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- Arnlind, Marianne Heibert
(author)
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Asthma treatment in primary care : studies of variability and health economic aspects
- 2009
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Doctoral thesis (other academic/artistic)abstract
- Background: Most asthma patients in Sweden are treated in primary care, but little is known about economic aspects of asthma treatment in that setting and about the regional variation in the use of antiasthmatics drugs and the adherence to national guidelines for the treatment of asthma. General aims: To analyze treatment of asthma patients in terms of classification of severity, quality of life, variation in utilization, clinical practice and costs from a societal perspective. Methods: A prospective cross-sectional design was used to study the pharmaceutical costs of asthma and their relationship to quality of life, asthma severity, clinical practice and lungfunction and to compare different approaches to classifying asthma severity, all in primary care. A prospective cluster-randomized controlled trial was carried out in primary care to study the effect of information and monitoring on asthma control. To study regional variations in antiasthmatics, a registry study based on the Swedish National Prescribed Drug Register was performed. In all studies, the population consists of adult patients. However, in the registry study, there was an upper limit of 44 years of age to exclude patients with COPD-patients. Results and conclusions: There are large variations in costs of pharmaceuticals for asthma treatment between primary care centers in Stockholm as well as between different Swedish regions. Asthma severity explains only a small part of the variations in pharmaceutical costs and does not account for the differences between centers. When different approaches used to classify severity were tested, no strategy tested strategies was superior. Adherence to guidelines is low among caregivers. There is room for improvement of both asthma control and quality of life of asthma patients treated in primary care. Adding structured information and monitoring by diary can improve the patient s outcome.
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| 4. |
- Iwarsson, Erik, et al.
(author)
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Analysis of cell-free fetal DNA in maternal blood for detection of trisomy 21, 18 and 13 in a general pregnant population and in a high risk population - a systematic review and meta-analysis
- 2017
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In: Acta Obstetricia et Gynecologica Scandinavica. - : WILEY-BLACKWELL. - 0001-6349 .- 1600-0412. ; 96:1
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Research review (peer-reviewed)abstract
- IntroductionThe aim of this study was to review the performance of non-invasive prenatal testing (NIPT) for detection of trisomy 21, 18 and 13 (T21, T18 and T13) in a general pregnant population as well as to update the data on high-risk pregnancies. Material and methodsSystematic review and meta-analysis. PubMed, Embase and the Cochrane Library were searched. Methodological quality was rated using QUADAS and scientific evidence using GRADE. Summary measures of diagnostic accuracy were calculated using a bivariate random-effects model. ResultsIn a general pregnant population, there is moderate evidence that the pooled sensitivity is 0.993 (95% CI 0.955-0.999) and specificity was 0.999 (95% CI 0.998-0.999) for the analysis of T21. Pooled sensitivity and specificity for T13 and T18 was not calculated in this population due to the low number of studies. In a high-risk pregnant population, there is moderate evidence that the pooled sensitivities for T21 and T18 are 0.998 (95% CI 0.981-0.999) and 0.977 (95% CI 0.958-0.987) respectively, and low evidence that the pooled sensitivity for T13 is 0.975 (95% CI 0.819-0.997). The pooled specificity for all three trisomies is 0.999 (95% CI 0.998-0.999). ConclusionsThis is the first meta-analysis using GRADE that shows that NIPT performs well as a screen for trisomy 21 in a general pregnant population. Although the false positive rate is low compared with first trimester combined screening, women should still be advised to confirm a positive result by invasive testing if termination of pregnancy is under consideration.
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| 5. |
- Jansson, Sven-Arne, et al.
