| 1. |
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| 2. |
- Merlo, Juan, et al.
(author)
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Social inequalities in health- do they diminish with age? Revisiting the question in Sweden 1999.
- 2003
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In: International Journal for Equity in Health. - : Springer Science and Business Media LLC. - 1475-9276. ; 2:1, s. 2-2
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Journal article (peer-reviewed)abstract
- BACKGROUND: Individuals with low income have poorer health and should, therefore, have higher health expenditure than people with high income particularly in countries with a universal health care system. However, it has been discussed if social inequities in health diminish with age and we, hence, aimed to analyse this question. METHODS: We performed an age stratified cross-sectional analysis using averages, logistic and linear regression modelling of health care contacts, health care expenditures and mortality in relation to individual income in five groups by quintiles. The population consisted of all the 249,855 men aged 40 to 80 years living in the county of Skane, Sweden during 1999. RESULTS: For working-age people (40-59 year old) we find a clear socioeconomic gradient with increasing probability of health care contact, relative expenditure and mortality as income decreased. The point estimations for 1st (highest)-2nd-3rd-4th and 5th (lowest) income groups were: (1.00-1.13-1.21-1.42 and 1.15), (1.00-1.16-1.29-1.69 and 1.89) and (1.00-1.35-1.44-2.82 and 4.12) for health care contact, relative expenditure and mortality respectively. However, in the elderly (75-80 year old) these point estimates were (1.00-0.83-0.59-0.61 and 0.39), (1.00-1.04-1.05-1.02 and 0.96) and (1.00-1.06-1.30-1.33 and 1.49). CONCLUSIONS: As expected among working-age individuals, lower income was associated with higher health care contact, relative expenditure and mortality. However, the existence of opposite socioeconomic gradients in health care utilisation and mortality in the elderly suggests that factors related to a high income might condition allocation of resources, or that current medical care is ineffective to treat determinants of income differences in mortality occurring earlier in the lifecourse.
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| 9. |
- Axelsson, Susanna, et al.
(author)
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Economic aspects of the detection of occlusal dentine caries.
- 2009
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In: Acta odontologica Scandinavica. - : Informa UK Limited. - 1502-3850 .- 0001-6357. ; 67:1, s. 38-43
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To evaluate the cost of true-positive occlusal dentine caries detection in permanent molars assessed by: (I) visual-tactile examination, (II) visual-tactile examination combined with bitewing radiographs, and (III) selective radiographic examination of patients with lesions detected clinically. A second aim was to analyse the different strategies when the costs of the subsequent restorative care are considered. METHODS: A model analysis was applied owing to the lack of original articles. Sensitivity and specificity were calculated from a systematic review and included in vitro and in vivo studies of medium and high quality. The direct costs for examinations and restorative care were extracted from the costs of the Public Dental Service in Sweden (2006). RESULTS: The diagnostic costs per true-positive finding were dependent on the occurrence of occlusal caries and increased with decreasing prevalence. The strategy by which radiographs were exposed selectively on the basis of findings from visual-tactile examination resulted in higher initial costs compared with the first and second strategies. When the costs of the subsequent restorative care were added, the selective strategy was most beneficial by up to 26% savings per true-positive diagnosis. However, with this selective strategy, more cases of true-positive dentine caries were assumed would remain undetected as compared with the combined strategy with visual-tactile examination and radiographs for all. CONCLUSIONS: The cost for a true-positive caries diagnosis was inversely related to caries occurrence, and different diagnostic strategies may display contrasting outcomes when subsequent restorative care is taken into account.
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| 10. |
- Axelsson, Susanna, et al.
(author)
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Effect of combined caries-preventive methods: a systematic review of controlled clinical trials.
- 2004
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In: Acta odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 62:3, s. 163-9
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Research review (peer-reviewed)abstract
- The aim of this systematic review was to evaluate the caries-preventive effect of combined caries-preventive methods, defined as two or more different interventions in combination, each expected to prevent dental caries. The Medline database was searched for articles published in the period January 1966 to June 2003. Twenty-four controlled studies met the inclusion criteria, and their value as evidence was assessed according to predetermined criteria. The level of evidence for the overall conclusion regarding each method was graded according to the protocol of the Swedish Council on Technology Assessment in Health Care. The scientific evidence for the combination of treatments involving fluoride that had a preventive effect on caries in children and adolescents was graded as moderate. However, for elderly patients the scientific evidence for the caries-preventive effect of different combinations of treatments was found to be incomplete. No conclusion could be drawn regarding the evidence for combinations of treatments being effective for groups at high caries risk, as the results from the identified clinical studies were conflicting.
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| 11. |
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| 12. |
- Bergenholtz, Gunnar, 1939, et al.
(author)
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Treatment of pulps in teeth affected by deep caries - A systematic review of the literature.
- 2013
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In: Singapore dental journal. - : World Scientific Pub Co Pte Lt. - 0377-5291. ; 34:1, s. 1-12
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Journal article (peer-reviewed)abstract
- BACKGROUND: This systematic review assesses the effect of methods commonly used to manage the pulp in cases of deep caries lesions, and the extent the pulp chamber remains uninfected and does not cause pulpal or periapical inflammatory lesions and associated tooth-ache over time.STUDY DESIGN: An electronic literature search included the databases PubMed, EMBASE, The Cochrane Central Register of Controlled Trials and Cochrane Reviews from January 1950 to March 2013. In addition, hand searches were carried out. Two reviewers independently evaluated abstracts and full-text articles. An article was read in full if at least one of the two reviewers considered the abstract potentially relevant. Altogether, 161 articles were read in full text. Of these, 24 studies fulfilled established inclusion criteria. Based on studies of at least moderate quality, the quality of evidence of each procedure was rated in four levels according to GRADE.RESULTS: No study reached the high quality level. Twelve were of moderate quality. The overall evidence was insufficient to assess which of indirect pulp capping, stepwise excavation, direct excavation and pulp capping/partial pulpotomy, pulpotomy or pulpectomy is the most effective treatment approach for teeth with deep caries.CONCLUSIONS: Because of the lack of good studies it is not possible to determine whether an injured pulp by deep caries can be maintained or whether it should be removed and replaced with a root canal filling. Both randomized studies and prospective observational studies are needed to investigate whether a pulp exposed to deep caries is best treated by measures intended to preserve it or by pulpectomy and root filling.
