| 1. |
- Ax, Anna-Karin, et al.
(författare)
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Short- and long-term effect of high versus low-to-moderate intensity exercise to optimise health-related quality of life after oncological treatment-results from the Phys-Can project
- 2022
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Ingår i: Supportive Care in Cancer. - Heidelberg, Germany : Springer Nature. - 0941-4355 .- 1433-7339. ; 30:7, s. 5949-5963
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: This study aimed to evaluate the effect of high intensity (HI) vs low-to-moderate intensity (LMI) exercise on health-related quality of life (HRQoL) up to 18 months after commencement of oncological treatment in patients with breast, colorectal or prostate cancer. In addition, we conducted a comparison with usual care (UC).METHODS: Patients scheduled for (neo)adjuvant oncological treatment (n = 577) were randomly assigned to 6 months of combined resistance and endurance training of HI or LMI. A longitudinal descriptive study (UC) included participants (n = 89) immediately before the RCT started. HRQoL was assessed by EORTC QLQ-C30 at baseline, 3, 6 and 18 months (1 year after completed exercise intervention) follow-up. Linear mixed models were used to study the groups over time.RESULTS: Directly after the intervention, HI scored significant (P = 0.02), but not clinically relevant, higher pain compared with LMI. No other significant difference in HRQoL was found between the exercise intensities over time. Clinically meaningful improvements in HRQoL over time were detected within both exercise intensities. We found favourable significant differences in HRQoL in both exercise intensities compared with UC over time.CONCLUSION: This study adds to the strong evidence of positive effect of exercise and shows that exercise, regardless of intensity, can have beneficial effects on HRQoL during oncological treatment and also for a substantial time after completion of an exercise intervention. In this study, for one year after.IMPLICATIONS FOR CANCER SURVIVORS: Patients can be advised to exercise at either intensity level according to their personal preferences, and still benefit from both short-term and long-term improvements in HRQoL.
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| 2. |
- Johansen, Karin, 1990-, et al.
(författare)
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Laparoscopic distal pancreatectomy is more cost-effective than open resection: results from a Swedish randomized controlled trial
- 2023
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Ingår i: HPB. - : ELSEVIER SCI LTD. - 1365-182X .- 1477-2574. ; 25:8, s. 972-979
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundLaparoscopic distal pancreatectomy is being implemented worldwide. The aim of this study was to perform a cost-effectiveness analysis from a health care perspective.MethodsThis cost-effectiveness analysis was based on the randomized controlled trial LAPOP, where 60 patients were randomized to open or laparoscopic distal pancreatectomy. For the follow-up of two years, resource use from a health care perspective was recorded, and health-related quality of life was assessed using the EQ-5D-5L. The per-patient mean cost and quality-adjusted life years (QALYs) were compared using nonparametric bootstrapping.ResultsFifty-six patients were included in the analysis. The mean health care costs were lower, €3863 (95% CI: -€8020 to €385), for the laparoscopic group. Postoperative quality of life improved with laparoscopic resection and resulted in a gain in QALYs of 0.08 (95% CI: −0.09 to 0.25). The laparoscopic group had lower costs and improved QALYs in 79% of bootstrap samples. With a cost-per-QALY threshold of €50 000, 95.4% of the bootstrap samples were in favour of laparoscopic resection.ConclusionLaparoscopic distal pancreatectomy is associated with numerically lower health care costs and improvements in QALYs compared with the open approach. The results support the ongoing transition from open to laparoscopic distal pancreatectomies.
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| 3. |
- Lundgren, Moa, et al.
