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1.
  • Eksell, Jörgen, et al. (författare)
  • Tourists' place-making performances through music
  • 2020
  • Ingår i: The Routledge Companion to Media and Tourism. ; , s. 235-245
  • Bokkapitel (refereegranskat)abstract
    • Traditionally tourists are treated as passive media consumers but this chapter departs from a performance perspective emphasizing tourists’ active role. This chapter deals with how popular music affects tourists’ experiences in destinations by exploring the performance of place-making practices by tourists as they engage with music. The performance perspective is complemented with a ritual perspective that also allows an analysis of mundane practices. The problematization focus on two situations in Liverpool and highlight a number of different practices. The dynamics between planned and unplanned, and scripted and spontaneous performances are explored as well as the mediatized nature of these practices.
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2.
  • Norrhall, Maria Fässberg, 1968, et al. (författare)
  • A feasible lifestyle program for early intervention in patients with chronic obstructive pulmonary disease (COPD): a pilot study in primary care.
  • 2009
  • Ingår i: Primary care respiratory journal : journal of the General Practice Airways Group. - : Springer Science and Business Media LLC. - 1475-1534. ; 18:4, s. 306-12
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: To evaluate the feasibility of a lifestyle program for early intervention in patients with COPD in a primary care population. METHODS: The study was performed in a Primary Health Care Centre in Western Sweden. During a four-week period, all smokers between 40-70 years of age were invited to answer a questionnaire and to perform spirometry. The intervention program included a specially designed smoking cessation program and programs for physical activity and diet. RESULTS: 84 smokers were included. 42% fulfilled the criteria for COPD. All of the COPD patients were in GOLD stage I and II. Among the COPD subjects, 38% were underweight and 56% had a low fat-free mass - both together indicating malnutrition and the need for nutritional treatment. By the end of the intervention program, 47% of the COPD patients had stopped smoking. CONCLUSIONS: The intervention program was feasible and effective with a very high smoking cessation rate.
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3.
  • Thorn, Jörgen, 1965, et al. (författare)
  • Management of chronic obstructive pulmonary disease (COPD) in primary care: a questionnaire survey in western Sweden.
  • 2008
  • Ingår i: Primary care respiratory journal : journal of the General Practice Airways Group. - : Springer Science and Business Media LLC. - 1471-4418. ; 17:1, s. 26-31
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: To assess the primary care management of chronic obstructive pulmonary disease (COPD) in relation to COPD guidelines. METHOD: A postal questionnaire was sent out to all Primary Health Care Centres (PHCCs) in western Sweden (n=232). The response rate was 75%. RESULTS: A majority of the PHCCs had a nurse and physician responsible for COPD care. They used spirometry equipment regularly, but only 50% reported that they calibrated it at least weekly. Less than 30% of the PHCCs reported access to a dietician, occupational therapist or physiotherapist. There was a structured smoking cessation program in 50% of the PHCCs. Larger PHCCs were more likely to use spirometry equipment regularly and to have specific personnel for COPD care. CONCLUSION: There is a need to establish structured programs for COPD care including smoking cessation programs for COPD patients with special trained staff. Larger PHCCs have a better infrastructure for providing guideline-defined COPD care.
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4.
  • Adolfsson, Jörgen, et al. (författare)
  • Identification of Flt3(+) lympho-myeloid stem cells lacking erythro-megakaryocytic potential: A revised road map for adult blood lineage commitment
  • 2005
  • Ingår i: Cell. - : Elsevier (Cell Press). - 0092-8674 .- 1097-4172. ; 121:2, s. 295-306
  • Tidskriftsartikel (refereegranskat)abstract
    • All blood cell lineages derive from a common hematopoietic stem cell (HSC). The current model implicates that the first lineage commitment step of adult pluripotent HSCs results in a strict separation into common lymphoid and common myeloid precursors. We present evidence for a population of cells which, although sustaining a high proliferative and combined lympho-myeloid differentiation potential, have lost the ability to adopt erythroid and megakaryocyte lineage fates. Cells in the Lin-Sca-1+c-kit+ HSC compartment coexpressing high levels of the tyrosine kinase receptor Flt3 sustain granulocyte, monocyte, and B and T cell potentials but in contrast to Lin-Sca-1(+)ckit(+)Flt3(-) HSCs fail to produce significant erythroid and megakaryocytic progeny. This distinct lineage restriction site is accompanied by downregulation of genes for regulators of erythroid and megakaryocyte development. In agreement with representing a lymphoid primed progenitor, Lin(-)Sca-l(+)c-kit(+)CD34(+)Flt3(+) cells display upregulated IL-7 receptor gene expression. Based on these observations, we propose a revised road map for adult blood lineage development.
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5.
  • Ahmadi, Nasser, 1958, et al. (författare)
  • Breathlessness in everyday life from a patient perspective: A qualitative study using diaries
  • 2014
  • Ingår i: Palliative & supportive care. - Cambridge, United Kingdom : Cambridge University Press. - 1478-9515 .- 1478-9523. ; 12:3, s. 189-194
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Breathlessness is a subjective symptom, which makes it difficult to define and understand. The aim of the present study was to illuminate how patients suffering from breathlessness experience their everyday life. Method: The study was a qualitative study, and the focus of the analysis was the patients’ descriptions of their experiences of breathlessness using a diary with two unstructured questions for a period of 7 consecutive days. Sixteen participants: 7men, mean age 65+7 (range 55–73 years old), and 9 women, mean age 65+9 (range 50–72 years old) participated in the study. Results: Two themes emerged from the analysis: 1) Impaired quality of life and 2) symptom tolerance and adaptation. The theme “impaired quality of life” included the categories limited physical ability, psychological burdens, and social life barriers. The theme “symptom tolerance and adaptation” included importance of health care, social support, hobbies and leisure activities, and coping strategies. Significance of results: The findings in our study showed that patients, in spite of considerable difficulties with shortness of breath, found relief in several types of activities, in addition to drug therapy. The result indicates that the “biopsychosocial model” is an appealing approach that should be discussed further to gain a better understanding of breathlessness.
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6.
  • Ahmadi, Nasser, 1958, et al. (författare)
  • Clinical characteristics of asymptomatic left ventricular diastolic dysfunction and its association with self-rated health and N-terminal B-type natriuretic peptide: a cross-sectional study
  • 2016
  • Ingår i: Esc Heart Failure. - : Wiley. - 2055-5822. ; 3:3, s. 205-211
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims Left ventricular hypertrophy, obesity, hypertension, and N-terminal B-type natriuretic peptide (Nt-proBNP) predict left ventricular diastolic dysfunction with preserved systolic function (DD-PSF). Self-rated health (SRH) is shown to be associated with chronic diseases, but the association of SRH with DD-PSF is unclear. In light of the clinical implications of DD-PSF, the following goals are of considerable importance: (1) to determine the role of SRH in patients with DD-PSF in the general population and (2) to study the association between Nt-proBNP and DD-PSF. Methods and results The current study is a cross-sectional study conducted on a random sampling of a rural population. Individuals 30-75 years of age were consecutively subjected to conventional echocardiography and tissue velocity imaging. Data were collected on 500 (48%) men and 538 (52%) women (n = 1038). DD-PSF was the main outcome, and SRH and Nt-proBNP were the primary indicators. Diabetes mellitus, hypertension, and obesity were accounted for as major confounders of the association with SRH. DD-PSF was identified in 137 individuals, namely, 79 men (15.8%) and 58 women (10.8%). In a multivariate regression model, SRH (OR 2.95; 95% CI 1.02-8.57) and Nt-proBNP (quartile 4 vs. quartile 1 OR 4.23; 95% CI 1.74-10.26) were both independently associated with DD-PSF. Conclusions SRH, evaluated based on a descriptive question on general health, should be included in the diagnostic process of DD-PSF. In agreement with previous studies, our study confirms that Nt-proBNP is a major indicator of DD-PSF.
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7.
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8.
  • Bergh, Håkan, 1958, et al. (författare)
  • Predictive factors for long-term sick leave and disability pension among frequent and normal attenders in primary health care over 5 years.
  • 2007
  • Ingår i: Public health. - : Elsevier BV. - 0033-3506. ; 121:1, s. 25-33
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: To find predictive factors for long-term sick leave (SL) and disability pension (DP) among frequent attenders (FAs) and normal attenders (NAs) in primary health care. STUDY DESIGN: A cohort study with follow-up over 5 years. METHODS: Groups of FAs and NAs were followed over 5 years. Information about background, situation, sociodemography, life events, social support and sense of coherence were gathered at baseline. Multiple logistic regression analysis was used to determine the influence of each variable on long-term SL and receipt of a DP. RESULTS: During the study period, 18.9% of FAs received long-term SL/DP compared with 6% of NAs. Chronic disease was a predictive factor for long-term SL/DP among FAs [odds ratio (OR) 7.0] and NAs (OR 3.4). Among FAs, a life event was also a predictive factor (OR 2.1). Each additional life event increased the ratio of FAs with long-term SL/DP by 110%. Conflicts and losses had the greatest negative effects on FAs. CONCLUSIONS: FAs are a high-risk group for long-term SL/DP. Besides chronic disease, a life event was the only predictive factor for long-term SL/DP among FAs. These findings indicate that FAs are a vulnerable group for stressful events. Consequently, healthcare personnel should take more notice of life events among FAs.