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| 13. |
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| 14. |
- Cederlund, Andreas, et al.
(author)
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Caries treatment in Swedish adults : effectiveness, costs and equity. A 4-year follow-up study of data from the Swedish national dental health register
- 2016
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In: Swedish Dental Journal. - : Swedish Dental Association. - 0347-9994. ; 40:2, s. 223-234
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Journal article (peer-reviewed)abstract
- Planering och styrning av tandvård på nationell nivå bör baseras på utvärderingar av jämlik fördelning, effektivitet och kostnader. Med inrättandet av tandhälsoregistret vid Socialstyrelsen öppnas möjligheter för studier av tandvårdens processer och resultat. Syftet med studien var att utifrån två identifierade kohorter longitudinellt följa och analysera frekvens och kostnader för ny fyllning eller tandkrona på tidigare restaurerad tand (omgörningar) samt relationen mellan förebyggande tandvårdsåtgärder i relation till reparativ och restaurativ tandvård orsakad av karies. Med hjälp av tandhälsoregistret studerades två kohorter omfattande den vuxna befolkningen. En longitudinell modell användes för uppföljning. I den första kohorten följdes 1 878 887 tänder hos 1 088 923 patienter mellan 42 och 48 månader. I den andra kohorten följdes 1 703 147 patienter under en period av mellan 48 och 54 månader. Fördelning av tandvård för olika åldersgrupper visade att kohorterna var representativa för hela patientgruppen. Fördelning av tandvårdsbesök varierade mellan 140 och 160 räknat per 1 000 invånare trots olika geografiska förutsättningar. Resultaten baserade på den första kohorten visar att 76% av tänderna inte fick någon ytterligare åtgärd med fyllning eller tandkrona under uppföljningsperioden, och att för resterande 24% av tänderna fick 77% endast en ny åtgärd. Det förelåg ingen könsskillnad, däremot skillnader på upp till tre intakta tänder mellan olika regioner. Resultat från den andra kohorten visade heller ingen könsskillnad. De genomsnittliga kostnaderna för reparativa åtgärder på grund av karies ökade gradvis i relation till ökade kostnader för förebyggande åtgärder. Vidare var kostnaderna för reparativa åtgärder lägre ju längre tid som följde mellan förebyggande åtgärder. Det nationella tandhälsoregistret utgör en värdefull källa för forskning om tandvård. Longitudinella registerdata för reparationer och preventiva åtgärder kan användas för att studera effektivitet, kostnader och jämlik fördelning av tandvård. Resultaten har en potential för förbättrad styrning av tandvården.
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| 15. |
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| 16. |
- Ernstsson, Olivia, et al.
(author)
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Cost of Illness of Multiple Sclerosis : A Systematic Review
- 2016
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:7
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Journal article (peer-reviewed)abstract
- BACKGROUND: Cost-of-illness (COI) studies of Multiple Sclerosis (MS) are vital components for describing the economic burden of MS, and are frequently used in model studies of interventions of MS. We conducted a systematic review of studies estimating the COI of MS, to compare costs between studies and examine cost drivers, emphasizing generalizability and methodological choices.MATERIAL AND METHOD: A literature search on studies published in English on COI of MS was performed in PubMed for the period January 1969 to January 2014, resulting in 1,326 publications. A mapping of studies using a bottom-up approach or top-down approach, respectively, was conducted for the 48 studies assessed as relevant. In a second analysis, the cost estimates were compared between the 29 studies that used a societal perspective on costs, human capital approach for indirect costs, presenting number of patients included, time-period studied, and year of price level used.RESULTS: The mapping showed that bottom-up studies and prevalence approaches were most common. The cost ratios between different severity levels within studies were relatively stable, to the ratio of 1 to 2 to 3 for disability level categories. Drugs were the main cost drivers for MS-patients with low disease severity, representing 29% to 82% of all costs in this patient group, while the main cost components for groups with more advanced MS symptoms were production losses due to MS and informal care, together representing 17% to 67% of costs in those groups.CONCLUSION: The bottom-up method and prevalence approach dominated in studies of COI of MS. Our findings show that there are difficulties in comparing absolute costs across studies, nevertheless, the relative costs expressed as cost ratios, comparing different severity levels, showed higher resemblance. Costs of drugs were main cost drivers for less severe MS and informal care and production losses for the most severe MS.
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| 17. |
- Frisk, Fredrik, 1971, et al.
(author)
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Pulp exposures in adults--choice of treatment among Swedish dentists.
