| 1. |
- Bergström, Göran, 1964, et al.
(author)
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Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population
- 2021
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In: Circulation. - Philadelphia : American Heart Association. - 0009-7322 .- 1524-4539. ; 144:12, s. 916-929
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Journal article (peer-reviewed)abstract
- Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.
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| 2. |
- Chauca Strand, Gabriella, 1995, et al.
(author)
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Cancer Drugs Reimbursed with Limited Evidence on Overall Survival and Quality of Life : Do Follow-Up Studies Confirm Patient Benefits?
- 2023
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In: Clinical drug investigation. - : Springer. - 1173-2563 .- 1179-1918. ; 43:8, s. 621-633
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Journal article (peer-reviewed)abstract
- Background and ObjectiveCancer drug costs have increased considerably within healthcare systems, but many drugs lack quality-of-life (QoL) and overall survival (OS) data at the time of reimbursement approval. This study aimed to review the extent of subsequent literature documenting improvements in OS and QoL for cancer drug indications where no such evidence existed at the time of reimbursement approval.MethodsDrug indications with claims of added therapeutical value but a lack of evidence on OS and QoL that were reimbursed between 2010 and 2020 in Sweden were included for review. Searches were conducted in PubMed and ClinicalTrial.gov for randomized controlled trials examining OS and QoL.ResultsOf the 22 included drug indications, seven were found to have at least one trial with conclusive evidence of improvements in OS or QoL after a mean follow-up of 6.6 years. The remaining 15 drug indications either lacked subsequent randomized controlled trial data on OS or QoL (n = 6) or showed no statistically significant improvements (n = 9). Only one drug demonstrated evidence of improvement in both OS and QoL for its indication.ConclusionsA considerable share of reimbursed cancer drug indications continue to lack evidence of improvement in both OS and QoL. With limited healthcare resources and an increasing cancer burden, third-party payers have strong incentives to require additional post-reimbursement data to confirm any improvements in OS and QoL.
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| 3. |
- Svensson, Mikael, 1980, et al.
(author)
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Analyses of quality of life in cancer drug trials - a review of measurements and analytical choices in post-reimbursement studies
- 2024
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In: BMC Cancer. - : BioMed Central (BMC). - 1471-2407. ; 24:1
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Research review (peer-reviewed)abstract
- Objectives: For drugs reimbursed with limited evidence of patient benefits, confirmatory evidence of overall survival (OS) and quality of life (QoL) benefits is important. For QoL data to serve as valuable input to patients and decision-makers, it must be measured and analyzed using appropriate methods. We aimed to assess the measurement and analyses of post-reimbursement QoL data for cancer drugs introduced in Swedish healthcare with limited evidence at the time of reimbursement. Methods: We reviewed any published post-reimbursement trial data on QoL for cancer drugs reimbursed in Sweden between 2010 and 2020 with limited evidence of improvement in QoL and OS benefits at the time of reimbursement. We extracted information on the instruments used, frequency of measurement, extent of missing data, statistical approaches, and the use of pre-registration and study protocols. Results: Out of 22 drugs satisfying our inclusion criteria, we identified published QoL data for 12 drugs in 22 studies covering multiple cancer types. The most frequently used QoL instruments were EORTC QLQ-C30 and EQ-5D-3/5L. We identified three areas needing improvement in QoL measurement and analysis: (i) motivation for the frequency of measurements, (ii) handling of the substantial missing data problem, and (iii) inclusion and adherence to QoL analyses in clinical trial pre-registration and study protocols. Conclusions: Our review shows that the measurements and analysis of QoL data in our sample of cancer trials covering drugs initially reimbursed without any confirmed QoL or OS evidence have significant room for improvement. The increasing use of QoL assessments must be accompanied by a stricter adherence to best-practice guidelines to provide valuable input to patients and decision-makers.
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| 4. |
- Amin, Khabat, et al.