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9.
  • Bräutigam Ewe, Marie, et al. (författare)
  • Characteristics of patients seeking a health promotion and weight reduction program in primary care
  • 2019
  • Ingår i: Journal of Multidisciplinary Healthcare. - Macclesfield : Dove Medical Press (Dovepress). - 1178-2390. ; 12, s. 235-242
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: An important task in primary health care (PHC) is to address lifestyle-related diseases. Overweight (OW) individuals make up a large proportion of PHC patients, and they increasingly have lifestyle-related illnesses that influence their quality of life. Structured health promotion and weight reduction programs could help these patients. The objective of this study was to explore the characteristics, lifestyle habits, and health conditions of individuals seeking a health promotion and weight reduction program in PHC.Patients and methods: The study involved a comparative cross-sectional design performed in PHC in southwestern Sweden. The study population comprised 286 participants (231 women, aged 40–65 years, body mass index [BMI] 28–35 kg/m2) who were recruited between March 2011 and April 2014 to the 2-year program by adverts in local newspapers and recruitment from three PHC centers. Two reference populations were used: a general population group and an OW group. The study population data were collected using a questionnaire, with validated questions regarding health, lifestyle, illnesses, and health care utilization.Results: People seeking a health promotion and weight reduction program were mostly women. They had a higher education level and experienced worse general health than the OW population, and they visited PHC more frequently than both reference groups. They also felt more stressed, humiliated, had more body pain, and smoked less compared to the general population. However, they did not exercise less or had a lower intake of fruits and vegetables than either reference population.Conclusion: Individuals seeking a weight reduction program were mostly women with a higher education level and a worse general health than the OW population. They used more health care services compared to the reference groups.
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10.
  • Bräutigam-Ewe, Marie, et al. (författare)
  • Characteristics of patients seeking a health promotion and weight reduction program in primary care
  • 2019
  • Ingår i: Journal of Multidisciplinary Healthcare. - 1178-2390. ; 12, s. 235-242
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: An important task in primary health care (PHC) is to address lifestyle-related diseases. Overweight (OW) individuals make up a large proportion of PHC patients, and they increasingly have lifestyle-related illnesses that influence their quality of life. Structured health promotion and weight reduction programs could help these patients. The objective of this study was to explore the characteristics, lifestyle habits, and health conditions of individuals seeking a health promotion and weight reduction program in PHC. Patients and methods: The study involved a comparative cross-sectional design performed in PHC in southwestern Sweden. The study population comprised 286 participants (231 women, aged 40-65 years, body mass index [BMI] 28-35 kg/m(2)) who were recruited between March 2011 and April 2014 to the 2-year program by adverts in local newspapers and recruitment from three PHC centers. Two reference populations were used: a general population group and an OW group. The study population data were collected using a questionnaire, with validated questions regarding health, lifestyle, illnesses, and health care utilization. Results: People seeking a health promotion and weight reduction program were mostly women. They had a higher education level and experienced worse general health than the OW population, and they visited PHC more frequently than both reference groups. They also felt more stressed, humiliated, had more body pain, and smoked less compared to the general population. However, they did not exercise less or had a lower intake of fruits and vegetables than either reference population. Conclusion: Individuals seeking a weight reduction program were mostly women with a higher education level and a worse general health than the OW population. They used more health care services compared to the reference groups.
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11.
  • Bräutigam-Ewe, Marie, et al. (författare)
  • Dietary advice on prescription: experiences with a weight reduction programme
  • 2017
  • Ingår i: Journal of Clinical Nursing. - Chichester : Wiley. - 0962-1067 .- 1365-2702. ; 26:5-6, s. 795-804
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims and objectivesTo describe overweight persons' experiences with weight reduction and participation in the dietary advice on prescription. BackgroundApproximately 20% of overweight individuals are able to successfully lose weight. Experiences from earlier weight reduction programmes indicate that those who succeed typically manage to avoid overeating to handle stress and have high motivation to lose weight. Those who fail have low self-control and engage in negative health behaviours such as eating when experiencing negative emotions and stress. DesignThe study used a descriptive qualitative design and was conducted at a Primary Health Care Centre in south-west Sweden. MethodsThe first nineteen study participants who completed the weight reduction programme in two years responded in writing to five open questions about their experiences with the programme. Data were analysed using inductive content analysis. ResultsThe participants appreciated the face-to-face meetings with the nurse because they felt seen and listened to during these sessions. They also felt their life situations and self-discipline had an impact on how well they were able to follow the programme. Dietary advice on prescription advice was considered to be helpful for achieving behavioural changes and losing weight. People who succeeded in sustainably losing weight described the importance of support from partners or close friends. ConclusionsTo achieve sustainable weight reduction, it is important to individualise the programme in order to address each person's life situation and the unique difficulties they may encounter. Relevance to clinical practiceMotivational interviewing appears to be a good technique for developing a successful relationship between the nurse and the patient. The dietary advice on prescription advice was perceived to be a good way to improve food habits and can easily be used at many Primary Health Care Centres. Patient's partners should also be offered the opportunity to participate in the programme.
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13.
  • Bräutigam-Ewe, Marie, et al. (författare)
  • Two-year weight, risk and health factor outcomes of a weight-reduction intervention programme : Primary prevention for overweight in a multicentre primary healthcare setting
  • 2020
  • Ingår i: Scandinavian Journal of Primary Health Care. - Abingdon : Taylor & Francis Group. - 0281-3432 .- 1502-7724. ; 38:2, s. 192-200
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To study the long-term effects of weight reduction, quality of life and sense of coherence in a primary health care (PHC)-based programme with two different intensities. Design: Prospective two-armed randomised intervention. Setting: Three PHC centres in south west of Sweden. Subjects: In total, 289 women and men aged 40-65 years with a BMI of 28-35 were recruited for a two-year weight-reduction programme. Participants were randomized to high-intensity or low-intensity groups. Blood samples, physical measurements and questionnaires were analysed. Participants received cookbooks and dietary lectures. The high-intensity group also received Motivational interviewing (MI), dietary advice on prescription (DAP- advice), a grocery store lecture, a website and weekly e-mails. Main outcome measures: Weight, quality of life, risks and health factors. Results: In total, 182 (64%) participants completed the 2-year follow-up. The total sample reduced their weight by 1 kg (p = 0.006). No significant differences regarding weight were found between the groups. Anxiety/depression decreased in EQ5-D (p = 0.021), EQ5-D VAS (p = 0.002) and SOC (p = 0.042). Between the groups, there were significant differences in EQ5-D usual activities (p = 0.004), anxiety/depression (p = 0.013), pain/discomfort (p = 0.041), fruit and vegetables (p = 0.005), HLV anxiety (p = 0.005), and visits to nurses (p = 0.012). Conclusion: The total population lost weight, and the high-intensity and low-intensity programmes did not result in significant differences in terms of weight. The high-intensity programme reported health benefits linked to lower levels of anxiety and depression, increased activity and intake of greens and reduced visits to physicians and nurses.Key points Both groups had a consisting weight- reduction after two years. High intensity did not lead to a significant difference in weight reduction between the groups. The high-intensity group reported more health effects, such as better quality of life, reduced anxiety, and increased greenery intake. It is unknown how much support patients in a weight- reduction programme in PHC require to succeed with weight loss and a healthy lifestyle. © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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14.