- 2013
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In: Swedish dental journal. - : Sveriges tandläkarförbund. - 0347-9994. ; 37:3, s. 153-60
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Journal article (peer-reviewed)abstract
- This study comprises a survey of Swedish dentists'treatment preferences in cases of carious exposure of the dental pulp in adults.The survey was conducted as part of a comprehensive report on methods of diagnosis and treatment in endodontics, published in 2010 by the Swedish Council on Health Technology Assessment. A questionnaire was mailed to a random subsample of 2012 dental offices where one dentist at each office was requested to answer all questions. Each questionnaire contained one of three sets of questions about endodontic practice routines.Thus around one-third of the subsample received case-specific questions about treating carious exposure. Only general practitioners aged below 70 years were included.The final study sample comprised 412 participants.The dentists were presented with two case scenarios. In Case 1 a 22-year old patient had a deep carious lesion in tooth 36 and in Case 2 a 50-year old patient had a deep carious lesion in tooth 14.The participants were asked to nominate their treatment of choice: pulp capping, partial pulpotomy or pulpectomy. For Case 1, 17 per cent of the respondents selected pulpectomy; the corresponding rate for Case 2 was 47 per cent. Female gender and age group 25-49 years were predictive of selection of less invasive treatment options. However, according to recent guidelines (2011) from the National Board of Health and Wellfare, Swedish dentists are recommended to elect pulpectomy prior to pulp capping/partial pulpotomy when confronted with a tooth having a cariously exposed pulp in adults.
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| 18. |
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| 19. |
- Gyllensten, Hanna, 1979, et al.
(author)
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Costs of illness of multiple sclerosis in Sweden : a population-based register study of people of working age
- 2018
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In: European Journal of Health Economics. - : Springer. - 1618-7598 .- 1618-7601. ; 19:3, s. 435-446
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Journal article (peer-reviewed)abstract
- BACKGROUND: Multiple sclerosis (MS) causes work disability and healthcare resource use, but little is known about the distribution of the associated costs to society.OBJECTIVES: We estimated the cost of illness (COI) of working-aged individuals with MS, from the societal perspective, overall and in different groups.METHODS: A population-based study was conducted, using data linked from several nationwide registers, on 14,077 individuals with MS, aged 20-64 years and living in Sweden. Prevalence-based direct and indirect costs in 2010 were calculated, including costs for prescription drug use, specialized healthcare, sick leave, and disability pension.RESULTS: The estimated COI of all the MS patients were SEK 3950 million, of which 75% were indirect costs. MS was the main diagnosis for resource use, causing 38% of healthcare costs and 67% of indirect costs. The distribution of costs was skewed, in which less than 25% of the patients accounted for half the total COI.CONCLUSIONS: Indirect costs contributed to approximately 75% of the estimated overall COI of MS patients of working age in Sweden. MS was the main diagnosis for more than half of the estimated COI in this patient group. Further studies are needed to gain knowledge on development of costs over time during the MS disease course.
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| 20. |
- Hallström, Inger, et al.
(author)
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Paediatric day care surgery increased parental participation reduces costs
- 1998
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In: European Journal of Public Health. - 1101-1262. ; 3:8, s. 247-249
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Journal article (peer-reviewed)abstract
- In this paper, the marginal or incremental consequences of increased parental participation in a day-care surgery unit are analysed. Information about the parental role and instruction concer treatment caused parents to assume a greater share of their child's postoperative care. This advantages for the involved participants. Children and their parents spent a shorter time at the attributable to nursing care were consequently reduced by 11%.
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| 21. |
- Jacobsen, Thomas, 1954, et al.
(author)
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Application of laser technology for removal of caries: A systematic review of controlled clinical trials
- 2011
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In: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 69:2, s. 65-74
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Research review (peer-reviewed)abstract
- Objective. To evaluate the scientific evidence regarding laser technology for removal of carious tissue. Material and methods. A search for literature on the effect of treatment and on economic aspects of laser technology identified 23 papers. No relevant studies on economic aspects were found. Regarding the effect of treatment, 16 papers were selected for assessment according to established criteria. Results. Cavity preparation and caries excavation by erbium laser were evaluated in three studies of medium quality. The time required to remove carious tissue was evaluated in five studies assessed as being of medium quality for this outcome. In four studies the effect of laser treatment on the dental pulp was included as an outcome but, due to the short follow-up time, the quality was assessed as low. Two studies that included the longevity of the restoration as an outcome were also assessed as being of low quality because the follow-up time was inadequate. Patient response was evaluated in three studies, which were assessed as being of medium quality with respect to this outcome. Conclusions. There is limited scientific evidence that laser treatment is as effective as a rotary bur for removing carious tissue. Treatment time is prolonged. There is limited scientific evidence that adults prefer laser treatment. No conclusions can be drawn regarding biological or technical complications, children's perception of laser treatment or the cost-effectiveness of the method. © 2011 Informa Healthcare.
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| 22. |
- Jacobsson, Lars, et al.
(author)
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ADHD : Diagnostik och behandling, vårdens organisation och patientens delaktigheten systematisk litteraturöversikt
- 2013
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Reports (peer-reviewed)abstract
- ADHD En funktionsnedsättning med debut i baranåren. Kärmsymtom karaktäriseras av uppmärksamhetsproblem, impulsivitet ioch hyperaktivitet.I ett antal fall sker en normalisering eller mognadsprocess, i andra fall kan någon form av psykisk ohälsa förekommma samtidigt. Den diagnostiska utredningen är omfattande, och både instrument för diagnostik och den diagnostiska processen bör undersökas bättre.Många olika insatser och behandlingar, förutom läkemedel förekommer idag, men kunskapen om eras nytta, risker och kostnader måste förbättras. Vissa läkemedel lindrar ADHD symtom vid korttidsbehandling, men nyttan av långtidsbehandling går inte att bedöma. Vanliga biverjkningar av dessa läkemedel är illamående och nedsatt aptit, för barn viktminskning och pulsökning.
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| 23. |
- Källestål, Carina, et al.