(author)
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Fall- and collision-related injuries among pedestrians in road traffic environment : A Swedish national register-based study
- 2022
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In: Journal of Safety Research. - : Elsevier. - 0022-4375 .- 1879-1247. ; 81, s. 153-165
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Journal article (peer-reviewed)abstract
- Objective: To investigate the burden of pedestrian injuries, including pedestrian fall injuries (PFI), compared to other transport-related injuries in Sweden and document their characteristics in terms of demographics, causes, type of injuries, and severity level with a focus on long-term consequences. Methods: Data were retrieved from the national Swedish Traffic Accident Data Acquisition register. A total of 361,531 fatalities and injuries were reported by emergency hospitals during 2010–2019, of which 127,804 were pedestrians (35%). We assessed the magnitude of PFIs and conducted comparative analyses to assess differences compared to other types of road users regarding sex, age, severity level, injury circumstances, hospital care, causes of accidents, and type of injuries. Results: Pedestrians were the second largest group of traffic-related deaths in Sweden after car occupants and accounted for just over a quarter of all fatal accidents in the road traffic environment. Of the total number of pedestrian fatalities, three out of four have been in collision accidents and the others in fall-related accidents. In terms of injuries, pedestrians were the largest group among all road users, regardless of the type of accident. PFIs accounted for a third of all injuries in the road traffic environment and nearly half of all injuries resulting in permanent medical impairment (i.e., 2.2 times more long-term consequences among PFIs compared to injured car occupants). Females (particularly middle-aged and older) and older adults were overrepresented, and most PFIs occurred on urban and municipal roads. The causes were often related to maintenance (e.g., slippery surfaces such as ice, snow, leaves or gravel together with uneven pavements and roads are the cause three out of four of PFIs). Among collision injuries, the representation was almost equal for sex and age. Conclusions: Injuries and fatalities among pedestrians are a considerable issue in the road traffic environment in Sweden. Contrary to other traffic groups, the incidence has not decreased over time, meaning that this issue must be met with specific measures and address the specific risk factors they are associated with. Practical Application: Including fall accidents in the definition of traffic accidents increases the chances of getting better information about the accidents and taking preventive measures.
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| 5. |
- Bonander, Carl, 1988-, et al.
(author)
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Are fire safe cigarettes actually fire safe? : Evidence from changes in US state laws
- 2018
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In: Injury Prevention. - : BMJ Publishing Group Ltd. - 1353-8047 .- 1475-5785. ; 24:3, s. 193-198
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To estimate the effects of fire safe cigarette laws on fire mortality and cigarette-related fires in the USA.METHODS: We examined the gradual implementation of the laws to identify their average effects, using difference-in-differences analysis to account for common year effects, time-invariant state effects, state-specific trends and observable time-varying state-level covariates.RESULTS: We found no statistically significant effects on all-cause fire mortality, residential fire mortality or cigarette-caused fire rates. The estimates for cigarette-caused fire deaths were significant under some specifications, but were not robust to the inclusion of state-specific trends or comparisons to effects on other cause-determined fires.CONCLUSIONS: Given the mixed state of our results, we conclude that previous claims regarding the effects of fire safe cigarette laws may be premature.
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| 6. |
- Bonander, Carl, 1988-
(author)
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Assessing the effects of societal injury control interventions
- 2016
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Doctoral thesis (other academic/artistic)abstract
- Injuries have emerged as one of the biggest public health issues of the 21th century. Yet, the causal effects of injury control strategies are often questioned due to a lack of randomized experiments. In this thesis, a set of quasi-experimental methods are applied and discussed in the light of causal inference theory and the type of data commonly available in injury surveillance systems. I begin by defining the interrupted time series design as a special case of the regression-discontinuity design, and the method is applied to two empirical cases. The first is a ban on the sale and production of non-reduced ignition propensity (RIP) cigarettes, and the second is a tightening of the licensing rules for mopeds. A two-way fixed effects model is then applied to a case with time-varying starting dates, attempting to identify the causal effects of municipality-provided home help services for the elderly. Lastly, the effect of the Swedish bicycle helmet law is evaluated using the comparative interrupted time series and synthetic control methods. The results from the empirical studies suggest that the stricter licensing rules and the bicycle helmet law were effective in reducing injury rates, while the home help services and RIP cigarette interventions have had limited or no impact on safety as measured by fatalities and hospital admissions. I conclude that identification of the impact of injury control interventions is possible using low cost means. However, the ability to infer causality varies greatly by empirical case and method, which highlights the important role of causal inference theory in applied intervention research. While existing methods can be used with data from injury surveillance systems, additional improvements and development of new estimators specifically tailored for injury data will likely further enhance the ability to draw causal conclusions in natural settings. Implications for future research and recommendations for practice are also discussed.