  • Cassinger, Cecilia, et al. (författare)
  • Geographies of fear – communicating safety in urban destinations
  • 2019
  • Konferensbidrag (refereegranskat)abstract
    • Countering fear and promoting experiences of security and safety among visitors are key issues in creating socially sustainable urban destinations. Security branding is a growing place branding paradigm through which to enhance experiences and perceptions of safety in cities, nations and regions (Coaffee and Van Ham, 2008; Coaffee and Rogers, 2008; Avraham and Ketter, 2008). This paper discusses how brand communication can be incorporated in urban policy and planning to accomplish socially sustainable city centres. Our focus is on relation between the mediatisation of cities and perceptions and experiences of safety among domestic and international visitors. Recent terror attacks, political unrest, and violent conflicts in many European countries are highly mediatised events (Couldry and Hepp, 2018) that influence images of urban destinations, which are particularly vulnerable to rumours and images circulating in media (Avraham, 2009; Avraham and Ketter, 2008). The study focuses on 10 Swedish urban destinations. Sweden is an interesting case in point due to high levels of media coverage, which is characterised by polarised narratives concerning the country as a utopia respectively dystopia (see e.g. Rapacioli, 2018). The research questions we seek to answer concern 1) how perceptions of safety are influenced by the image of Sweden conveyed on online news and social media (Instagram and Twitter) platforms, and 2) the relation between visitors’ overall image of the destinations and their experiences of safety. The research questions are addressed by a mixed methods approach using survey methods and media analysis to capture the role of place image for visitors’ perceptions and experiences of safety. The findings demonstrate that the mediatisation of the country of Sweden follows narratives of safety respectively unsafety, which influence the way Swedish cities are perceived. Furthermore, findings indicate a correlation between positive city image and high levels of perceived safety among visitors. The paper discusses these findings in relation to social sustainability and proposes communicative strategies to handle and counter fears in urban destinations. References Avraham, E. and Ketter, E. (2008), “Will we be safe there? Analysing strategies for altering unsafe place images”, Place Branding and Public Diplomacy, Vol. 4 No. 3, pp. 196-204. Avraham, E. (2009), “Marketing and managing nation branding during prolonged crisis: The case of Israel”, Place Branding and Public Diplomacy, Vol. 5 No. 3, pp. 202-212. Coaffee, J., & Rogers, P. (2008), “Reputational risk and resiliency: The branding of security in place-making”, Place Branding and Public Diplomacy, Vol. 4 No. 3, pp. 205-217. Coaffee, J., & Van Ham, P. (2008), “‘Security branding’: The role of security in marketing the city, region or state”, Place Branding and Public Diplomacy, Vol. 4 No. 3, pp. 191-195. Couldry, N. and Hepp, A. (2018), “The continuing lure of the mediated centre in times of deep mediatization: Media Events and its enduring legacy”, Media, Culture & Society, Vol. 40 No. 1, pp. 114–117. Rapacioli, P. (2018), Good Sweden, Bad Sweden: The use and abuse of Swedish values in a post-truth world. Stockholm: Volante.
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15.
  • Cassinger, Cecilia, et al. (författare)
  • Geographies of fear – visitors’ perceptions of safety in urban destinations
  • 2019
  • Konferensbidrag (refereegranskat)abstract
    • Countering fear and promoting experiences of security and safety among visitors are key issues in creating socially sustainable urban destinations. Security branding is a growing place branding paradigm through which to enhance experiences and perceptions of safety in cities, nations and regions (Coaffee and Van Ham, 2008; Coaffee and Rogers, 2008; Avraham and Ketter, 2008). This paper discusses how brand communication can be incorporated in urban policy and planning to accomplish socially sustainable city centres. Our focus is on relation between the mediatisation of cities and perceptions and experiences of safety among domestic and international visitors. Recent terror attacks, political unrest, and violent conflicts in many European countries are highly mediatised events (Couldry and Hepp, 2018) that influence images of urban destinations, which are particularly vulnerable to rumours and images circulating in media (Avraham, 2009; Avraham and Ketter, 2008). The study focuses on 10 Swedish urban destinations. Sweden is an interesting case in point due to high levels of media coverage, which is characterised by polarised narratives concerning the country as a utopia respectively dystopia (see e.g. Rapacioli, 2018). The research questions we seek to answer concern 1) how perceptions of safety are influenced by the image of Sweden conveyed on online news and social media (Instagram and Twitter) platforms, and 2) the relation between visitors’ overall image of the destinations and their experiences of safety. The research questions are addressed by a mixed methods approach using survey methods and media analysis to capture the role of place image for visitors’ perceptions and experiences of safety. The findings demonstrate that the mediatisation of the country of Sweden follows narratives of safety respectively unsafety, which influence the way Swedish cities are perceived. Furthermore, findings indicate a correlation between positive city image and high levels of perceived safety among visitors. The paper discusses these findings in relation to social sustainability and proposes communicative strategies to handle and counter fears in urban destinations. Keywords: place image, urban destinations, branding security, social sustainability, mediatisation References Avraham, E. and Ketter, E. (2008), “Will we be safe there? Analysing strategies for altering unsafe place images”, Place Branding and Public Diplomacy, Vol. 4 No. 3, pp. 196-204. Avraham, E. (2009), “Marketing and managing nation branding during prolonged crisis: The case of Israel”, Place Branding and Public Diplomacy, Vol. 5 No. 3, pp. 202-212. Coaffee, J., & Rogers, P. (2008). “Reputational risk and resiliency: The branding of security in placemaking”, Place Branding and Public Diplomacy, Vol. 4 No. 3, pp. 205-217. Coaffee, J., & Van Ham, P. (2008). “‘Security branding’: The role of security in marketing the city, region or state”, Place Branding and Public Diplomacy, Vol. 4 No. 3, pp. 191-195. Couldry, N. and Hepp, A. (2018), “The continuing lure of the mediated centre in times of deep mediatization: Media Events and its enduring legacy”, Media, Culture & Society, Vol. 40 No. 1, pp. 114–117. Rapacioli, P. (2018), Good Sweden, Bad Sweden: The use and abuse of Swedish values in a posttruth world. Stockholm: Volante.
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16.
  • Cassinger, Cecilia, et al. (författare)
  • Mediatization of terror attacks and city brand image: A study of the Stockholm attack and the ’Last Night in Sweden’ event
  • 2018
  • Konferensbidrag (refereegranskat)abstract
    • There is a growing interest within place branding research for how experiences of safety influence the image of the city (e.g. Coaffee and Van Ham, 2008).Previous research demonstrates that fear is socially constructed and amplified by mass media (Avraham and Ketter, 2008) and social media (Doosti et al., 2016; Jansson, 2018). The realm of media has become more complex in an era characterised as posttruth in which ”objective facts are less influential in shaping public opinion than appeals to emotion and personal belief” (Oxford Dictionaries, 2016).The research aim in this paper is to examine the mechanisms of how terror attacks in urban environments are mediatized and the consequences for city image. The paper analyses two instances of terror in two Swedish cities as media events (Couldry and Hepp, 2018). The first instance concern the deadly terror attack in Stockholm, 2017, whereas the second instance refer to Donald Trump’s statement of a false terror attack in Malmo. Lefebvre’s (2004) rhythmanalysis approach is adopted to investigate rhythms of Twitter and online news flows. The study demonstrates that the mediatization of the rumored attack in Malmo had greater impact on city image than the actual one. At the time of the event, Malmo city suffered from a negative image, which made the city vulnerable to extremist and populist media narratives. The celebrity status ofTrump and circulation of exaggerated news about Sweden also created much negative publicity and attention. The ambiguity around what had happened open up aspace in which fantasies and conspiracy theories could grow. Real and imaginary elements were woven together in an almost phantasmal way. By contrast, in the Stockholm case there was no ambiguity with regards to the attack and the image of the city was relatively quickly restored.
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17.
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18.
  • Cassinger, Cecilia, et al. (författare)
  • The mediatized tourism city under terror: Dilemmas and strategies for destination management organisations
  • 2018
  • Konferensbidrag (refereegranskat)abstract
    • The concern of this paper is with the mediatisation of tourism cities through fast circulating narratives on digital platforms in an era characterised as post-truth involving the spread of fake news and disinformation. Hence far, there is scarce knowledge on how misleading information and false rumours concerning terrorism affect the image of tourism cities. In addition, extant research studies predominately concern image in destinations, which are in a permanent state of crisis or war. Less is known of cities that are randomly subjected to terrorist attacks. The research aim in the paper is therefore to advance the knowledge of the narrative rhythm of the mediatized destination in the aftermath of an actual terror attack in contrast to a false one. A mixed-methods approach is used to examine the event trend of online search traffic, Twitter data, and news in the aftermath of the Stockholm terror attack, and President Trump’s misleading claim of a non-existing terror attack in the city of Malmö in Sweden during 2015. Emerging narratives in different stages of the course of these events were identified and analysed. In the false case a broad range of stories emerged quickly which tried to establish a dominant narrative of the city. Whereas in the real case, the emerging narratives are more condensed and related to the event. The study contributes with novel knowledge on the role played by disinformation in the mediatisation of cities. The study raises questions to the need and importance for destination management organisations to handle and respond to disinformation in false events.
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19.
