| 1. |
- Ahmadi, Nasser, 1958, et al.
(författare)
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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
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Ingår i: Esc Heart Failure. - : Wiley. - 2055-5822. ; 3:3, s. 205-211
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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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| 2. |
- Bräutigam Ewe, Marie, et al.
(författare)
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Characteristics of patients seeking a health promotion and weight reduction program in primary care
- 2019
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Ingår i: Journal of Multidisciplinary Healthcare. - Macclesfield : Dove Medical Press (Dovepress). - 1178-2390. ; 12, s. 235-242
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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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| 3. |
- Bräutigam-Ewe, Marie, et al.
(författare)
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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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| 4. |
- Bräutigam-Ewe, Marie, et al.
(författare)
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Dietary advice on prescription: experiences with a weight reduction programme
- 2017
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Ingår i: Journal of Clinical Nursing. - Chichester : Wiley. - 0962-1067 .- 1365-2702. ; 26:5-6, s. 795-804
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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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| 5. |
- Cassinger, Cecilia, et al.
(författare)
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Geographies of fear – communicating safety in urban destinations
- 2019
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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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| 6. |
- Cassinger, Cecilia, et al.
(författare)
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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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| 7. |
- Cassinger, Cecilia, et al.
(författare)
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Mediatization of terror attacks and city brand image: A study of the Stockholm attack and the ’Last Night in Sweden’ event
- 2018
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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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| 8. |
- Cassinger, Cecilia, et al.
(författare)
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The mediatized tourism city under terror: Dilemmas and strategies for destination management organisations
- 2018
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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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| 9. |
- Cassinger, Cecilia, et al.
(författare)
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The narrative rhythm of terror: : A study of the Stockholm terrorist attack and the 'Last Night in Sweden' event
- 2018
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Ingår i: International Journal of Tourism Cities. - 2056-5607. ; 4:4, s. 484-494
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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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| 10. |
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| 11. |
- Ewing, Marcela, 1960, et al.
(författare)
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Diagnostic profile characteristics of cancer patients with frequent consultations in primary care before diagnosis: a case control study
- 2018
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 35:5, s. 559-566
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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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| 12. |
- Ewing, Marcela, 1960, et al.
(författare)
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Identification of patients with non-metastatic colorectal cancer in primary care: a case-control study.
- 2016
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Ingår i: The British journal of general practice : the journal of the Royal College of General Practitioners. - 1478-5242. ; 66:653
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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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| 13. |
- Ewing, Marcela, 1960, et al.
(författare)
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Increased consultation frequency in primary care, a risk marker for cancer: a case-control study
- 2016
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 34:2, s. 205-212
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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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| 14. |
- Holtedahl, Knut, et al.
(författare)
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Abdominal symptoms and cancer in the Abdomen : Prospective cohort study in European primary care
- 2018
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Ingår i: British Journal of General Practice. - : ROYAL COLL GENERAL PRACTITIONERS. - 0960-1643 .- 1478-5242. ; 68:670, s. 301-310
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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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| 15. |
- Holtedahl, K., et al.
(författare)
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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
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Ingår i: Heliyon. - : Elsevier BV. - 2405-8440. ; 3:6
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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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| 16. |
- Högberg, Cecilia, 1953-
(författare)
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Diagnosing colorectal cancer in primary care : the value of symptoms, faecal immunochemical tests, faecal calprotectin and anaemia
- 2017
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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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| 17. |
- Lundgren, Stefan, et al.
(författare)
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Tingsrätters effektivitet och produktivitet
- 2017
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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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| 18. |
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| 19. |
- Oja, C., et al.
(författare)
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Making life work for both themselves and their parents alone- how children aged 11-16 view themselves in relation to their chronically ill parents in a primary health care setting
- 2019
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Ingår i: International Journal of Adolescence and Youth. - : Informa UK Limited. - 0267-3843 .- 2164-4527. ; 24:4, s. 408-420
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Tidskriftsartikel (refereegranskat)abstract
- This study explores the main concern and life strategies of children whose parents are chronically ill in a Primary Health Care (PHC) center in Stockholm, Sweden. Data was collected through semi-structured individual interviews, and qualitative inductive constant comparative analysis resulted in a conceptual model. The two main strategies the children used were to understand the situation and to adopt a parental role. Children saw themselves as main contributors into the functioning of their families. Results show that these children also viewed their situation as difficult. It is an important mental health task for professionals in PHC to reach out and inform both ill parents and their children that children are very interested and involved in their parents' health. These children need respect for both their capacity and their vulnerability as they struggle to make life stable and functional for themselves and their parents. Further research and development of appropriate interventions are needed in this ethically challenging area.
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| 20. |
- Sällfors-Holmqvist, Anna, et al.
(författare)
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Autoimmune diseases in Adult Life after Childhood Cancer in Scandinavia (ALiCCS).
- 2015
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 1468-2060 .- 0003-4967.
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Tidskriftsartikel (refereegranskat)abstract
- The pattern of autoimmune diseases in childhood cancer survivors has not been investigated previously. We estimated the risk for an autoimmune disease after childhood cancer in a large, population-based setting with outcome measures from comprehensive, nationwide health registries.
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| 21. |
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