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| 7. |
- Bonander, Carl, 1988-, et al.
(author)
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Can the provision of a home help service for the elderly population reduce the incidence of fall-related injuries?
- 2016
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In: Injury Prevention. - : BMJ. - 1353-8047 .- 1475-5785. ; 22:Suppl.2, s. A181-A181
-
Journal article (peer-reviewed)abstract
- Background Fall-related injuries are a global public health problem, especially in elderly populations. In this study, the effect of an intervention aimed at reducing the risk of falls in the homes of community-dwelling elderly persons was evaluated. The intervention, which involves home hazards reduction by providing a minor home help service, is provided in the majority of Swedish municipalities.Methods Intention-to-treat effect estimates were derived using quasi-experimental time series intervention (ITS) analysis for immediate effects and a difference-in-discontinuity (RD) design for long term effects, and community-level estimates were pooled using meta-analysis. The outcome measure was the incidence of fall-related hospitalizations in the treatment population, the age of which varied by municipality (≥65 years, ≥67 years, ≥70 years or ≥75 years).Results We found no statistically significant reductions in injury incidence in the ITS (IRR 1.01 [95% CI: 0.98–1.05]) or RD (IRR 1.00 [95% CI: 0.97–1.03]) analyses. The results are robust to several different model specifications, including segmented panel regression analysis with linear trend change and community fixed effects parameters.Conclusions It is unclear whether absence of an effect is due to a low efficacy of the home hazards modifications provided, or a result of low utilisation. Additional studies of the effects on other quality of life measures are recommended before conclusions are drawn regarding the cost-effectiveness of the provision of home help services
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| 8. |
- Bonander, Carl, 1988-, et al.
(author)
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Can the provision of a minor home help service for the elderly population reduce the incidence of fall-related injuries? : A quasi-experimental study of the community-level effects on hospital admissions in Swedish municipalities
- 2016
-
In: Injury Prevention. - : BMJ Publishing Group Ltd. - 1353-8047 .- 1475-5785. ; 22:6, s. 412-419
-
Journal article (peer-reviewed)abstract
- BackgroundFall-related injuries are a global public health problem, especially in elderly populations. The effect of an intervention aimed at reducing the risk of falls in the homes of community-dwelling elderly persons was evaluated. The intervention mainly involves the performance of complicated tasks and hazards assessment by a trained assessor, and has been adopted gradually over the last decade by 191 of 290 Swedish municipalities. MethodsA quasi-experimental design was used where intention-to-treat effect estimates were derived using panel regression analysis and a regression-discontinuity (RD) design. The outcome measure was the incidence of fall-related hospitalizations in the treatment population, the age of which varied by municipality (≥65 years, ≥67 years, ≥70 years or ≥75 years).ResultsWe found no statistically significant reductions in injury incidence in the panel regression (IRR 1.01 [95% CI: 0.98-1.05]) or RD (IRR 1.00 [95% CI: 0.97-1.03]) analyses. The results are robust to several different model specifications, including segmented panel regression analysis with linear trend change and community fixed effects parameters.ConclusionsIt is unclear whether the absence of an effect is due to a low efficacy of the services provided, or a result of low adherence. Additional studies of the effects on other quality of life measures are recommended before conclusions are drawn regarding the cost-effectiveness of the provision of home help service programs.