(author)
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Economic evaluation of dental caries prevention : a systematic review
- 2003
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In: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 61:6, s. 341-346
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Research review (other academic/artistic)abstract
- The aim of the present study was to perform a systematic review of economic evaluations of caries prevention. A search in Medline from 1966 until May 2003 and a manual search in a number of journals identified 154 references, 74 of which were included. There were 17 original studies including an economic evaluation, and these form the basis of the present article. The rest were reviews, model studies and reports concerning economic practice in dentistry. The results show that the reviewed original studies on economic evaluation of caries prevention do not provide support for the economic value of caries prevention. The scarcity of well-conducted studies, as well as contra-dictory evidence in the reviewed articles, makes it difficult to judge the health-economic effect of the studied caries-prevention methods.
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| 24. |
- Liedholm, Rolf, et al.
(author)
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Economic aspects of mandibular third molar surgery
- 2010
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In: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 68:1, s. 43-48
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Journal article (peer-reviewed)abstract
- Objective. The aim of this study was to make estimates from a dental care and societal perspective on costs of mandibular third molar surgery. Material and methods. A total of 64 patients were recruited from three Swedish oral and maxillofacial specialist clinics. Calculations were made prospectively on utilization of labor time, specific medical services and materials, and standardized utilization of other direct costs. Indirect costs were identified from patient surveys. Results. The base case average direct cost of surgery was 217 Euro. Adding the patient's average cost due to absence from work and transportation of 333 Euro increased overall costs to 550 Euro per patient. About 86% of the patients reported some absence following surgery. Conclusions. The indirect costs were on average higher than the direct costs, i.e. the patient's loss of time caused higher costs than the intervention per se. Appropriate indications for mandibular third molar removal can minimize the risks of complications and individual or societal costs.
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| 25. |
- Lindström, Eva, et al.
(author)
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Schizofreni - läkemedelsbehandling, patientens delaktighet och vårdens organisation : En systematisk litteraturöversikt
- 2012
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Reports (other academic/artistic)abstract
- Schizofreni är i de flesta fall en kronisk och invalidiserande psykisk sjukdom. Antipsykotiska läkemedel (neuroleptika) är namnet på den grupp läkemedel som är avsedd att lindra de psykotiska symtomen som uppstår vid schizofreni. Antipsykotiska läkemedel kan indelas i första generationens antipsykotika och andra generationens antipsykotika. Denna litteraturöversikt kompletterar SBU:s systematiska översikt från år 1997 med en granskning av andra generationens antipsykotika. I översikten ingår också ett kapitel om den kunskap man idag har om hur personer med schizofreni upplever sin medverkan och sin delaktighet i behandling och vård. Dessutom ingår ett kapitel där man undersökt värdet av integrerade vårdformer för personer med olika psykiatriska tillstånd där huvuddelen av dem har schizofreni.
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| 26. |
- Lingström, Peter, et al.
(author)
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Dietary factors in the prevention of dental caries : a systematic review
- 2003
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In: Acta Odontologica Scandinavica. - : Informa Healthcare. - 0001-6357 .- 1502-3850. ; 61:6, s. 331-340
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Research review (other academic/artistic)abstract
- The aim of this study was, systematically, to evaluate the effect of die-tary changes in the prevention of dental caries. A search and analysis strategy was followed, as suggested by the Swedish Council on Tech-nology Assessment in Health Care (SBU). The search strategy for arti-cles published in 1966-2003 was performed using electronic databases and reference lists of articles and selected textbooks. Out of 714 arti-cles originally identified, 18 met the inclusion criteria for a random-ized or controlled clinical trial--at least 2 years’ follow-up and caries increment as a primary endpoint. This included the total or partial substitution of sucrose with sugar substitutes or the addition of pro-tective foods to chewing gum. No study was found evaluating the ef-fect of information designed to reduce sugar intake/frequency as a sin-gle preventive measure. It is suggested that the evidence for the use of sorbitol or xylitol in chewing gum, or for the use of invert sugar, is in-conclusive. No caries-preventive effect was found from adding calcium phosphate or dicalcium phosphate dihydrate to chewing gums. The review clearly demonstrates the need for well-designed randomized clinical studies with adequate control groups and high compliance.
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| 27. |
- Mejàre, Ingegerd, et al.
(author)
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Caries-preventive effect of fissure sealants : a systematic review
- 2003
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In: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 61:6, s. 321-330
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Research review (other academic/artistic)abstract
- The objectives of this study were to evaluate systematically the evi-dence of the caries-preventive effect of fissure sealing of occlusal tooth surfaces and to examine factors potentially modifying the effect. The search strategies included electronic databases, reference lists of arti-cles, and selected textbooks. Inclusion criteria were randomized or quasi-randomized clinical trials or controlled clinical trials comparing fissure sealing with no treatment or another preventive treatment in children up to 14 years of age at the start; the outcome measure was caries increment; the diagnostic criteria had been described; and the follow-up time was at least 2 years. Inclusion decisions were taken and grading of the studies was done independently by two of the authors. The main measure of effect was relative risk reduction. Thirteen stud-ies using resin-based or glass ionomer sealant materials were included in the final analysis. The results showed that most studies were per-formed during the 1970s and a single application had been utilized. The relative caries risk reduction pooled estimate of resin-based seal-ants on permanent 1st molars was 33% (relative risk = 0.67; CI = 0.55-0.83). The effect depended on retention of the sealant. In conclu-sion, the review suggests limited evidence that fissure sealing of 1st permanent molars with resin-based materials has a caries-preventive effect. The evidence is incomplete for permanent 2nd molars, premo-lars and primary molars and for glass ionomer cements. Overall, there remains a need for further trials of high quality, particularly in child populations with a low and a high caries risk, respectively.