  • Cassinger, Cecilia, et al. (författare)
  • The narrative rhythm of terror: : A study of the Stockholm terrorist attack and the 'Last Night in Sweden' event
  • 2018
  • Ingår i: International Journal of Tourism Cities. - 2056-5607. ; 4:4, s. 484-494
  • Tidskriftsartikel (refereegranskat)abstract
    • PurposeThe purpose of this paper is to examine how the mediatisation of terror attacks affects the brand image of tourism cities.Design/methodology/approachInformed by theories of mediatisation and space, the study analyses two different types of terror attacks in Sweden during 2017 as media events. The focus of analysis is on identifying spatial and temporal patterns that underpin the narrative rhythm of the discussions of the events on Twitter and online news platforms.FindingsThe findings demonstrate that the unfolding of the events can be divided into three phases of varying intensity in rhythm and implications for city brand image. The manifestation of an imaginary terror attack in a digital environment had a greater impact on the narratives of the city than an actual one.Research limitations/implicationsRythmanalysis is introduced as a useful device to examine how urban space is mediatised through social media and online news flows.Originality/valueThe study contributes with novel knowledge on the mediatisation of city space on digital media platforms in a post-truth world. It shows that city administrations need to deal with both real and imaginary terror attacks, especially when there is an already established negative image of the city.
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20.
  • Costache, Madalina Elena, et al. (författare)
  • Higher- and lower-order personality traits and cluster subtypes in social anxiety disorder
  • 2020
  • Ingår i: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 15:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Social anxiety disorder (SAD) can come in different forms, presenting problems for diagnostic classification. Here, we examined personality traits in a large sample of patients (N = 265) diagnosed with SAD in comparison to healthy controls (N = 164) by use of the Revised NEO Personality Inventory (NEO-PI-R) and Karolinska Scales of Personality (KSP). In addition, we identified subtypes of SAD based on cluster analysis of the NEO-PI-R Big Five personality dimensions. Significant group differences in personality traits between patients and controls were noted on all Big Five dimensions except agreeableness. Group differences were further noted on most lower-order facets of NEO-PI-R, and nearly all KSP variables. A logistic regression analysis showed, however, that only neuroticism and extraversion remained significant independent predictors of patient/control group when controlling for the effects of the other Big Five dimensions. Also, only neuroticism and extraversion yielded large effect sizes when SAD patients were compared to Swedish normative data for the NEO-PI-R. A two-step cluster analysis resulted in three separate clusters labelled Prototypical (33%), Introvert-Conscientious (29%), and Instable-Open (38%) SAD. Individuals in the Prototypical cluster deviated most on the Big Five dimensions and they were at the most severe end in profile analyses of social anxiety, self-rated fear during public speaking, trait anxiety, and anxiety-related KSP variables. While additional studies are needed to determine if personality subtypes in SAD differ in etiological and treatment-related factors, the present results demonstrate considerable personality heterogeneity in socially anxious individuals, further underscoring that SAD is a multidimensional disorder.
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21.
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22.
  • Eksell, Jörgen, et al. (författare)
  • Exploring the constitution of resilience in places : a media place approach to tourism studies
  • Ingår i: Tourism Culture & Communication. - 1098-304X.
  • Tidskriftsartikel (refereegranskat)abstract
    • Resilience in tourism studies has mainly departed from a socio-ecological system-theory approach and has developed knowledge in relation to different tourism contexts. This approach has consequences for the conceptualization of resilience and sets limits. Calls for theory development on resilience see a need to take account of, for instance, politics and power relations, and conflicts over resources. As a response to this call, this conceptual article discusses the ontological underpinnings of resilience in tourism studies from an interdisciplinary approach and argues for a media place approach to resilience. From a general socio-ecological system approach a tourist place is ontologically constituted as a subject with clear boundaries even if it has interactions, relations and dependencies. The tourism place is therefore constituted as a fixed entity in its essence, even if equilibriums can be positioned differently. However, tourism resilience is a complex issue that calls for additional perspectives. The proposed interdisciplinary media place approach follows changes and dependencies between mediatization of tourism places and changes in the resilience of tourism places. The role of mediatization and its significance for changes in places are put at the centre of the analysis. The approach assumes that a tourist place is constituted as a verb that is constantly created and recreated in a process. Additionally, resilience in places must also be conceptualised ontologically as a fluid concept that evolves over time. In order to understand sudden and long term changes in tourism place resilience, special attention must be given to nodes or flows of information that connect the media systems and constitute places. Further, the articles conclude that resilience is molded by the politics of media practices. An interdisciplinary approach brings new answers to complex questions that cannot be solved from a single disciplinary perspective.
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23.
  • Eksell, Jörgen, et al. (författare)
  • Framtidens möten
  • 2024
  • Rapport (populärvet., debatt m.m.)abstract
    • The Future of Meetings is about new business models, interaction, and communication in the meetings industry. The report examines how the pandemic has affected it and whether the crisis has brought new opportunities.It focuses on changes in the industry's value proposition, how guests in physical, hybrid and digital meetings and conferences interact and the role of hosting and hospitality in these. A good meeting is of great importance for the development of society.in addition, the report contains interviews with Annika Hallman, Head of Meetings, Göteborg & Co and Göteborg Convention Bureau, and Krister Andersson, CEO Umeå Congress.
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24.
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25.
  • Eksell, Jörgen, et al. (författare)
  • Place-making of resilience in urban regions in the aftermath of Covid-19
  • 2021
  • Konferensbidrag (refereegranskat)abstract
    • The Covid-19 pandemic has fundamentally changed travel patterns to and in major urban regions. Destinations have seen a dramatic shift from overtourism to undertourism. This has led to new challenges for regional destination management organisations (DMOs) as tourists and residents seek green areas in cities and visit adjacent natural reserves. Therefore this research explores how the Covid-19 pandemic has reconceptualised the relationship between the urban and rural in densely populated regions. In particular the paper discusses the relationship between media narratives, tourism flows, and place-making, and the implications for resilience in urban regions.This paper departs from theories of geography of communication (GoC). Media and communication scholars have this far been largely absent from resilience theorising and research (Houston et al., 2015). GoC explores the interconnectedness of media and space and has evolved as a result of the spatial turn (see Warf & Arias, 2009; Adams & Jansson, 2012). In addition, this paper introduces place-making of tourists, i.e. the organic and unplanned behaviour and actions of individuals (Lew, 2017) to further emphasize the consequences for resilience in regions. Place-making is generally separated from placemaking which imply a top-down plan and design of places reflecting norms and political structures of the community (Lew, 2017).The data consists of interviews with relevant stakeholders (DMO representatives and managers of nature reserves and tourist attractions) and online news media texts on the region Scania, Sweden. The region offers cities such as Malmoe and Lund, small towns and rural landscapes with a large number of national parks and reserves. A paradigmatic analysis of narratives that locate common themes or conceptual manifestations was conducted on the collected data (cf. Polkinghorne 1995). The reason is that narratives turn information and events into something that seems to be naturally occurring and meaningful to those encountering the narratives. The analysis reveals an intimate relationship between resilience in places and media narratives, and how the latter transform both conceptions of urban and rural places and place-making. During the pandemic, green and rural areas as well as natural reserves are contrived as places of physical distance. The latter is commonly understood as safe places and in consequence, new tourist groups have travelled to these areas. Tourists have performed place-making such as hiking and cycling on trails, but also set up fires in undesignated areas, and littered in reserves. To cope with the surge of tourists, site management of reserves has introduced new placemaking regimes such as parking services etc. The pandemic has changed the place-making of tourists, which in turn has affected the resilience of the places. The study points to a need for regional DMOs to not only develop placemaking in these areas, but also develop a GoC approach to place-making of tourists. The GoC-perspective advances an interdisciplinary approach to resilience in places that reveals how both place-making and the constitution of resilience in tourism places are molded by the politics by media and communication practices of a number of stakeholders.ReferencesAdams, P. C. & Jansson, A. (2012) Communication Geography: A Bridge Between Disciplines. Communication Theory, 22(3), 299–318.Berbés-Blázquez, M. & Scott, D. (2017) The Development of Resilience Thinking. In Butler, R. W. (Ed.), Tourism and resilience: 9-22. Allingford, Oxfordshire: CABI. Butler, R. (Ed) (2017) Tourism and resilience. Allingford: CABI. Houston, J. B., Spialek, m. L., Cox, J., Greenwood, M. M., & First, J. (2015). The Centrality of Communication and Media in Fostering Community Resilience: A Framework for Assessment and Intervention, American Behavioural Scientist, 59 (2): 270-283Lew A. A. (2017). Tourism planning and place making: place-making or placemaking? Tourism Geographies. 2017;19(3):448-466. Warf, B. & Arias, S. (2009). The Reinsertion of space in social sciences and humanities. In B.Warf, & S. Arias (Eds). The spatial turn: interdisciplinary perspectives: 1-10. London: Routledge.
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26.
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27.
  • Eksell, Jörgen, et al. (författare)
  • Semester på hemmaplan? Personer med utländsk bakgrunds resvanor och turismkonsumtion i Sverige.