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| 9. |
- Bonander, Carl, 1988-
(author)
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Compared with what? : Estimating the effects of injury prevention policies using the synthetic control method
- 2018
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In: Injury Prevention. - : BMJ Publishing Group Ltd. - 1353-8047 .- 1475-5785. ; 24, s. I60-I66
-
Journal article (peer-reviewed)abstract
- Introduction This paper discusses the application of the synthetic control method to injury-related interventions using aggregate data from public information systems. The method selects and determines the optimal control unit in the data by minimising the difference between the pre-intervention outcomes in one treated unit (eg, a state) and a weighted combination of potential control units. Method I demonstrate the synthetic control method by an application to Florida's post-2010 policy and law enforcement initiatives aimed at bringing down opioid overdose deaths. Using opioid-related mortality data for a panel of 46 states observed from 1999 to 2015, the analysis suggests that a weighted combination of Maine (46.1%), Pennsylvania (34.4%), Nevada (5.4%), Washington (5.3%), West Virginia (4.3%) and Oklahoma (3.4%) best predicts the preintervention trajectory of opioid-related deaths in Florida between 1999 and 2009. Model specification and placebo tests, as well as an iterative leave-k-out sensitivity analysis are used as falsification tests. Results The results indicate that the policies have decreased the incidence of opioid-related deaths in Florida by roughly 40% (or -6.19 deaths per 100.000 person-years) by 2015 compared with the evolution projected by the synthetic control unit. Sensitivity analyses yield an average estimate of -4.55 deaths per 100.000 person-years (2.5th percentile: -1.24, 97.5th percentile: -7.92). The estimated cumulative effect in terms of deaths prevented in the postperiod is 3705 (2.5th percentile: 1302, 97.5th percentile: 6412). Discussion Recommendations for practice, future research and potential pitfalls, especially concerning low-count data, are discussed. Replication codes for Stata are provided.
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| 10. |
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| 11. |
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| 12. |
- Bonander, Carl, 1988-, et al.
(author)
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Evidensbaserade åtgärder för cyklisters säkerhet : kunskapsöversikt
- 2013
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Reports (other academic/artistic)abstract
- Att cykla förespråkas ofta av hälso-, miljö- och framkomlighetsskäl, men är samtidigt ett av de farligare transportmedlen utifrån ett skadeperspektiv. För att cyklismen ska kunna utvecklas hållbart krävs därmed även att fokus läggs på säkerhetsaspekten vid policybeslut som syftar till att öka cyklandet. Syftet med denna rapport är att återge en samlad bild av det vetenskapliga kunskapsläget när det gäller säkerhetsfrämjande åtgärder för cyklister.Cykelhjälmar är ett välbeforskat ämne inom detta område och evidensen pekar relativt entydigt att hjälmar ger ett bra skydd mot huvud- och hjärnskador. Vissa studier har även uppmätt en skyddande effekt mot ansiktsskador, men detta har på senare tid delvis ifrågasatts. En ytterligare aspekt som har belysts är om dagens mjukare cykelhjälmar ger ett lika bra skydd som hjälmar med hårdare skal, som var vanligare förr. Denna hypotes har hittills varken kunnat styrkas eller förkastas, bl a till följd av att man inte registrerar hjälmtyp inom sjukvården. Cykelhjälmslagstiftning är ett annat kontroversiellt ämne där det har hävdats att hjälmlagarna som infördes i Australien och Nya Zeeland på 1990-talet avskräckte människor från att cykla, med åtföljande negativ effekt på folkhälsan till flöjd av minskad motion. Ingen stark evidens för denna hypotes har hittats, och det verkar för övrigt som att cykelhjälmslagar har haft en reducerande effekt på antalet cykelrelaterade huvudskador i de länder som har lyckats implementera dem på ett sätt som faktiskt ökar hjälmanvändningen i populationen. Effekten förefaller dock kulturellt betingad, och skillnader i bötesavgift eller risken att bli bötfälld är troligtvis av stor betydelse. Utbildning och ekonomiska styrmedel kan fungera som alternativ till lagstiftning, men evidensen för att utbildning verkligen ökar hjälmanvändningen är svag. Gällande ekonomiska styrmedel pekar evidensen mot