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| 28. |
- Norlund, Anders
(author)
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Costs of radiotherapy
- 2003
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In: Acta Oncologica. - : Informa UK Limited. - 1651-226X .- 0284-186X. ; 42:5-6, s. 411-415
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Journal article (peer-reviewed)abstract
- A systematic assessment of radiotherapy for cancer was conducted by The Swedish Council on Technology Assessment in Health Care (SBU) in 2001. The assessment included an overview of the capacity for radiotherapy in terms of infrastructure of cancer care and an estimation of the costs of radiotherapy in Sweden. A postal questionnaire distributed to all 16 centres of radiotherapy in Sweden showed the following results: In 2000 there were 57 accelerators with complementary equipment in operation, 24 of which had been installed 10 or more years ago earlier. The total cost of external radiation therapy was estimated at SEK 427 million in the year 2000, or approximately 5% of the estimated total cost of oncology care in Sweden. The total cost of brachytherapy was estimated at SEK 43 million or about one-tenth of that of external radiotherapy. The total cost of external radiotherapy has increased since the last inquiry (1991) by about 16% more than the general inflation in Sweden, but at the same time the volume of fractions has increased by about 37%. Thus, an increase in the efficiency of external radiotherapy, calculated per fraction, was achieved in the 1990s. At the department level, there was a clear correlation between cost of salaries and output of fractions of external radiotherapy, thus indicating the adaptation of manpower to the volume of patients. There was an even higher correlation between the number of accelerators and the volume of fractions of radiotherapy, which suggests the occurrence of certain economies of scale in Swedish external radiotherapy.
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| 29. |
- Norlund, Lena, et al.
(author)
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The increase of plasma homocysteine concentrations with age is partly due to the deterioration of renal function as determined by plasma cystatin C
- 1998
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In: Clinical Chemistry and Laboratory Medicine. - 1434-6621. ; 36:3, s. 175-178
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Journal article (peer-reviewed)abstract
- One of the main determinants of plasma homocysteine in healthy subjects is serum creatinine. In the present study, we therefore investigated the relation between plasma homocysteine concentration, serum creatinine and a new marker for glomerular filtration rate, plasma cystatin C concentration. Cystatin C reflects the glomerular filtration better than serum creatinine and is not related to the muscle mass and formation of creatinine. The study group consisted of 255 healthy subjects from a well-defined area in the southern part of Sweden. The concentration of plasma homocysteine was increased in men compared to women. This difference disappeared when men and women were stratified by serum creatinine values. Statistically significant correlations were noted between plasma homocysteine and age, plasma cystatin C and serum creatinine. It is shown that plasma homocysteine is not only correlated to serum creatinine as a result of renal function but also as a result of the relationship between homocysteine production and creatine-creatinine synthesis. Using linear regression we were able to show that plasma cystatin C had a higher explanatory value than age. Serum creatinine showed a lower explanatory power than age. The findings in the present study might suggest that the increase of plasma homocysteine concentration with age could be partly due to the deterioration of renal function.
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| 30. |
- Olsson, Erik, 1967-, et al.
(author)
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The effect of group-based cognitive behavioral therapy on inflammatory biomarkers in patients with coronary disease : results from the SUPRIM-trial
- 2018
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In: Upsala Journal of Medical Sciences, Supplement. - : Uppsala Medical Society. - 0300-9726 .- 0300-9734 .- 2000-1967. ; 123:3, s. 167-173
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Journal article (peer-reviewed)abstract
- Background: The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) is a prospective randomized controlled trial of a group-based cognitive behavioral therapy (CBT) stress management program for coronary heart disease (CHD) patients. The intervention reduced the risk of fatal or non-fatal first recurrent cardiovascular (CV) events. The aim of the present study was to analyze if the positive effects of the CBT program on clinical outcomes could have been mediated by changes in biomarkers for inflammation.Methods: Altogether 362 patients with CHD were randomly assigned to intervention or usual care. The inflammatory biomarkers (VCAM-1, TNF-R1, TNF-R2, PTX3, and hs-CRP) were serially assessed at five time points every six months from study start until 24 months later, and analyzed with linear mixed models.Results: Baseline levels of the inflammatory markers were near normal, indicating a stable phase. The group-based CBT stress management program did not significantly affect the levels of inflammatory biomarkers in patients with CHD. Three out of five (VCAM-1, TNF-R2, and PTX3) inflammatory biomarkers showed a slight increase over time in both study groups, and all were positively associated with age.Conclusion: Group-based CBT stress management did not affect biomarkers for inflammation in patients with CHD. It is therefore unlikely that inflammatory processes including these biomarkers were mediating the effect the CBT program had on the reduction in CV events. The close to normal baseline levels of the biomarkers and the lack of elevated psychological distress symptoms indicate a possible floor effect which may have influenced the results.Keywords: Biomarkers, CBT, CHD, inflammation, stress management
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| 31. |
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| 32. |
- Petersson, Lars G, et al.
(author)
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Professional fluoride varnish treatment for caries control: a systematic review of clinical trials.
- 2004
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In: Acta odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 62:3, s. 170-6
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Research review (peer-reviewed)abstract
- The aim of this paper was systematically to evaluate the caries-preventive effect of professional fluoride varnish treatments. A search of the literature for articles published between 1966 and August 2003 was carried out in electronic databases, reference lists of articles, and selected textbooks in accordance with the strategy of the Swedish Council on Technology Assessment in Health Care. Out of 302 identified papers, 24 randomized and controlled clinical trials comparing fluoride varnish with placebo, no active treatment or other fluoride preventive regimens of at least 2 years' study duration were included. The trials that met the inclusion criteria were assessed independently and systematically by at least two reviewers and scored from A to C according to predetermined criteria for methodology and performance. The main outcome measure was the preventive fraction expressed as a percentage. The results displayed limited evidence (evidence level 3) for the caries preventive effect of topical applications of fluoride varnishes in permanent teeth. The average prevented fraction was 30% (0-69%) when compared with untreated controls. Inconclusive evidence (evidence level 4) was found for fluoride varnish treatment in the primary dentition and in adults. This systematic review reinforces the need for future dinical research of high quality, incorporating modern concepts of dinical performance and evaluation to assess dental caries control using professional fluoride varnish.