  • 2022
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Sweden is a multicultural country in which about 20 percent of the population has a foreign background. People who belong to different population groups live here and have diverse cultural backgrounds and lifestyles. This means that the Swedish tourism and hospitality industry today communicates with a very diversified Swedish target group.This report, which is the result of a commissioned research project for Visit Sweden, is thus aimed at you who want to understand this growing target group. The study sheds light on Swedes with a foreign background in tourism consumption in Sweden by examining the segment's knowledge of Swedish destinations, sources for travel inspiration, travel reasons and obstacles to vacationing more in Sweden. The study shows that the foreign background is less important for tourism consumption compared with socioeconomics, level of education and establishment in the labor market. However, the segment is very heterogeneous and that there are few reasons to treat people with this background as a segment. Therefore, the report offers nuances about the segment people with foreign background, rather than general conclusions. The report also contributes with increased knowledge of how the Swedish tourism and hospitality industry can form offers to this target group. Inclusive communication is presented at one of several paths to improve communication, with swedes with foreign background.
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28.
  • Eksell, Jörgen, et al. (författare)
  • The communication for resilience of urban destinations during the COVID-19 pandemic.
  • 2022
  • Konferensbidrag (refereegranskat)abstract
    • This paper explores how urban Destination Management Organisations (DMOs) in Sweden, have understood their communicative role, developed communicative strategies and tactics during the COVID-19 pandemic. The overall aim of this research is to develop understanding of the role of communication strategies for developing urban destination resilience. This study is conducted in collaboration with the Swedish network of destination management organisations (SNDMO) in a research project financed by the Swedish Agency for Economic and Regional Growth (2021-2022). 40 semi-structured interviews with members of SNDMO were performed. The results show that in order to deal with the difficult situation many new stakeholder collaborations have started. An obstacle is the complexity that comes with stakeholder communication that includes several actors. The communicative role of the DMOS has expanded during the pandemic. The communicative strategies and tactics that evolved during the crisis are characterised by handling a number of contradictions and dilemmas. The results indicate the success of the DMO is dependent on its ability to be proactive, adapt to a constantly changing environment, and use established networks for communication work. This project increases the understanding of communicative strategies employed for urban resilience that emerges in complex interactions between stakeholders and the communicative role of DMOs in extraordinary situations.
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29.
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30.
  • Ewing, Marcela, 1960, et al. (författare)
  • Diagnostic profile characteristics of cancer patients with frequent consultations in primary care before diagnosis: a case control study
  • 2018
  • Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 35:5, s. 559-566
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. Many patients with common cancers are late diagnosed. Objectives. Identify consultation profiles and clinical features in patients with the seven most common cancers, who had consulted a general practitioner (GP) frequently before their cancer diagnosis. Methods. A case-control study was conducted in Region Vastra Gotaland, Sweden. A total of 2570 patients, diagnosed in 2011 with prostate, breast, colorectal, lung, gynaecological and skin cancers including malignant melanoma, and 9424 controls were selected from the Swedish Cancer Register and a regional health care database. Diagnostic codes [International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10)] from primary care for patients with >= 4 GP consultations registered in the year before cancer diagnosis were collected. Likelihood ratios (LRs) were calculated for variables associated with the different cancers. Results. Fifty-six percent of the patients had consulted a GP four or more times in the year before cancer diagnosis. Alarm symptoms or signs represented 60% of the codes with the highest LR, but only 40% of the 10 most prevalent codes. Breast lump had the highest LR, 11.9 [95% confidence interval (CI) 8.0-17.8]; abnormalities of plasma proteins had an LR of 5.0 (95% CI 3.0-8.2) and abnormal serum enzyme levels had an LR of 4.6 (95% CI 3.6-5.9). Early clinical features associated with cancer had been registered already at the first two GP consultations. Conclusion. One out of six clinical features associated with cancer were presented by cancer patients with four or more pre-referral consultations already at the two first consultations. These early clinical features that were focal and had benign characteristics might have been missed diagnostic opportunities.
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31.
  • Ewing, Marcela, 1960, et al. (författare)
  • Identification of patients with non-metastatic colorectal cancer in primary care: a case-control study.
  • 2016
  • Ingår i: The British journal of general practice : the journal of the Royal College of General Practitioners. - 1478-5242. ; 66:653
  • Tidskriftsartikel (refereegranskat)abstract
    • Colorectal cancer is the third most common cancer worldwide and second most common in Europe. Despite screening, it is often diagnosed at an unfavourable stage.To identify and quantify features of non-metastatic colorectal cancer in primary care to enable earlier diagnosis by GPs.A case-control study was conducted using diagnostic codes from national and regional healthcare databases in Sweden.A total of 542 patients diagnosed with non-metastatic colorectal cancer in 2011 and 2139 matched controls were selected from the Swedish Cancer Register (SCR) and a regional healthcare database respectively. All diagnostic codes (according to ICD-10) from primary care consultations registered the year before the date of cancer diagnosis (according to the SCR) were collected from the regional database. Odds ratios were calculated for variables independently associated with non-metastatic colorectal cancer using multivariable conditional logistic regressions. Positive predictive values (PPVs) of these variables were calculated, both individually and in combination with each other.Five features were associated with colorectal cancer before diagnosis: bleeding, including rectal bleeding, melaena, and gastrointestinal bleeding (PPV 3.9%, 95% confidence interval [CI] = 2.3 to 6.3); anaemia (PPV 1.4%, 95% CI = 1.1 to 1.8); change in bowel habit (PPV 1.1%, 95% CI = 0.9 to 1.5; abdominal pain (PPV 0.9%, 95% CI = 0.7 to 1.1); and weight loss (PPV 1.0%, 95% CI = 0.3 to 3.0); all P-value <0.05. The combination of bleeding and change in bowel habit had a PPV of 13.7% (95% CI = 2.1 to 54.4); for bleeding combined with abdominal pain this was 12.2% (95% CI = 1.8 to 51.2). A risk assessment tool for non-metastatic colorectal cancer was designed.Bleeding combined with either diarrhoea, constipation, change in bowel habit, or abdominal pain are the most powerful predictors of non-metastatic colorectal cancer and should result in prompt referral for colorectal investigation.
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32.
  • Ewing, Marcela, 1960, et al. (författare)
  • Increased consultation frequency in primary care, a risk marker for cancer: a case-control study
  • 2016
  • Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 34:2, s. 205-212
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To identify early diagnostic profiles such as diagnostic codes and consultation patterns of cancer patients in primary care one year prior to cancer diagnosis. Design: Total population-based case–control study. Setting and subjects: 4562 cancer patients and 17,979 controls matched by age, sex, and primary care unit. Data were collected from the Swedish Cancer Register and the Regional Healthcare Database. Method: We identified cancer patients in the Västra Götaland Region of Sweden diagnosed in 2011 with prostate, breast, colorectal, lung, gynaecological, and skin cancers including malignant melanoma. We studied the symptoms and diagnoses identified by diagnostic codes during a diagnostic interval of 12 months before the cancer diagnosis. Main outcome measures: Consultation frequency, symptom density by cancer type, prevalence and odds ratios (OR) for the diagnostic codes in the cancer population as a whole. Results: The diagnostic codes with the highest OR were unspecified lump in breast, neoplasm of uncertain behaviour, and abnormal serum enzyme levels. The codes with the highest prevalence were hyperplasia of prostate, other skin changes and abdominal and pelvic pain. The frequency of diagnostic codes and consultations in primary care rose in tandem 50 days before diagnosis for breast and gynaecological cancer, 60 days for malignant melanoma and skin cancer, 80 days for prostate cancer and 100 days for colorectal and lung cancer. Conclusion: Eighty-seven percent of patients with the most common cancers consulted a general practitioner (GP) a year before their diagnosis. An increase in consultation frequency and presentation of any symptom should raise the GP’s suspicion of cancer. Key points Knowledge about the prevalence of early symptoms and other clinical signs in cancer patients in primary care remains insufficient. •Eighty-seven percent of the patients with the seven most common cancers consulted a general practitioner 12 months prior to cancer diagnosis. •Both the frequency of consultation and the number of symptoms and diseases expressed in diagnostic codes rose in tandem 50–100 days before the cancer diagnosis. •Unless it is caused by a previously known disease, an increased consultation rate for any symptom should result in a swift investigation or referral from primary care to confirm or exclude cancer.
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33.
