physical activity and exercise has been described as major barriers for persons with chronic pain. The ability to notice bodily inner sensations and stimuli (body awareness, BA) is described in the literature as having either a positive or a negative impact on a person’s health and well-being. However, the concept of BA is complex and therefore greater insight into this phenomenon is needed.Aim: The overall aim of this thesis was to investigate pain, fatigue and fear-avoidance beliefs in relation to physical activity and their correlates in persons with RA. A further overall aim was to develop a psychometric measurement of BA. A final overall aim was to deepen our understanding of BA in persons with RA.Methods: Study I was a psychometric evaluation of a Swedish version of the Body Awareness Questionnaire (BAQ) in a student population and in adults with RA. Studies II - III were a cross-sectional survey studies in adults with RA. Study IV was a phenomenological study using the empirical phenomenological psychological (EPP) method in adults with RA.Results: In study I, the value of Cronbach's alpha coefficients for the total score in the Swedish version of the BAQ was satisfactory. According to confirmatory factor analysis (CFA), neither a one-factor model nor a four-factor model tested in this study fulfilled the pre-specified criteria. In study II, pain was significantly associated with health-related quality of life (HRQoL) and disease activity. Fatigue was significantly associated with disease activity, BA and positive affect. The adjusted R2 was 28.6% for fatigue and 50.0% for pain. Study III showed that, for socio-demographic factors, being male and having a below average income were associated with an increased risk of high fear-avoidance beliefs about physical activity (mFABQ high). Moreover, the two disease-specific factors, which are most indicative of mFABQ high, were high level of pain and poor health. Concerning psychosocial factors, low HRQoL and low exercise self- efficacy were significantly associated with mFABQ high. The model fit was 0.27 (Nagelkerkés R2). In study IV, some general characteristics were found, which had to do with the disease giving rise to a higher degree of negatively toned BA. BA was a reactive process of searching or controlling for disease-related symptoms, or a reactive process that was triggered by emotions. In addition, BA was an active process in the sense of taking an inventory of abilities. All the participants had the ability to shift focus from BA to the outside world.Conclusions: This thesis showed that pain, fatigue and fear-avoidance beliefs about physical activity in persons with RA have several potential correlates, including socio-demographic, disease-specific and psychosocial factors for the variables investigated. The Swedish version of the BAQ is simple to administer and should be used as a tool to measure self-reported attentiveness to normal body processes. Cronbach’s alpha coefficient for the total score was satisfactory; nevertheless, since neither of the models fulfilled the pre-specified criteria further testing of the Swedish version of the BAQ is required. BA was found to be both positively and negatively toned in persons with RA, though RA resulted in a higher degree of negatively toned BA. Thus, the ability to shift attention, from BA to activities in the outside world, could sometimes be beneficial for the person’s general health and well-being. Having the opportunity to participate in meaningful and purposeful daily real-world activities keeps the mind busy (and distracted) and can decrease the negative BA.
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| 38. |
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| 39. |
- Nelson, Eugene C., et al.
(författare)
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Patient focused registries can improve health, care, and science
- 2016
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Ingår i: BMJ. British Medical Journal. - : BMJ Publishing Group Ltd. - 0959-8146 .- 0959-535X. ; 354
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Tidskriftsartikel (refereegranskat)abstract
- Large scale collection and analysis of data on patients’ experiences and outcomes have become staples of successful health systems worldwide. The systems go by various names—including registries, quality registries, clinical databases, clinical audits, and quality improvement programmes—but all collect standardised information on patients’ diagnoses, care processes, and outcomes, enabling systematic comparison and analysis across multiple sites. Hundreds of what we will term, for simplicity, “registries,” now exist around the world. The United Kingdom is home to over 50 clinical audit programmes, the United States has over 110 federally qualified registries certified to report quality metrics, and Sweden, perhaps the registry epicentre, has over 100, covering conditions from birth to frail old age.These registries have had far reaching effects. They facilitate public reporting, retrospective and prospective research, professional development, and service improvement. They reveal variations in practices, processes, and outcomes, and identify targets for improvement. In the UK, they have been associated with many notable successes, including improvements in management of cardiovascular disease and stroke, cancer, and joint replacement.