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| 33. |
- Rehnberg, Ove, et al.
(author)
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Controlling diesel emissions underground
- 1982
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In: World Mining. - 0043-8707. ; 35:6, s. 48-52
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Journal article (peer-reviewed)abstract
- An enquiry to the Swedish mining industry included questions concerning planned mine production, mining methods, number and types of diesel-powered equipment, diesel engines, and transmission types of working cycles. The result representing the situation in 1977 in 37 mines are shown. LHD's are the main fuel consumers (50 percent) and the main contaminators of the air. Subsequent work was concentrated on a duty cycle for this type of equipment.
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| 34. |
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| 35. |
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| 36. |
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| 37. |
- Sollenius, Ola, et al.
(author)
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Health economic evaluations in orthodontics : a systematic review
- 2016
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In: European Journal of Orthodontics. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; 38:3, s. 259-265
-
Research review (peer-reviewed)abstract
- Background: Economic evaluation is assuming increasing importance as an integral component of health services research. Aim: To conduct a systematic review of the literature and assess the evidence from studies presenting orthodontic treatment outcomes and the related costs. Materials/methods: The literature review was conducted in four steps, according to Goodman’s model, in order to identify all studies evaluating economic aspects of orthodontic interventions. The search covered the databases Medline, Cinahl, Cochrane, Embase, Google Scholar, National Health Service Economic Evaluation Database, and SCOPUS, for the period from 1966 to September 2014. The inclusion criteria were as follows: randomized controlled trials or controlled clinical trials comparing at least two different orthodontic interventions, evaluation of both economic and orthodontic outcomes, and study populations of all ages. The quality of each included study was assessed as limited, moderate, or high. The overall evidence was assessed according to the GRADE system (The Grading of Recommendations Assessment, Development and Evaluation). Results: The applied terms for searches yielded 1838 studies, of which 989 were excluded as duplicates. Application of the inclusion and exclusion criteria identified 26 eligible studies for which the full-text versions were retrieved and scrutinized. At the final analysis, eight studies remained. Three studies were based on cost-effectiveness analyses and the other five on cost-minimization analysis. Two of the cost-minimization studies included a societal perspective, i.e. the sum of direct and indirect costs. The aims of most of the studies varied widely and of studies comparing equivalent treatment methods, few were of sufficiently high study quality. Thus, the literature to date provides an inadequate evidence base for economic aspects of orthodontic treatment. Conclusion: This systematic review disclosed that few orthodontic studies have presented both economic and clinical outcomes.There is currently insufficient evidence available about the health economics of orthodontic interventions. Further investigation is warranted.
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| 38. |
- Staël von Holstein, Christer, et al.
(author)
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Dyspepsi och reflux. Systematisk litteraturöversikt från SBU
- 2007
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In: Läkartidningen. - 0023-7205. ; 104:18, s. 7-1414
-
Journal article (peer-reviewed)abstract
- SBU performed a systematic review concerning dyspepsia and gastroesophageal reflux disease (GERD). The review included the perspective of managing patients in primary care. Dyspepsia is a common condition but varies from one geographic area to another. Despite presenting symptoms of dyspepsia, a majority of patients may not have an ulcer diagnosis (non-ulcer dyspepsia [NUD]). For undiagnosed GERD and diagnosed erosive GERD, proton pump inhibitors (PPIs) provide better relief of symptoms than histamine-H2 antagonists. When it comes to long-term treatment of erosive GERD, continued use of PPIs leads to better patient outcomes than PPIs on demand. PPIs are safe for long-term treatment and indicated even for young patients. Adverse effects are rare. Eradication of H. pylori reduces the risk of duodenal ulcer and ventricular ulcer. Eradication of H. pylori is more effective than acid suppression alone for preventing a new episode of bleeding. Eradication of H. pylori for patients with NUD may provide minor relief of symptoms. But because the majority of patients with NUD are not infected with H. pylori, the treatment will have no effect on them. PPIs may provide some relief of NUD symptoms, but studies that analyzed the effectiveness of PPIs for NUD symptoms also included patients with GERD. As a result, it is difficult to draw any conclusions in that regard. Patients with Barrett's esophagus are at increased risk of developing adenocarcinoma of the esophagus. However, published studies offer no evidence that screening or surveillance will detect cancer at an early stage. There is a need for independent dyspepsia research, including health economic studies.
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| 39. |
- Twetman, Svante, et al.
(author)
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Adjunct methods for caries detection: A systematic review of literature.