  • Helgesson, Östen, 1957, et al. (författare)
  • Quality of life in cancer survivors as observed in a population study of Swedish women
  • 2007
  • Ingår i: Scandinavian Journal of Primary HealthCare. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 25:4, s. 220-5
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To investigate quality of life, measured by the SF-36 scales, in a population-based sample of women who have survived cancer at any site and, specifically, breast cancer. Design. A representative cohort of women was observed over 24 years with regard to cancer prevalence, incidence, and quality of life. Setting. Gothenburg, Sweden. Subjects. A total of 1462 women aged 38-60 years at baseline. Main outcome measures. Differences in quality of life between cancer survivors and cancer-free controls measured by the SF-36 Short Form Health Survey, with adjustment for age and additionally for social status, and history of major disease (diabetes, stroke, and myocardial infarction) at follow-up in 1992-93. Results. In women who had survived cancer, a lower feeling of general health was the only score found to be significantly associated with having had cancer. Similar analysis was conducted separately for breast cancer cases. Survivors of breast cancer reported lower vitality and when controlled for major disease also lower general health compared with women who had not had cancer. All other results were independent when adjusted for social status, and also for history of major disease. Conclusions. Women who have survived cancer report lowered general health, and breast cancer cases lowered vitality, but considering the non-significant results for the other scores and summary scales it can be concluded that the well-being of women who have survived a cancer on the whole did not differ profoundly from that of other women.
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34.
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35.
  • Holtedahl, Knut, et al. (författare)
  • Abdominal symptoms and cancer in the Abdomen : Prospective cohort study in European primary care
  • 2018
  • Ingår i: British Journal of General Practice. - : ROYAL COLL GENERAL PRACTITIONERS. - 0960-1643 .- 1478-5242. ; 68:670, s. 301-310
  • Forskningsöversikt (refereegranskat)abstract
    • Background: Different abdominal symptoms may signal cancer, but their role is unclear. Aim: To examine associations between abdominal symptoms and subsequent cancer diagnosed in the abdominal region. Design and setting: Prospective cohort study comprising 493 GPs from surgeries in Norway, Denmark, Sweden, Scotland, Belgium, and the Netherlands. Method: Over a 10-day period, the GPs recorded consecutive consultations and noted: patients who presented with abdominal symptoms pre-specified on the registration form; additional data on non-specific symptoms; and features of the consultation. Eight months later, data on all cancer diagnoses among all study patients in the participating general practices were requested from the GPs. Results: Consultations with 61 802 patients were recorded and abdominal symptoms were documented in 6264 (10.1%) patients. Malignancy, both abdominal and non-abdominal, was subsequently diagnosed in 511 patients (0.8%). Among patients with a new cancer in the abdomen (n = 251), 175 (69.7%) were diagnosed within 180 days after consultation. In a multivariate model, the highest sex- and age-adjusted hazard ratio (HR) was for the single symptom of rectal bleeding (HR 19.1, 95% confidence interval = 8.7 to 41.7). Positive predictive values of >3% were found for macroscopic haematuria, rectal bleeding, and involuntary weight loss, with variations according to age and sex. The three symptoms relating to irregular bleeding had particularly high specificity in terms of colorectal, uterine, and bladder cancer. Conclusions: A patient with undiagnosed cancer may present with symptoms or no symptoms. Irregular bleeding must always be explained. Abdominal pain occurs with all types of abdominal cancer and several symptoms may signal colorectal cancer. The findings are important as they influence how GPs think and act, and how they can contribute to an earlier diagnosis of cancer.
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36.
  • Holtedahl, K., et al. (författare)
  • Abdominal symptoms in general practice: Frequency, cancer suspicions raised, and actions taken by GPs in six European countries. Cohort study with prospective registration of cancer
  • 2017
  • Ingår i: Heliyon. - : Elsevier BV. - 2405-8440. ; 3:6
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Abdominal symptoms are diagnostically challenging to general practitioners (GPs): although common, they may indicate cancer. In a prospective cohort of patients, we examined abdominal symptom frequency, initial diagnostic suspicion, and actions of GPs in response to abdominal symptoms. Methods Over a 10-day period, 493 GPs in Norway, Denmark, Sweden, Belgium, the Netherlands, and Scotland, recorded consecutive consultations: sex, date of birth and any specified abdominal symptoms. For patients with abdominal symptoms, additional data on non-specific symptoms, GPs’ diagnostic suspicion, and features of the consultation were noted. Data on all cancer diagnoses among all included patients were requested from the GPs eight months later. Findings Consultations with 61802 patients were recorded. Abdominal symptoms were recorded in 6264 (10.1%) patients. A subsequent malignancy was reported in 511 patients (0.8%): 441 (86.3%) had a new cancer, 70 (13.7%) a recurrent cancer. Abdominal symptoms were noted in 129 (25.2%) of cancer patients (P < 0.001), rising to 34.5% for the 89 patients with cancer located in the abdominal region. PPV for any cancer given any abdominal symptom was 2.1%. In symptomatic patients diagnosed with cancer, GPs noted a suspicion of cancer for 85 (65.9%) versus 1895 (30.9%) when there was no subsequent cancer (P < 0.001). No suspicion was noted in 32 (24.8%) cancer patients. The GP's intuitive cancer suspicion was independently associated with a subsequent new cancer diagnosis (OR 2.11, 95% CI 1.15–3.89). Laboratory tests were ordered for 45.4% of symptomatic patients, imaging for 10.4%, referral or hospitalization for 20.0%: all were more frequent in subsequent cancer patients (P < 0.001). Interpretation Abdominal symptoms pointed to abdominal cancers rather than to other cancers. However, the finding of abdominal symptoms in only one third of patients with an abdominal cancer, and the lack of cancer suspicion in a quarter of symptomatic cancer patients, provide challenges for GPs’ diagnostic thinking and referral practices. © 2017 The Authors
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37.
  • Holtedahl, K., et al. (författare)
  • Symptoms and signs of colorectal cancer, with differences between proximal and distal colon cancer: a prospective cohort study of diagnostic accuracy in primary care
  • 2021
  • Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 22:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: In an abdominal symptom study in primary care in six European countries, 511 cases of cancer were recorded prospectively among 61,802 patients 16years and older in Norway, Denmark, Sweden, Netherlands, Belgium and Scotland. Colorectal cancer is one of the main types of cancer associated with abdominal symptoms; hence, an in-depth subgroup analysis of the 94 colorectal cancers was carried out in order to study variation in symptom presentation among cancers in different anatomical locations. Method: Initial data capture was by completion of standardised forms containing closed questions about symptoms recorded during the consultation. Follow-up data were provided by the GP after diagnosis, based on medical record data made after the consultation. GPs also provided free text comments about the diagnostic procedure for individual patients. Fisher’s exact test was used to analyse differences between groups. Results: Almost all symptoms recorded could indicate colorectal cancer. ‘Rectal bleeding’ had a specificity of 99.4% and a PPV of 4.0%. Faecal occult blood in stool (FOBT) or anaemia may indicate gastrointestinal bleeding: when these symptoms and signs were combined, sensitivity reached 57.5%, with 69.2% for cancer in the distal colon. For proximal colon cancers, none of 18 patients had ‘Rectal bleeding’ at the initial consultation, but three of the 18 did so at a later consultation. ‘Abdominal pain, lower part’, ‘Constipation’ and ‘Distended abdomen, bloating’ were less specific and also less sensitive than ‘Rectal bleeding’, and with PPV between 0.7% and 1.9%. Conclusions: Apart from rectal bleeding, single symptoms did not reach the PPV 3% NICE threshold. However, supplementary information such as a positive FOBT or persistent symptoms may revise the PPV upwards. If a colorectal cancer is suspected by the GP despite few symptoms, the total clinical picture may still reach the NICE PPV threshold of 3% and justify a specific referral. © 2021, The Author(s).
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38.
  • Holtedahl, Knut, et al. (författare)
  • Symptoms and signs of urogenital cancer in primary care
  • 2023
  • Ingår i: BMC primary care. - : BMC. - 2731-4553. ; 24:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Urogenital cancers are common, accounting for approximately 20% of cancer incidence globally. Cancers belonging to the same organ system often present with similar symptoms, making initial management challenging. In this study, 511 cases of cancer were recorded after the date of consultation among 61,802 randomly selected patients presenting in primary care in six European countries: a subgroup analysis of urogenital cancers was carried out in order to study variation in symptom presentation. METHODS: Initial data capture was by completion of standardised forms containing closed questions about symptoms recorded during the consultation. The general practitioner (GP) provided follow-up data after diagnosis, based on medical record data made after the consultation. GPs also provided free text comments about the diagnostic procedure for individual patients. RESULTS: The most common symptoms were mainly associated with one or two specific types of cancer: 'Macroscopic haematuria' with bladder or renal cancer (combined sensitivity 28.3%), 'Increased urinary frequency' with bladder (sensitivity 13.3%) or prostatic (sensitivity 32.1%) cancer, or to uterine body (sensitivity 14.3%) cancer, 'Unexpected genital bleeding' with uterine cancer (cervix, sensitivity 20.0%, uterine body, sensitivity 71.4%). 'Distended abdomen, bloating' had sensitivity 62.5% (based on eight cases of ovarian cancer). In ovarian cancer, increased abdominal circumference and a palpable tumour also were important diagnostic elements. Specificity for 'Macroscopic haematuria' was 99.8% (99.7-99.8). PPV>3% was noted for 'Macroscopic haematuria' and bladder or renal cancer combined, for bladder cancer in male patients. In males aged 55-74, PPV=7.1% for 'Macroscopic haematuria' and bladder cancer. Abdominal pain was an infrequent symptom in urogenital cancers. CONCLUSIONS: Most types of urogenital cancer present with rather specific symptoms. If the GP considers ovarian cancer, increased abdominal circumference should be actively determined. Several cases were clarified through the GP's clinical examination, or laboratory investigations.