(författare)
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Reasons for hospitalisation and cumulative mortality in people, 75 years or older, at high risk of hospital admission: a prospective study
- 2024
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Ingår i: BMC Geriatrics. - : BMC. - 1471-2318. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background A small proportion of the older population accounts for a high proportion of healthcare use. For effective use of limited healthcare resources, it is important to identify the group with greatest needs. The aim of this study was to explore frequency and reason for hospitalisation and cumulative mortality, in an older population at predicted high risk of hospital admission, and to assess if a prediction model can be used to identify individuals with the greatest healthcare needs. Furthermore, discharge diagnoses were explored to investigate if they can be used as basis for specific interventions in the high-risk group. Methods All residents, 75 years or older, living in ostergotland, Sweden, on January 1st, 2017, were included. Healthcare data from 2016 was gathered and used by a validated prediction model to create risk scores for hospital admission. The population was then divided into groups by percentiles of risk. Using healthcare data from 2017-2018, two-year cumulative incidence of hospitalisation was analysed using Gray ' s test. Cumulative mortality was analysed with the Kaplan-Meier method and primary discharge diagnoses were analysed with standardised residuals. Results Forty thousand six hundred eighteen individuals were identified (mean age 82 years, 57.8% women). The cumulative incidence of hospitalisation increased with increasing risk of hospital admission (24% for percentiles < 60 to 66% for percentiles 95-100). The cumulative mortality also increased with increasing risk (7% for percentiles < 60 to 43% for percentiles 95-100). The most frequent primary discharge diagnoses for the population were heart diseases, respiratory infections, and hip injuries. The incidence was significantly higher for heart diseases and respiratory infections and significantly lower for hip injuries, for the population with the highest risk of hospital admission (percentiles 85-100). Conclusions Individuals 75 years or older, with high risk of hospital admission, were demonstrated to have considerable higher cumulative mortality as well as incidence of hospitalisation. The results support the use of the prediction model to direct resources towards individuals with highest risk scores, and thus, likely the greatest care needs. There were only small differences in discharge diagnoses between the risk groups, indicating that interventions to reduce hospitalisations should be personalised. Trial registration clinicaltrials.gov Identifier: NCT03180606, first posted 08/06/2017.
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| 4. |
- Marcusson, Jan, et al.
(författare)
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Proactive healthcare for frail elderly persons : study protocol for a prospective controlled primary care intervention in Sweden
- 2019
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:5
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Tidskriftsartikel (refereegranskat)abstract
- Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction.Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire.Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.
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| 5. |
- Melo Zurita, Maria de Lourdes, et al.
(författare)
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Global Water Governance and Climate Change : Identifying Innovative Arrangements for Adaptive Transformation
- 2018
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Ingår i: Water. - : MDPI AG. - 2073-4441. ; 10:1
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Forskningsöversikt (refereegranskat)abstract
- A convoluted network of different water governance systems exists around the world. Collectively, these systems provide insight into how to build sustainable regimes of water use and management. We argue that the challenge is not to make the system less convoluted, but rather to support positive and promising trends in governance, creating a vision for future environmental outcomes. In this paper, we analyse nine water case studies from around the world to help identify potential innovative arrangements' for addressing existing dilemmas. We argue that such arrangements can be used as a catalyst for crafting new global water governance futures. The nine case studies were selected for their diversity in terms of location, scale and water dilemma, and through an examination of their contexts, structures and processes we identify key themes to consider in the milieu of adaptive transformation. These themes include the importance of acknowledging socio-ecological entanglements, understanding the political dimensions of environmental dilemmas, the recognition of different constructions of the dillema, and the importance of democratized processes.
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| 6. |
- Plummer, Ryan, et al.
(författare)
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Flood Governance : A multiple country comparison of stakeholder perceptions and aspirations
- 2018
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Ingår i: Environmental Policy and Governance. - : Wiley. - 1756-932X .- 1756-9338. ; 28:2, s. 67-81
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Tidskriftsartikel (refereegranskat)abstract
- Flooding is routinely among the most disastrous annual events worldwide with extensive impacts on human wellbeing, economies and ecosystems. Thus, how decisions are made about floods (i.e. flood governance) is extremely important and evidence shows that it is changing, with non-governmental actors (civil society and the private sector) becoming involved in new and sometimes hybrid governance arrangements. This study investigates how stakeholders perceive floods to be governed and how they believe decision-making ought to occur, with the intent of determining to what extent changing governance is evident on the ground and how well (or poorly) it aligns with desired governance arrangements. Flood governance stakeholders were surveyed in five flood-prone geographical areas from Australia, Canada, Italy, the Netherlands and Sweden. The findings suggest that a reconfiguration of flood governance is underway with relatively little consensus regarding the specific arrangements and mechanisms in place during this transitionary period. Across the five cases, stakeholders indicated that they wanted flood governance to be organized at multiple levels, with strong government involvement and with diverse actor groups, and through mechanisms that match the involvement of these actors, with a lack of desirability for some specific configurations involving the private sector in particular. There was little alignment between stakeholder perceptions of governance currently in place and their desired arrangements, except for government involvement. Future research directions highlight the importance of the inclusion of stakeholder perspectives in assessing flood governance, and following the transition in flood governance over time.
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