- 2013
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In: Acta odontologica Scandinavica. - : Informa UK Limited. - 1502-3850 .- 0001-6357. ; 71:3-4, s. 388-397
-
Journal article (peer-reviewed)abstract
- Abstract Objective. To assess the diagnostic accuracy of adjunct methods used to detect and quantify dental caries. Study design. A systematic literature search for relevant papers was conducted with pre-determined inclusion and exclusion criteria. Abstracts and full text articles were assessed independently by two reviewers. The study characteristics were compiled in tables and quality graded according to the QUADAS tool. The level of evidence for each diagnostic technology (fiber-optic methods, fluorescence methods, electrical methods) was based on studies of high or moderate quality according to the GRADE approach. Results. Twenty-five reports fulfilled the inclusion criteria. One study was of high quality, 10 were graded as moderate, while the remaining 14 reports were of low quality. Electrical methods (ECM) and laser fluorescence (DIAGNOdent) displayed sensitivities and specificities around 70-80% regarding occlusal dentin lesions with a mean Youden's index of 0.52-0.54. The mean accuracy of laser fluorescence for detecting enamel and dentin lesions was 0.68 and 0.91, respectively. The heterogeneity of the published reports hampered the analysis. Conclusions. There was insufficient scientific evidence for diagnostic accuracy regarding fiber-optic methods and quantitative light-induced fluorescence (+OOO). The electrical methods and laser fluorescence could be useful adjuncts to visual-tactile and radiographic examinations, especially on occlusal surfaces in permanent and primary molars, but evidence was graded as limited (++OO). No conclusions could be drawn regarding the cost-effectiveness of the methods. There is an obvious need to standardize study designs for in vitro and in vivo validation of the different methods.
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| 40. |
- Twetman, Svante, et al.
(author)
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Caries-preventive effect of fluoride toothpaste : a systematic review
- 2003
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In: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 61:6, s. 347-355
-
Research review (other academic/artistic)abstract
- With a questionnaire addressed to general dental practitioners in Sweden, the Swedish Council on Technology Assessment in Health Care launched a project group in 1999 to systematically review and evaluate the existing literature on various caries preventive methods. The aim of this article was to report findings concerning the caries preventive effect of fluoride toothpastes in various age groups, with special emphasis on fluoride concentration and supervised versus non-supervised brushing. A systematic search in electronic databases for articles published between 1966 and April 2003 was conducted with the inclusion criteria of a randomized or controlled clinical trial, at least 2 years follow-up and caries increment in the permanent (DMFS/T) or primary (dmfs/t) dentition as endpoint. Out of 905 articles originally identified, 54 met the inclusion criteria. These studies were assessed independently by at least two reviewers and scored A-C according to predetermined criteria for methodology and performance. The measure of effect was the prevented fraction (PF), expressed as percent. The results revealed strong evidence (level 1) (i) for the caries preventive effect of daily use of fluoride toothpaste compared to placebo in the young permanent dentition (PF 24.9%), (ii) that toothpastes with 1,500 ppm of fluoride had a superior preventive effect compared with standard dentifrices with 1,000 ppm F in the young permanent dentition (PF 9.7%), and (iii) that higher caries reductions were recorded in studies with supervised toothbrushing compared with non-supervised (PF 23.3%). However, incomplete evidence (level 4) was found regarding the effect of fluoride toothpaste in the primary dentition. In conclusion, this review reinforced the importance of daily toothbrushing with fluoridated toothpastes for preventing dental caries, although long-term studies in age groups other than children and adolescents are still lacking.
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| 41. |
- Twetman, Svante, et al.
(author)
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Caries-preventive effect of sodium fluoride mouthrinses: a systematic review of controlled clinical trials.
- 2004
-
In: Acta odontologica Scandinavica. - Oslo : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 62:4, s. 223-30
-
Research review (peer-reviewed)abstract
- The Swedish Council on Technology Assessment in Health Care launched a project group in 1999 to systematically review and evaluate the existing literature on different caries-preventive methods. The aim of this article was to report the findings concerning the caries-preventive effect of fluoride mouthrinses (FMRs) in various age groups, with special reference to background fluorides. A systematic search in electronic databases for literature published between 1966 and August 2003 was conducted with the inclusion criteria of a randomized or controlled clinical trial, at least 2 years' follow-up, and caries increment in the permanent dentition (DeltaDMFS/T) as endpoint. Out of 174 articles originally identified, 62 met the inclusion criteria. These studies were assessed independently by at least two reviewers and scored A-C according to predetermined criteria for methodology and performance. The measure of effect was the prevented fraction (PF) expressed as percent. The level of evidence was based on 25 articles. The results revealed limited evidence (evidence level 3) for the caries-preventive effect (PF 29%) of daily or weekly sodium fluoride rinses compared with placebo in permanent teeth of schoolchildren and adolescents with no additional fluoride exposure and for a caries-preventive effect on root caries in older adults. Inconclusive evidence (evidence level 4) was found regarding the effect of FMRs in schoolchildren and adolescents exposed to additional fluoride sources such as daily use of fluoride toothpaste. No firm support for the use of FMRs was disclosed in a small number of studies designed for patients at caries risk. Furthermore, no association between the frequency of the rinses and prevented fraction or saved surfaces per year was found. In conclusion, this systematic review suggests that sodium fluoride mouthrinses may have an anti-caries effect in children with limited background of fluoride exposure, while its additional effect in children with daily use of fluoride toothpaste could be questioned. The need for further clinical trials to elucidate the effect of FMRs in risk patients and older adults is emphasized.
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| 42. |
- Von Holstein, Christer Staël, et al.