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39.
  • Högberg, Cecilia, 1953- (författare)
  • Diagnosing colorectal cancer in primary care : the value of symptoms, faecal immunochemical tests, faecal calprotectin and anaemia
  • 2017
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Colorectal cancer (CRC) is the third most common cancer in men and the second most common in women worldwide. Adenomas can be precursors to CRC, and inflammatory bowel disease (IBD) can present with the same symptoms as CRC. The majority of patients with CRC initially consult primary care. Symptoms associated with CRC are also common among primary care patients, but seldom caused by any significant disease. Reliable diagnostic aids would be helpful in deciding which patients to refer. Faecal immunochemical tests (FITs) are commonly used for this purpose in primary care in Sweden, but there is little evidence to support this use. Faecal calprotectin (FC) has been suggested as an additional test.Aim: To explore how doctors in primary care investigate patients with suspected CRC, the value of FITs, symptoms and presence of anaemia in diagnosing CRC and adenomas in primary care, and whether FC tests could contribute to diagnosis.Methods: Three studies (1-3) were carried out in Region Jämtland Härjedalen, Sweden. There was no screening programme for CRC. We used a point of care qualitative dip-stick 3-sample FIT with a cut-off of 25-50μg haemoglobin/g faeces, and a calprotectin enzyme-linked immunosorbent assay (ELISA) test with a cut-off of 100 μg/g faeces. 1: A retrospective, population-based study including all patients diagnosed with CRC or adenomas with high-grade dysplasia (HGD) during the period 2005-2009 that initially consulted primary care. Symptoms, FIT results, anaemia and time to diagnosis were retrieved from medical records. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated from FIT results at the region’s health centres 2008- 2009. (Paper I.) 2: A prospective cohort study including consecutive patients where primary care doctors requested FITs and/or FC tests, at four health centres, from 30 Jan 2013 to 31 May 2014. FITs, FC tests, haemoglobin and iron deficiency tests were analysed; patients and doctors answered questionnaires about symptoms. Patients were examined with bowel imaging or followed for two years. Findings of CRC, adenomas with HGD, adenomas with low grade dysplasia (LGD) ≥1 cm and IBD were registered. (Papers II and III.) 3: A qualitative study of interviews with eleven primary care doctors. We explored what made them suspect CRC, and their practices regarding investigation and referral with particular attention to their use of FITs. Qualitative content analysis with an inductive approach was used for the analysis. (Paper IV.)Results: 1: Paper I: Of 495 patients 323 (65.3%) started the investigation in primary care. FITs were analysed in 215. In 23 cases with CRC, FITs were negative; 15 (65.2%) had anaemia. In 33 cases with CRC, FITs were performed due to asymptomatic anaemia; 10 (30.3%) had negative FITs. The time from start of investigation, to the diagnosis of CRC or adenomas with HGD, was significantly longer for patients with negative FITs.2: 377 patients (9 diagnosed with CRC, 10 with IBD) were included. Paper II: Concordance of positive answers about symptoms from patients and doctors was generally low. Rectal bleeding (recorded by 43.5% of patients and 25.6% of doctors) was the only symptom related to CRC and IBD. The FIT showed a better PPV than rectal bleeding for CRC and IBD. When patients recorded rectal bleeding, the FIT had a PPV of 22.6% and a NPV of 98.9% for CRC and IBD. Paper III: The best test for detecting CRC and IBD was the combination of a positive FIT and/or anaemia with a sensitivity, specificity, PPV and NPV of 100%, 61.7%, 11.7% and 100% respectively. The FC test had no additional value to the FIT alone. The sensitivity, specificity, PPV and NPV of the FIT for CRC in study 1 was estimated at 88.4%, 73.3%, 6.2% and 99.7% respectively. In study 2, corresponding figures were 88.9%, 67.4%, 6.3% and 99.6% respectively.3: Paper IV: We identified four categories: “Careful listening – with awareness of the pit-falls”, “tests can help – the FIT can also complicate the diagnosis”, “to refer or not to refer – safety margins are necessary”, and “growing more confident – but also more humble”. All doctors had found their own way to handle FIT results in the absence of guidelines.Conclusion: The diagnostic process when suspecting CRC can be described as navigating uncertain waters with safety margins. FITs were often used by primary care doctors but with considerable variations in interpretation and handling of results. Rectal bleeding was the only symptom related to CRC and IBD, but the FIT showed a better PPV than rectal bleeding. The combination of a negative FIT and no anaemia may be useful as a rule-out test when CRC is suspected in primary care, and this potentially also applies when patients present with rectal bleeding. Further studies are needed to confirm this and to determine the optimal FIT cut-off value for this use. 
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40.
  • Jonasson, Inger, et al. (författare)
  • A new primary care model for the rehabilitation of strokepatients with impaired arm and hand function - a pilot study.
  • 2012
  • Ingår i: Vård i Norden. - 0107-4083. ; 32:2, s. 15-20
  • Tidskriftsartikel (refereegranskat)abstract
    • ABSTRACT Background: A new treatment method, Constraint-Induced Movement Therapy (CIMT), has been tested by stroke patients in hospital but not in primary care. Reduced time in hospital increases primary care’s responsibility for rehabilitation and necessitates the development of new methods. Aim: To investigate the effect of CIMT on stroke patients in primary care. Method: Sixteen patients with stroke were offered a ten-day intensive group-training course, six hours per day. They were included in median value 17 months (range:7-120) after stroke. They were prevented from using their non-affected hand by wearing a glove for 90% of their waking hours. Measurements with 14 standardized instruments were performed up to three months after intervention. Findings: The results revealed a significant improvement in the patients’motor and everyday life functions. There was a marked recovery of lost capacity in ADL, which combined with the increase in the performance of meaningful tasks led to improved possibilities of living an independent life. The improvements in motor function and recovery of lost ADL functions were maintained at the three month follow-up. The training intervention was perceived as highly satisfactory. Conclusion: CIMT in a group setting in primary health care seems to be a successful rehabilitation model after stroke. KEY WORDS: ADL, constraint-induced movement therapy, occupational therapy, primary care, rehabilitation outcome
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41.
  • Lundgren, Stefan, et al. (författare)
  • Tingsrätters effektivitet och produktivitet
  • 2017
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Statens reformering av tingsrätterna har inte gett förväntad effekt. Trots förändrade arbetssätt och en sammanslagning av tingsrätter från 96 till 48 når många tingsrätter inte regeringens verksamhetsmål.Riksrevisionens granskning av den långsiktiga tekniska effektiviteten åren 2012– 2015 visar att effektiviteten är hög men att det finns en utvecklingspotential. Den varierar dock mellan de olika tingsrätterna. Vidare visar granskningen att produktiviteten har minskat över åren för en majoritet av tingsrätterna. Det framkommer också att tingsrätternas storlek har en koppling till nivån på ineffektiviteten.Granskningen bygger på DEA-metoden som mäter effektiviteten genom en inbördes jämförelse av tingsrätterna.För att höja effektiviteten och produktiviteten hos tingsrätterna rekommenderar Riksrevisionen Domstolsverket och tingsrätterna med att påbörja ett arbete för att identifiera interna och externa faktorer som påverkar både effektivitet och produktivitet. Riksrevisionen rekommenderar även Domstolsverket att ta hänsyn till att ineffektiviteten inte är jämt fördelad om effektiviseringsarbete ska genomföras. Enligt den modell som Riskrevisionen använt bedöms ett antal tingsrätter vara effektiva varför generella metoder för effektivisering riktade på samma sätt till samtliga tingsrätter inte nödvändigtvis är lämpliga.
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42.
  • Lydell, Marie C, 1961, et al. (författare)
  • Predictive factors for work capacity in patients with musculoskeletal disorders.