att gratis hjälmutdelning är det som fungerar bäst. Större satsningar på samhällsnivå verkar fungera bättre än hjälmprogram som inriktar sig på skolor.När det gäller åtgärder för trafikmiljön är evidensen inte helt entydig, men det verkar som att fysiskt separerade cykelbanor är att föredra framför cykelfält (ett fält för cyklister på vägen, avgränsas med en spärrlinje). Fysiskt separerade cykelbanor kan dock vara mer problematiska i väjningsreglerade korsningar, vilket kan bero på att bilister inte uppmärksammar cyklister på samma sätt som när ett cykelfält finns anlagt på sidan av vägbanan. Detta ökar behovet av säkra cykelöverfarter och när det gäller sådana förefaller förhöjda cykelöverfarter fungera bättre än färgmarkerade överfarter. Olycksrisken på kombinerade gång- och cykelvägar bör inte förväxlas med olycksrisken på cykelspecifika banor, och ytterligare forskning behövs för att avgöra effekten av kombinerade banor. Rondeller verkar vara problematiska för cyklister om det inte finns en fysiskt separerad cykelbana i anslutning till dem. Övriga åtgärder som har uppvisat en positiv effekt är belysning på landsbygdsvägar, refuger i bostadsområden och dynamiska hastighetsskyltar i skolzoner.Intressant nog ser det ut att finnas få studier som har försökt mäta effekten av synbarhetsökande medel (t.ex. reflexer) med tillförlitliga utvärderingsmått (skaderisk eller olycksrisk). Att montera varselljus på cykeln som går igång automatiskt och inte kan kontrolleras av cyklisten verkar dock minska risken för kollisionsolyckor under dagtid.Även allmän cykelsäkerhetsutbildning i skolar har undersökts. Av de få studier som använt tillförlitliga utvärderingsmått har ingen kunnat uppvisa en positiv effekt. Fler studier behövs för att bedöma effekten av sådana åtgärder innan utbildning kan rekommenderas med starkt vetenskapligt stöd.
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| 13. |
- Bonander, Carl, 1988-, et al.
(author)
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Injury risks in schoolchildren with attention-deficit/hyperactivity or autismspectrumdisorder : Results from two school-based health surveys of 6- to 17-year-old children in Sweden
- 2016
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In: Journal of Safety Research. - : Elsevier. - 0022-4375 .- 1879-1247. ; 58, s. 49-56
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Journal article (peer-reviewed)abstract
- Introduction: Injuries are one of the leading causes of death and disability among children in Sweden and attention-deficit/hyperactivity disorder (ADHD) has previously been associated with an increased risk of injury in pediatric populations elsewhere in the world. Current evidence regarding the possible link between autism spectrum disorder (ASD) and injury risk appears limited, even though some potentially risk-increasing symptoms overlap. The purpose of this study was thus to study the association between both ADHD and ASD concerning the risk of injury among Swedish schoolchildren. Methods: Two samples were used: a population based register study containing data from 18,416 children ranging from the ages of 6-17 years collected by school nurses during 2012/2014 (Survey A), and a national cross-sectional study of 3202 ninth-grade children (similar to 15 years old) collected from 92 schools in 2011 (Survey B). The data were analyzed using chi(2)-tests and log binomial generalized linear models to obtain risk ratios (RR), comparing cases reportedly affected by ADHD or ASD to unaffected controls. Results: After adjusting for confounders, ADHD was associated with a 65% increased risk of injury (RR 1.65 [95% CI: 132-2.05] in Survey A, and a 57% increased risk of injury (RR 1.57 [95% CI: 1.27-1.95]) in Survey B. ASD was not significantly associated with any differences in injury risk (RR 0.81 [95% CI: 0.57-1.14]). Conclusions: The results indicate that there is an elevated injury risk among Swedish schoolchildren with ADHD but not for children with ASD. Future studies should focus on causal mechanisms mediating the association between ADHD and injuries in order to facilitate injury prevention strategies. Practical applications: Parents and teachers of schoolchildren with ADHD should be made aware of the elevated injury risks associated with the diagnosis. Safety experts and injury control professionals should consider the development of specialized prevention strategies in order to reduce these risks.
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| 14. |
- Bonander, Carl, 1988-, et al.