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| 40. |
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| 41. |
- Nilsson, Staffan, 1955-
(författare)
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Chest pain and ischemic heart disease : Diagnosis and management in primary health care
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aims. In patients consulting for chest pain, it is of great importance to evaluate the possibility of ischemic heart disease (IHD). The aims in this thesis were to investigate the accuracy of the general practitioners’ clinical assessments and the applicability of exercise testing and myocardial perfusion scintigraphy (MPS) in patients consulting for chest pain in primary care.Statins are known to prevent IHD. A further aim was therefore to investigate if a relation could be detected on a population basis between the use of statins and the morbidity of acute myocardial infarction (AMI).Methods. All patients from 20 to 79 years, consulting for a new episode of chest pain in three primary health care centres, were included during almost two years from 1998 to 2000. The patients were managed according to the clinical evaluation. The presence of IHD was excluded either by clinical examination only, or if stable IHD was in question, by exercise testing and if the exercise test was inconclusive by an additional MPS. If unstable IHD or myocardial infarction was suspected, referral for emergency hospital examination was made.Correlations between statin sales and the morbidity of AMI in Sweden’s municipalities were analysed in an ecological, register based study. Adjustment was made for sales of antidiabetics, socio-economic deprivation indexes and geographic coordinates.Results. Consultations for chest pain represented 1.5% of all consultations in the ages 20 to 79 and were made by 554 patients. In 281 patients IHD was excluded by clinical examination only. In 208 patients stable IHD and in 65 unstable IHD was in question. Four patients (1.4%) evaluated as not having IHD, were diagnosed with angina pectoris or AMI within three months. Exercise testing was performed in 191 patients and revealed no IHD in 134 and IHD in 14 patients. In 43 patients the exercise test results were equivocal. Thirty-nine of these patients underwent MPS, which showed no IHD in 20 and IHD in 19 of the patients.In a follow up almost six years later, neither mortality rate nor prevalence of IHD differed significantly between the 384 study patients evaluated not to have IHD and the population controls.Statin sales and AMI-incidence or mortality showed no strong associations from 1998 to 2002.Conclusions.·Primary care is an appropriate level of care for ruling out IHD as the cause of chest pain, with sufficient safety and for diagnostics of stable IHD.·Exercise testing and myocardial perfusion scintigraphy are useful procedures when investigating chest pain patients in primary care.·The results indicate that preventive measures other than increased statin treatment should be considered to further decrease AMI-morbidity.
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| 42. |
- Olsson, Jesper, et al.
(författare)
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System characteristics of healthcare organizations conducting successful improvements
- 2007
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Ingår i: Journal of Health Organization & Management. - : Emerald. - 1477-7266 .- 1758-7247. ; 21:3, s. 283-296
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Tidskriftsartikel (refereegranskat)abstract
- Purpose - In a previous study, based on a survey to all clinical department and primary care center managers in Sweden, it was concluded that the prevailing general improvement strategy is characterized by: drivers for improvement are staff needs, patients and data are not as important, improvements mainly focus on administrative routines and stress management, improvements are mainly reached, by writing guidelines, and conducting meetings, the majority of managers perceive outcomes from this strategy as successful. The purpose of current research in this paper is to investigate whether there is any other improvement strategy at play in Swedish health care. Design/methodology/approach - Data from the study of all Swedish managers were stratified into two populations based on an instrument predicting successful improvement. One population represented organizations with exceptionally high probability of successful imrpovement and remaining organizations represented the general improvement strategy. Findings - The paper finds that organizations with high probability for successful change differed from the comparison population at the p=0.05 level in many of the surveyed characteristics. They put emphasis on patient focus, measuring outcomes, feedback of data, interorganizational collaboration, learning and knowledge, communication/ information, culture, and development of administration and management. Thus these organizations center their attention towards behavioral changes supported by data. Practical implications - Organizations predicted to conduct successful improvement apply comprehensive improvement strategies as suggested in the literature. Such actions are part of the Patient Centered Task Alignment strategy and it is suggested that this concept has managerial implications as well, as it might be useful in further studies on improvement work in health care. Originality/value - This paper provides empirically based findings on a successful improvement strategy that can aid research-informed policy decisions on organizational improvement strategies. © Emerald Group Publishing Limited.