  • 2005
  • Ingår i: Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. - Oslo, Norway : Taylor & Francis. - 1650-1977 .- 1651-2081. ; 37:5, s. 281-5
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To identify predictive factors for work capacity in patients with musculoskeletal disorders. DESIGN: A descriptive, evaluative, quantitative study. SUBJECTS/PATIENTS: The study was based on 385 patients who participated in a rehabilitation programme. METHODS: Patients were divided into 2 groups depending on their ability to work. The groups were compared with each other with regard to sociodemographic factors, diagnoses, disability pension and number of sick days. The patient's level of exercise habits, ability to undertake activities, physical capacity, pain and quality of life were compared further using logistic regression analysis. RESULTS: Predictive factors for work capacity, such as ability to undertake activities, quality of life and fitness on exercise, were identified as important independent factors. Other well-known factors, i.e. gender, age, education, pain and earlier sickness certification periods, were also identified. Factors that were not significantly different between the groups were employment status, profession, diagnosis and levels of exercise habits. CONCLUSION: Identifying predictors for ability to return to work is an essential task for deciding on suitable individual rehabilitation. This study identified new predictive factors, such as ability to undertake activities, quality of life and fitness on exercise.
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43.
  • Lydell, Marie C, 1961, et al. (författare)
  • Predictive factors of sustained return to work for persons with musculoskeletal disorders who participated in rehabilitation.
  • 2009
  • Ingår i: Work (Reading, Mass.). - Amsterdam : IOS Press. - 1051-9815 .- 1875-9270. ; 33:3, s. 317-328
  • Tidskriftsartikel (refereegranskat)abstract
    • Musculoskeletal disorders (MSD) account for the majority of total morbidity cases in the working-age Swedish population. These disorders are thought to be the reason given for one-third of total certified sick leave requests. In addition to the high cost to society, MSD involve both physical and emotional suffering, pain and financial and social problems for the injured persons. The aim of this study was to identify predictive multidimensional factors for sustainable return to work (RTW) in a long-term follow-up persons with MSD. During the period 1992-1999, 385 persons participated in a rehabilitation program. Ten years later, 354 of these took part in a prospective follow-up study. The average post-rehabilitation time was ten years (range=7-13 years) and 243 persons (69%) completed a questionnaire. The "working full-time" group (n=110) and the "sick-listed" group (n=73) were included in the study. The two groups were compared in terms of predictors for RTW. Multiple stepwise logistic regression and bivariate analysis, as well as parametric and non-parametric tests, were used to identify predictive factors. The number of sick-listed days before rehabilitation, age, self-rated pain, life events, gender, physical capacity, self-rated functional capacity, educational level and light physical labor were predictors of long-term RTW. Return to work an be facilitated by planning at an early stage of the certified sick leave period using instrument that take these predictors into account.
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44.
  • Lydell, Marie C, 1961, et al. (författare)
  • Return or no return - psychosocial factors related to sick leave in persons with musculoskeletal disorders: a prospective cohort study.
  • 2011
  • Ingår i: Disability and rehabilitation. - Abingdon : Informa UK Limited. - 1464-5165 .- 0963-8288. ; 33:8, s. 661-666
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose. The aim of this study was to compare psychosocial factors between healthy persons and sick-listed persons with musculoskeletal disorders (MSD); both groups with MSD 10 years ago. Methods. This cohort study was prospective and 385 persons participated in a rehabilitation program 10 years ago, and 354 persons took part in the follow-up. Of these, 243 persons completed a questionnaire. Two groups were included in the study: a healthy group (not sick-listed) (n = 112) and a sick-listed group (n = 74). Psychosocial factors related to sick leave were compared between the groups. Results. In the 10-year follow-up, the healthy group showed a significantly higher quality of life, more control over the working situation, better sense of coherence and unexpectedly more life events. There was no significant difference in social integration and emotional support between the groups. Conclusions. Using the knowledge about the characteristics of the healthy group, adequate rehabilitation for every sick-listed person with a musculoskeletal disorder can be given and therefore facilitate the returning to work process. A multidimensional approach taking into account a person's physical condition and workplace related problems, as well as psychosocial factors, is of great importance for the person and for society.
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45.
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46.
  • Lydell, Marie, 1961-, et al. (författare)
  • Thoughts and feelings of future working life as a predictor of return to work : a combined qualitative and quantitative study of sick-listed persons with musculoskeletal disorders
  • 2011
  • Ingår i: Disability and Rehabilitation. - London : Taylor & Francis Group. - 0963-8288 .- 1464-5165. ; 33:13-14, s. 1262-1271
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose. The main aim of this study was to describe the thoughts and feelings of future working life related to return to work (RTW) in sick-listed persons due to musculoskeletal disorders (MSD). Further aim was to compare these descriptions with the person’s actual working situation 1, 5 and 10 years after a rehabilitation period.Methods. This study consisted of two parts. The first part had an explorative design, and qualitative content analysis was chosen in order to analyse the response to an open question regarding future working life answered before, persons sick-listed due to MSD (n = 320), took part in a rehabilitation programme 10 years ago. The second part had a prospective design and quantitative analysis was used to compare the results of the qualitative analysis with RTW and the working situation 1, 5 and 10 years after baseline.Results. Three categories emerged from the data with a total of nine subcategories. In the categories Motivation and optimism and Limitations to overcome, there were significantly more persons who had RTW 1 year after baseline when compared with the category Hindrance and hesitation. There were also some significant differences between the subcategories.Conclusions. The question, regarding thoughts and feelings of future working life, may be a simple screening method to predict RTW in persons sick-listed with MSD. This will guide the rehabilitation team to adjust the rehabilitation to each person’s needs and facilitating RTW.
  •  
47.
  • Marklund, Bertil, 1945, et al. (författare)
  • Computer-supported telephone nurse triage: an evaluation of medical quality and costs.
  • 2007
  • Ingår i: Journal of nursing management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 15:2, s. 180-7
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: To evaluate a telephone nurse triage model in terms of appropriateness of referrals to the appropriate level of care, patient's compliance with given advice and costs. BACKGROUND: A key concern in each telephonic consultation is to evaluate if appropriate. METHOD: An evaluative design in primary health care with consecutive patients (N = 362) calling telephone nurse triage between November 2002 and February 2003. RESULTS: The advice was considered adequate in 325 (97.6%) cases. The patients' compliance with self-care was 81.3%, to primary health care 91.1% and to Accident and Emergency department 100%. The nurses referred self-care cases (64.7%) and Accident and Emergency cases (29.6%) from a less adequate to an appropriate level of care. The cost saving per call leading to a recommendation of self-care was euro 70.3, to primary health care euro 24.3 and to Accident and Emergency department euro 22.2. CONCLUSIONS: The telephone nurse triage model showed adequate guidance for the patients concerning level of care and released resources for the benefit of both patients and the health care system.
  •  
48.
  • Marklund, Berit, et al. (författare)
  • Effects on Sickness Pattern of Early Mini-rehabilitation Groups Among Patients with Musculoskeletal Problems in Primary Healthcare
  • 1999
  • Ingår i: Scandinavian Journal of Occupational Therapy. - London, UK : Informa Healthcare. - 1103-8128 .- 1651-2014. ; 6:2, s. 90-94
  • Tidskriftsartikel (refereegranskat)abstract
    • People with musculoskeletal problems are repetitive users of the occupational and primary healthcare services; it seems that traditional medical treatment and physiotherapy are of little help. The aim of this study was to evaluate the effects on the sickness pattern among patients with musculoskeletal problems after an early rehabilitation programme and 3 months later based on interdisciplinary efforts in primary healthcare. The intervention was implemented in one of two primary healthcare areas during a 10-month period involving an intervention group (n=138) and a control group (n=75). Descriptive and analytical statistics were used. The result reflected a significantly shorter average sick period in the intervention group (63.8 days) than in the control group (92.8 days). The study indicates that such a model of early rehabilitation based on interdisciplinary efforts has the potential to provide significant socioeconomic benefits. © 1999 Scandinavian University Press.
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49.
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50.
  • Månsson, Jörgen, 1958, et al. (författare)
  • Collection and retrieval of structured clinical data from electronic patient records in general practice. A first-phase study to create a health care database for research and quality assessment.
  • 2004
  • Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 22:1, s. 6-10
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To evaluate prerequisites, practicalities, attitudes and limitations related to the collection of structured clinical data in everyday general practice for use in the future establishment of a national registration network. DESIGN: Prospective study. SETTING: Primary health care centres in south-western Sweden. SUBJECTS: Fourteen participating general practitioners in five primary health care centres. MAIN OUTCOME MEASURES: Feasibility and workload involved in structured data entry and in the retrieval of data from different record systems. The accuracy of clinical data in terms of clinical variables, correctness and representativeness. RESULTS: All four record systems could deliver basic data on the patient population. One centre had to be excluded from further data retrieval because of limitations in the data retrieval export format. Collecting data in everyday practice was feasible with acceptable data accuracy and moderate workload. CONCLUSION: It was feasible to collect, retrieve and store structured clinical data with respect to accuracy and extra workload. Interest in a national registration network and an increasing demand for information about primary health care in order to optimise clinical practices and support research, creates prerequisites for establishing a valid and reliable database. However, developmental work focusing on classification limitations, coding tools and routines for data retrieval is necessary.
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