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- Fagerberg, Björn, et al.
(författare)
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Extremvärme ett ökande problem för globala folkhälsan : Klimatförändringarnas negativa hälsoeffekter drabbar även Sverige
- 2016
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 113:31-33
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Forskningsöversikt (övrigt vetenskapligt/konstnärligt)abstract
- High temperatures have a direct impact on body functions. Heat waves increase mortality risks due to myocardial infarction, stroke, and pulmonary disease. Cold temperatures also increase mortality, but with a longer latency. A recent study found only a small difference between the minimal mortality temperature (MMT) and the temperatures at which mortality rose steeply, although the majority of deaths occurred at temperatures below MMT. Global climate change with increasing temperatures seriously threatens health, work capacity, and generation of household incomes, particularly among poor people in hot countries. In Sweden, heat waves increase mortality in vulnerable groups of elderly people and patients with chronic heart and lung diseases, as well as those performing intensive physical work in hot environments. The medical profession can play an important role not only in prevention of climate change, but also in adaptation to climate change with the goal of minimizing health risks.
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| 6. |
- Vilhelmsson, Andreas, et al.
(författare)
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Global folkhälsa : om livsvillkor, sjukdomar och social rättvisa
- 2016
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Aldrig i mänsklighetens historia har jordens befolkning haft det så bra som de har det nu. Världens rikedomar är större än de någonsin tidigare varit och i takt med det ökade välståndet blir världens invånare överlag allt friskare och allt äldre. Samtidigt har de generella välfärds- och hälsoökningarna inte kommit alla till del. En person som idag föds i USA förväntas tjäna 100 gånger mer under sin livstid än en samtida person i Zambia, samtidigt som en genomsnittlig japan förväntas leva 38 år längre än en sierra leonian. Ett stort problem är således att den globala hälsoförbättringen de senaste decennierna har varit djupt ojämlik. Syftet med denna bok är att redogöra för de globala folkhälsoproblem som idag utgör den största bördan för mänskligheten, liksom för de övergripande globala faktorer som har en påverkan på olika befolkningars hälsa. Boken syftar även till att presentera en begreppslig ram för folkhälsoområdet, och den diskuterar ett antal etiska aspekter rörande den globala hälsosituationen och dess olika orsaker. Den argumenterar slutligen för att det globala samfundet bör ta ett större ansvar för att åtgärda nuvarande problem och skapa en hållbar förändring.
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| 7. |
- Vilhelmsson, Andreas, et al.
(författare)
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Pharmaceutical Industry Off-label Promotion and Self-regulation: A Document Analysis of Off-label Promotion Rulings by the United Kingdom Prescription Medicines Code of Practice Authority 2003-2012.
- 2016
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Ingår i: PLoS Medicine. - : Public Library of Science (PLoS). - 1549-1676. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: European Union law prohibits companies from marketing drugs off-label. In the United Kingdom — as in some other European countries, but unlike the United States — industry self-regulatory bodies are tasked with supervising compliance with marketing rules. The objectives of this study were to (1) characterize off-label promotion rulings in the UK compared to the whistleblower-initiated cases in the US, and (2) shed light on the UK self-regulatory mechanism for detecting, deterring, and sanctioning off-label promotion. Methods and Findings: We conducted structured reviews of rulings by the UK self-regulatory authority, the Prescription Medicines Code of Practice Authority (PMCPA), between 2003 and 2012. There were 74 off-label promotion rulings involving 43 companies and 65 drugs. Nineteen companies were ruled in breach more than once, and ten companies were ruled in breach three or more times over the 10ten-year period. Drawing on a typology previously developed to analyzeanalyse US whistleblower complaints, we coded and analyzedanalysed the apparent strategic goals of each off-label marketing scheme and the practices consistent with those alleged goals. 50% of rulings cited efforts to expand drug use to unapproved indications, and 39% and 38% cited efforts to expand beyond approved disease entities and dosing strategies, respectively. The most frequently described promotional tactic was attempts to influence prescribers (n = 72, 97%), using print material (70/72, 97%), for example, advertisements (21/70, 30%). Although rulings cited prescribers as the prime target of off-label promotion, competing companies lodged the majority of complaints (prescriber: n = 16, 22%, versuss. companies: n = 42, 57%). Unlike US whistleblower complaints, few UK rulings described practices targeting consumers (n = 3, 4%), payers (n = 2, 3%), or company staff (n = 2, 3%). Eight UK rulings (11%) pertaining to six drugs described promotion of the same drug for the same off-label use as was alleged by whistleblowers in the US. However, while the UK cases typically related to only one or a few claims made in printed material, several complaints in the US alleged multifaceted and covert marketing activities. Because this study is limited to PMCPA rulings and whistleblower-initiated federal cases, it may offer a partial view of exposed off-label marketing. Conclusion: The UK self-regulatory system for exposing marketing violations relies largely on complaints from company outsiders, which may explain why most off-label promotion rulings relate to plainly visible promotional activities such as advertising. This contrasts with the US, where Department of Justice investigations and whistleblower testimony have alleged complex off-label marketing campaigns that remain concealed to company outsiders. UK authorities should consider introducing increased incentives and protections for whistleblowers combined with US-style governmental investigations and meaningful sanctions. UK prescribers should be attentive to, and increasingly report, off-label promotion.