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| 43. |
- Olsson, Jesper, et al.
(författare)
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The one-person randomized controlled trial
- 2005
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Ingår i: Quality Management in Health Care. - : Ovid Technologies (Wolters Kluwer Health). - 1063-8628 .- 1550-5154. ; 14:4, s. 206-216
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Tidskriftsartikel (refereegranskat)abstract
- Currently, the gold standard for collection of clinical evidence is the randomized controlled trial (RCT), preferably with large, multicenter samples of subjects. Although this approach provides valuable information, many clinicians find it difficult to translate RCT results to the individual patient level. In this report, a statistical approach called Design of Experiments (DOE) is described as a method of applying the principles of RCTs one person at a time. An overview of the method, with a simple clinical example, is presented. As shown, DOE is a more efficient method than the sequential approach often taken by clinicians and their patients when evaluating various treatment choices. Further, the effect of multiple interventions can be assessed, alone or in combination with each other. In this way, DOE can be an important addition to the field of evidence-based medicine, although further studies are needed.
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| 44. |
- Ovretveit, John, et al.
(författare)
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Continuous innovation : developing and using a clinical database with new technology for patient-centred care - the case of the Swedish quality register for arthritis
- 2013
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 25:2, s. 118-124
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Tidskriftsartikel (refereegranskat)abstract
- Objective. We describe and explain the development of a clinical quality database and its use for different clinical, management and patient empowerment purposes.Design. A longitudinal case study covering 1993–2009.Setting. Rheumatology departments in Swedish hospitals.Participants. Those involved in developing the clinical database and its applications and a limited number of users.Intervention(s). Different methods for inputting and storing clinical and patient data and for analysing and presenting the data to providers and patients.Main outcome measure(s). Participants’ perceptions of the value of different applications and of influences, which helped and hindered the development of the system.Results. Different innovations were introduced at different times continually to increase the ultility of the clinical data and the clinic- and patient coverage of the clinical data system. Limited interview data show postive patient and provider perceptions of the latest application to collect and present data as time trend visual display in the clinical consultation.Conclusions. A longitudinal perspective revealed how a clinical quality register was developed and how new technologies not imagined in the early 1990s continue to increase the ultility and value of the clinical database. This historical perspective provided limited evidence of impact, but does provide lessons for current strategies for innovation for quality in health care and of the need to consider innovolution processes, rather than discrete innovations, given the rapid pace of change in new technologies. More evidence is needed of the impact of such registers, and of enhancements, on providers and patients and on costs.
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| 45. |
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| 46. |
- Simard, Julia F., et al.
(författare)
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Ten years with biologics : to whom do data on effectiveness and safety apply?
- 2011
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Ingår i: Rheumatology. - : Oxford University Press (OUP). - 1462-0324 .- 1462-0332. ; 50:1, s. 204-213
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Tidskriftsartikel (refereegranskat)abstract
- Methods. We identified all adult patients with RA (n = 9612), PsA (n = 1417) and other SpA (n = 1652) initiating a first biologic therapy between 1 January 1999 and 31 December 2008, registered in the Swedish Biologics Register (ARTIS), including information on demographics, disease characteristics and 1-year risk of first-line treatment discontinuation. Results. Over calendar time, measures of disease activity at start declined substantially for all indications, and diminished between first-, second- and third-line therapy starts. One-year risks of first-line therapy discontinuation increased. Switchers to anti-TNF and non-TNF biologics had different comorbidities. Despite < 50% drug retention at 5 years, most patients remained exposed to some biologic. Conclusions. The trends in baseline characteristics and drug retention underscores that any effects of biologics, including comparison between different biologics, must be interpreted in light of the characteristics of the population treated. The observed differences further call for continued vigilance to properly evaluate the safety profiles of biologic treatments as they are currently used. Exposure to multiple biologics presents a challenge for attribution of long-term effects.
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