(author)
-
Dyspepsi och reflux. Systematisk litteraturöversikt från SBU : [Dyspepsia and reflux. Systematic literature review from SBU]
- 2007
-
In: Läkartidningen. - 0023-7205 .- 1652-7518. ; 104:18, s. 1414-1417
-
Journal article (peer-reviewed)abstract
- SBU performed a systematic review concerning dyspepsia and gastroesophageal reflux disease (GERD). The review included the perspective of managing patients in primary care. Dyspepsia is a common condition but varies from one geographic area to another. Despite presenting symptoms of dyspepsia, a majority of patients may not have an ulcer diagnosis (non-ulcer dyspepsia [NUD]). For undiagnosed GERD and diagnosed erosive GERD, proton pump inhibitors (PPIs) provide better relief of symptoms than histamine-H2 antagonists. When it comes to long-term treatment of erosive GERD, continued use of PPIs leads to better patient outcomes than PPIs on demand. PPIs are safe for long-term treatment and indicated even for young patients. Adverse effects are rare. Eradication of H. pylori reduces the risk of duodenal ulcer and ventricular ulcer. Eradication of H. pylori is more effective than acid suppression alone for preventing a new episode of bleeding. Eradication of H. pylori for patients with NUD may provide minor relief of symptoms. But because the majority of patients with NUD are not infected with H. pylori, the treatment will have no effect on them. PPIs may provide some relief of NUD symptoms, but studies that analyzed the effectiveness of PPIs for NUD symptoms also included patients with GERD. As a result, it is difficult to draw any conclusions in that regard. Patients with Barrett's esophagus are at increased risk of developing adenocarcinoma of the esophagus. However, published studies offer no evidence that screening or surveillance will detect cancer at an early stage. There is a need for independent dyspepsia research, including health economic studies.
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| 43. |
- Wennhall, Inger, et al.
(author)
-
Cost-analysis of an oral health outreach program for preschool children in a low socioeconomic multicultural area in Sweden.
- 2010
-
In: Swedish Dental Journal. - : Swedish Dental Association. - 0347-9994. ; 34:1, s. 1-7
-
Journal article (peer-reviewed)abstract
- The aim was to calculate the total and the net costs per child included in a 3-year caries preventive program for preschool children and to make estimates of expected lowest and highest costs in a sensitivity analysis. The direct costs for prevention and dental care were applied retrospectively to a comprehensive oral health outreach project for preschool children conducted in a low-socioeconomic multi-cultural urban area. The outcome was compared with historical controls from the same area with conventional dental care. The cost per minute for the various dental professions was added to the cost of materials, rental facilities and equipment based on accounting data. The cost for fillings was extracted from a specified per diem list. Overhead costs were assumed to correspond to 50% of salaries and all costs were calculated as net present value per participating child in the program and expressed in Euro. The results revealed an estimated total cost of 310 Euro per included child (net present value) in the 3-year program. Half of the costs were attributed to the first year of the program and the costs of manpower constituted 45% of the total costs. When the total cost was reduced with the cost of conventional care and the revenue of avoided fillings, the net cost was estimated to 30 Euro. A sensitivity analysis displayed that a net gain could be possible with a maximal outcome of the program. In conclusion, the estimated net costs were displayed and available to those considering implementation of a similar population-based preventive program in areas where preschool children are at high caries risk
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| 44. |
- Wiberg, Michael, et al.
(author)
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Sources and level of income among individuals with multiple sclerosis compared to the general population : A nationwide population-based study.
- 2015
-
In: Multiple Sclerosis Journal. - : SAGE Publications. - 1352-4585 .- 1477-0970. ; 21:13, s. 1730-1741
-
Journal article (peer-reviewed)abstract
- INTRODUCTION: Multiple sclerosis (MS) is associated with reduced work capacity, but there is limited knowledge about MS patients' sources of income.OBJECTIVES: The purpose of this study was to elucidate MS patients' earnings and social benefits compared to those of the general population.METHODS: From nationwide registers of all residents in Sweden aged 21-64 years in 2010 (n=5,291,764), those with an MS diagnosis (n=13,979) were compared to a propensity score matched reference group (n=69,895). Descriptive statistics and regression models were used to estimate the percentage difference between the MS patients and the matched references regarding the following annual incomes: earnings, disability pension, sickness absence, disability allowance, unemployment compensation and social assistance.RESULTS: Both MS patients and the matched references received most of their income from earnings followed by disability pension and sickness absence. MS patients that were diagnosed in 2010 had 15% lower earnings than the matched references, while MS patients diagnosed before 2005 had 38% lower earnings. Corresponding figures regarding summed social benefits were 33% and 130% higher for MS patients, respectively.CONCLUSION: The results indicate that MS patients are overrepresented, in relative and absolute terms, regarding health-related benefits and have lower levels of earnings. However, the redistributing welfare systems appear to financially compensate the MS patients considerably.
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| 45. |
- Wiedel, Anna-Paulina, et al.
(author)
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A cost minimization analysis of early correction of anterior crossbite-a randomized controlled trial
- 2016
-
In: European Journal of Orthodontics. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; 38:2, s. 140-145
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: Economic evaluations provide an important basis for allocation of resources and health services planning. The aim of this study was to evaluate and compare the costs of correcting anterior crossbite with functional shift, using fixed or removable appliances (FA or RA) and to relate the costs to the effects, using cost-minimization analysis. DESIGN, SETTING, AND PARTICIPANTS: Sixty-two patients with anterior crossbite and functional shift were randomized in blocks of 10. Thirty-one patients were randomized to be treated with brackets and arch wire (FA) and 31 with an acrylic plate (RA). Duration of treatment and number and estimated length of appointments and cancellations were registered. Direct costs (premises, staff salaries, material, and laboratory costs) and indirect costs (the accompanying parents' loss of income while absent from work) were calculated and evaluated with reference to successful outcome alone, to successful and unsuccessful outcomes and to re-treatment when required. Societal costs were defined as the sum of direct and indirect costs. INTERVENTIONS: Treatment with FA or RA. RESULTS: There were no significant differences between FA and RA with respect to direct costs for treatment time, but both indirect costs and direct costs for material were significantly lower for FA. The total societal costs were lower for FA than for RA. LIMITATIONS: Costs depend on local factors and should not be directly extrapolated to other locations. CONCLUSION: The analysis disclosed significant economic benefits for FA over RA. Even when only successful outcomes were assessed, treatment with RA was more expensive. TRIAL REGISTRATION: This trial was not registered. PROTOCOL: The protocol was not published before trial commencement.
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