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| 8. |
- Vilhelmsson, Andreas, et al.
(författare)
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Pharmaceutical lobbying and pandemic stockpiling of Tamiflu: a qualitative study of arguments and tactics
- 2018
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Ingår i: Journal of Public Health. - : Oxford University Press (OUP). - 1741-3842 .- 1741-3850. ; 40:3, s. 646-651
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Tidskriftsartikel (refereegranskat)abstract
- Background Little is known about how pharmaceutical companies lobby authorities or experts regarding procurement or the use of vaccines and antivirals. This paper investigates how members of Denmark's pandemic planning committee experienced lobbying efforts by Roche, manufacturer of Tamiflu, the antiviral that was stockpiled before the 2009 A(H1N1) pandemic. Methods Analysis of interviews with six of seven members of the Danish core pandemic committee, supplemented with documentary analysis. We sought to identify (1) arguments and (2) tactics used in lobbying, and to characterize interviewees' views on the impact of (3) lobbying and (4) scientific evidence on the decision to stockpile Tamiflu. Results Roche lobbied directly (in its own name) and through a seemingly independent third party. Roche used two arguments: (1) the procurement agreement had to be signed quickly because the drug would be delivered on a first-come, first-served basis and (2) Denmark was especially vulnerable to an influenza crisis because it had smaller Tamiflu stocks than other countries. Most interviewees suspected that lobbying had an impact on Tamiflu procurement. Conclusions Our study highlights risks posed by pharmaceutical lobbying. Arguments and tactics deployed by Roche are likely to be repeated whenever many countries are negotiating drug procurements in a monopolistic market.
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| 9. |
- Vilhelmsson, Andreas, et al.
(författare)
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Reducing health inequalities with interventions targeting behavioral factors among individuals with low levels of education - A rapid review
- 2018
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:4
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Forskningsöversikt (refereegranskat)abstract
- Individuals with low levels of education systematically have worse health than those with medium or high levels of education. Yet there are few examples of attempts to summarize the evidence supporting the efficacy of interventions targeting health-related behavior among individuals with low education levels, and a large part of the literature is descriptive rather than analytical. A rapid review was carried out to examine the impact of such interventions. Special attention was given to the relative impact of the interventions among individuals with low education levels and their potential to reduce health inequality. Of 1,365 articles initially identified, only 31 were deemed relevant for the review, and of those, nine met the inclusion and quality criteria. The comparability of included studies was limited due to differences in study design, sample characteristics, and definitions of exposure and outcome variables. Therefore, instead of performing a formal meta-analysis, an overall assessment of the available evidence was made and summarized into some general conclusions. We found no support for the notion that the methods used to reduce smoking decrease inequalities in health between educational groups. Evidence was also limited for decreasing inequality through interventions regarding dietary intake, physical activity and mental health. Only one study was found using an intervention designed to decrease socioeconomic inequalities by increasing the use of breast cancer screening. Thus, we concluded that there is a lack of support regarding this type of intervention as well. Therefore, the main conclusion is that solid evidence is lacking for interventions aimed at individual determinants of health and that more research is needed to fill this gap in knowledge.
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| 10. |
- Vilhelmsson, Andreas
(författare)
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Using Qualitative Content Analysis to Study Consumer Reports on Adverse Drug Reactions
- 2018
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Bok (refereegranskat)abstract
- Using qualitative content analysis on adverse drug reactions reports filed to an open Internet-based reporting system in Sweden, this study explored patients’ and consumers’ experiences of antidepressant treatment and the medical encounter. By scrutinizing free text comments in 181 individual consumer reports of adverse drug reactions, we could obtain important information about how people, as individuals and as a group, experience mental health problems, their diagnosis and treatment, and their relationships with the health care personnel.
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