(author)
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Health-related quality of life, assessed with a disease-specific questionnaire, in Swedish adults suffering from well-diagnosed food allergy to staple foods
- 2013
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In: Clinical and Translational Allergy. - : Wiley. - 2045-7022. ; 3:21
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Journal article (peer-reviewed)abstract
- BackgroundOur aim was to investigate the factors that affect health related quality of life (HRQL) in adult Swedish food allergic patients objectively diagnosed with allergy to at least one of the staple foods cow’s milk, hen’s egg or wheat. The number of foods involved, the type and severity of symptoms, as well as concomitant allergic disorders were assessed.MethodsThe disease-specific food allergy quality of life questionnaire (FAQLQ-AF), developed within EuroPrevall, was utilized. The questionnaire had four domains: Allergen Avoidance and Dietary Restrictions (AADR), Emotional Impact (EI), Risk of Accidental Exposure (RAE) and Food Allergy related Health (FAH). Comparisons were made with the outcome of the generic questionnaire EuroQol Health Questionnaire, 5 Dimensions (EQ-5D). The patients were recruited at an outpatient allergy clinic, based on a convincing history of food allergy supplemented by analysis of specific IgE to the foods in question. Seventy-nine patients participated (28 males, 51 females, mean-age 41 years).ResultsThe domain with the most negative impact on HRQL was AADR, assessing the patients’ experience of dietary restrictions. The domain with the least negative impact on HRQL was FAH, relating to health concerns due to the food allergy. One third of the patients had four concomitant allergic disorders, which had a negative impact on HRQL. Furthermore, asthma in combination with food allergy had a strong impact. Anaphylaxis, and particularly prescription of an epinephrine auto-injector, was associated with low HRQL. These effects were not seen using EQ-5D. Analyses of the symptoms revealed that oral allergy syndrome and cardiovascular symptoms had the greatest impact on HRQL. In contrast, no significant effect on HRQL was seen by the number of food allergies.ConclusionsThe FAQLQ-AF is a valid instrument, and more accurate among patients with allergy to staple foods in comparison to the commonly used generic EQ-5D. It adds important information on HRQL in food allergic adults. We found that the restrictions imposed on the patients due to the diet had the largest negative impact on HRQL. Both severity of the food allergy and the presence of concomitant allergic disorders had a profound impact on HRQL.
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| 6. |
- Jansson, Sven-Arne, et al.
(author)
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Okänt hur mycket astma och allergier kostar samhället : kostnadsstudier kan ge bättre planering av vård och forskning
- 2007
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In: Läkartidningen. - 0023-7205 .- 1652-7518. ; 104:39, s. 2792-2796
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Journal article (peer-reviewed)abstract
- Få studier av kostnader för allergisjukdomar är genomförda nationellt och internationellt. I Sverige är det endast astma som är studerat, och för rinit och eksem finns endast ett fåtal internationella studier. Inom födoämnesöverkänslighet finns över huvud taget inga sjukdomskostnadsstudier publicerade. Det är svårt att jämföra olika studier, såväl nationellt som internationellt, på grund av olika studiedesign, hälso- och sjukvårdssystem och behandlingstraditioner. De svenska kostnaderna för de studerade allergisjukdomarna har skattats och uppgår sannolikt till över 10 miljarder kronor totalt per år, varav kostnaden för astma uppgår till cirka 7 miljarder kronor. Det är viktigt att studier kommer till stånd i Sverige för att få en uppfattning om de faktiska svenska kostnaderna för allergisjukdomarna.
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| 7. |
- Johansson, Eva, et al.
(author)
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Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines: A systematic review of the literature
- 2013
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In: Acta Oncologica. - : Informa Healthcare. - 0284-186X .- 1651-226X. ; 52:5, s. 886-892
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Research review (peer-reviewed)abstract
- Background. The use of central venous lines carries a significant risk for serious complications and high economic costs. Lately, the peripherally inserted central venous catheter (PICC) has gained in popularity due to presumed advantages over other central venous lines. The aim of this systematic literature review was to identify scientific evidence justifying the use of PICC. Material and methods. The literature review was performed according to the principles of Cochrane Collaboration. The electronic literature search included common databases up to March 2011. Only those studies rated as high or moderate quality were used for grading of evidence and conclusions. Results. The search resulted in 827 abstracts, 48 articles were read in full text, and 11 met the inclusion criteria. None of the articles was classified as high quality and two had moderate quality. The results of these two studies indicate that PICC increases the risk for deep venous thrombosis (DVT), but decreases the risk for catheter occlusion. The quality of scientific evidence behind these conclusions, however, was limited. Due to the lack of studies with sufficiently high quality, questions such as early complications, patient satisfaction and costs could not be answered. Discussion. We conclude that although PICCs are frequently used in oncology, scientific evidence supporting any advantage or disadvantage of PICC when comparing PICC with traditional central venous lines is limited, apart from a tendency towards increased risk for DVT and a decreased risk for catheter occlusion with PICC.
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- Protudjer, Jennifer L. P., et al.
(author)
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Household Costs Associated with Objectively Diagnosed Allergy to Staple Foods in Children and Adolescents
- 2015
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In: Journal of Allergy and Clinical Immunology-In Practice. - : Elsevier BV. - 2213-2198 .- 2213-2201. ; 3:1, s. 68-75
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Journal article (peer-reviewed)abstract
- BACKGROUND: We previously reported that indirect and intangible costs burden households with a food allergic adult. We now extend our investigation to households with food allergic children and adolescents. OBJECTIVE: The objective of this study was to estimate direct, indirect, and intangible costs of food allergy in households with a child and/or adolescent with objectively diagnosed allergy to staple foods (cow's milk, hen's egg, and/or wheat), and to compare these costs with age-and sex-matched controls. METHODS: Direct and indirect cost parent-reported data collected via the Food Allergy Socio-Economic Questionnaire of 84 children (0-12 years) and 60 adolescents (13-17 years) with objectively diagnosed allergy to staple foods ("cases") and age- and sex-matched controls (n = 94 children; n = 56 adolescents) were compared. Annual household costs were calculated. Total household costs included direct plus indirect costs. Intangible costs included parent-reported health of their child and/or adolescent, standard of living, and perceptions of well-being. RESULTS: Amongst cases, total household costs were higher by (sic)3961 for children and (sic)4792 for adolescents versus controls (P < .05), and were driven by direct (eg, medications) and indirect (eg, time with health care professionals) costs. For children only, a history of anaphylaxis was associated with higher direct costs than no anaphylaxis ((sic)13,016 vs (sic)10,044, P < .05). Intangible costs (eg, parent-reported health of a child and/or adolescent) were significantly impacted amongst cases versus controls (P < .01). CONCLUSION: Households with a child and/or adolescent with objectively diagnosed allergy to staple foods have higher total household costs than controls. Direct and indirect costs were significantly higher for cases versus controls amongst children only. Amongst both age groups, such allergy adversely impacted intangible costs. (C) 2015 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology.
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| 10. |
- Protudjer, Jennifer Lisa Penner, et al.
(author)
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Impaired health-related quality of life in adolescents with allergy to staple foods
- 2016
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In: Clinical and Translational Allergy. - : Wiley. - 2045-7022. ; 6
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Journal article (peer-reviewed)abstract
- Background: Cow's milk, hen's egg and wheat are staple foods in a typical western diet. Despite the ubiquity of these foods, the impact of staple food allergy on health-related quality of life (HRQL) amongst adolescents is incompletely understood. The aims of this study were to make use of the Swedish version of EuroPrevall's disease-specific food allergy quality of life questionnaire-teenager form (FAQLQ-TF) and to investigate the association between objectively-diagnosed staple food allergy and HRQL amongst adolescents. Methods: In this cross-sectional study, 58 adolescents aged 13-17 years [n = 40 (69 %) boys] with objectively-diagnosed allergy to the staple foods cow's milk, hen's egg and/or wheat and living in Stockholm, Sweden were included. Adolescents completed the FAQLQ-TF, which has a corresponding scale of 1 = best HRQL, and 7 = worst HRQL. Overall HRQL and domain-specific HRQL were established. Adolescents also reported symptoms, adrenaline auto injector (AAI) prescription and presence of other food allergies. A history of anaphylaxis was defined among those reporting difficulty breathing, inability to stand/collapse, and/or loss of consciousness. Clinically different HRQL was set at a mean difference of >= 0.5. Results: Overall mean HRQL was poorer than average [mean: 4.70/7.00 (95 % CI 4.30-5.01)]. The domain risk of accidental exposure was significantly associated with clinically better HRQL than the domain allergen avoidance and dietary restrictions (mean difference = 0.76; p < 0.001). Girls had clinically worse, but not statistically significantly different mean HRQL than boys (mean difference = 0.71; p < 0.07). HRQL tended to be worse amongst those with allergies to more than three foods or an AAI prescription. The number and types of symptoms, including a history of anaphylaxis were not associated with worse HRQL. Conclusions: As ascertained via a food allergy-specific questionnaire, adolescents with staple food allergy report poorer than average HRQL, specifically in relation to emerging independence and the need for support. Girls have clinically worse HRQL than boys. The number and type of previous symptoms and history of anaphylaxis were not associated with worse HRQL.
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