(author)
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Model-based economic evaluation of ice cleat distribution programmes for the prevention of outdoor falls among adults from a Swedish societal perspective
- 2022
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In: Injury Prevention. - : BMJ Publishing Group Ltd. - 1353-8047 .- 1475-5785. ; 28:2, s. 125-130
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Journal article (peer-reviewed)abstract
- Background: Slipping on snow or ice poses a significant health risk among older adults in Sweden. To combat this problem, about 80 Swedish municipalities have distributed ice cleats to older citizens (65+ years old) over the last decade. This paper details a cost-benefit analysis of such programmes. Materials and methods: We developed a decision-analytical model to estimate the costs and benefits of ice cleat programmes in Swedish municipalities compared with a business-as-usual scenario. The modelled benefits of the programme were based on effect estimates from previous research, data from population and healthcare registers and a survey of attitudes to and actual ice cleat use. The modelled costs of the programme were based on resource use data collected from 34 municipalities with existing ice cleat programmes. We assessed heterogeneity in the potential impact and benefit-to-cost ratios across all Swedish municipalities as a function of the average number of days with snow cover per year. Uncertainty in the cost-benefit results was assessed using deterministic and probabilistic sensitivity analyses. Results: The average benefit-to-cost ratio was 87, ranging from about 40 in low-risk municipalities to 140 in high-risk municipalities, implying that the potential benefits of ice cleat programmes greatly outweigh their costs. Probabilistic and deterministic sensitivity analyses support the robustness of this conclusion to parameter uncertainty and large changes in assumptions about the magnitude of the impact on ice cleat use and injuries. Conclusion: The benefits of distributing ice cleats to older adults appear to outweigh the costs from a Swedish societal perspective.
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| 15. |
- Bonander, Carl, 1988-
(author)
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Searching for causal effects of road traffic safety interventions : applications of the interrupted time series design
- 2015
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Licentiate thesis (other academic/artistic)abstract
- Traffic-related injuries represent a global public health problem, and contribute largely to mortality and years lived with disability worldwide. Over the course of the last decades, improvements to road traffic safety and injury surveillance systems have resulted in a shift in focus from the prevention of motor vehicle accidents to the control of injury events involving vulnerable road users (VRUs), such as cyclists and moped riders. There have been calls for improvements to the evaluation of safety interventions due to methodological problems associated with the most commonly used study designs. The purpose of this licentiate thesis was to assess the strengths and limitations of the interrupted time series (ITS) design, which has gained some attention for its ability to provide valid effect estimates. Two national road safety interventions involving VRUs were selected as cases: the Swedish bicycle helmet law for children under the age 15, and the tightening of licensing rules for Class 1 mopeds. The empirical results suggest that both interventions were effective in improving the safety of VRUs. Unless other concurrent events affect the treatment population at the exact time of intervention, the effect estimates should be internally valid. One of the main limitations of the study design is the inability to identify why the interventions were successful, especially if they are complex and multifaceted. A lack of reliable exposure data can also pose a further threat to studies of interventions involving VRUs if the intervention can affect the exposure itself. It may also be difficult to generalize the exact effect estimates to other regions and populations. Future studies should consider the use of the ITS design to enhance the internal validity of before-after measurements.
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| 16. |
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| 17. |
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| 18. |
- Bonander, Carl, 1988-, et al.
(author)
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Universities as engines for regional growth? : Using the synthetic control method to analyze the effects of research universities
- 2016
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In: Regional Science and Urban Economics. - : Elsevier. - 0166-0462 .- 1879-2308. ; 60, s. 198-207
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Journal article (peer-reviewed)abstract
- Are research universities important for regional growth and development? We study the impact on the regional economy of granting research university status to three former university colleges in three different regions in Sweden. We analyze the development in the treated regions compared to a set of control regions that are created using the synthetic control method. We find small or no effects on the regional economy. Our findings cast doubt on the effectiveness of research universities in fostering regional growth and development We contribute to the existing research by using a more credible identification strategy in assessing the effects of universities on the regional economy compared to what has usually been used in previous studies.
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| 19. |
- Bonander, Carl, 1988-, et al.
(author)
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Vaccination nudges : A study of pre-booked COVID-19 vaccinations in Sweden
- 2022
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In: Social Science and Medicine. - : Elsevier. - 0277-9536 .- 1873-5347. ; 309, s. 1-11
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Journal article (peer-reviewed)abstract
- A nudge changes people’s actions without removing their options or altering their incentives. During the COVID-19 vaccine rollout, the Swedish Region of Uppsala sent letters with pre-booked appointments to inhabitants aged16–17 instead of opening up manual appointment booking. Using regional and municipal vaccination data, wedocument a higher vaccine uptake among 16- to 17-year-olds in Uppsala compared to untreated control regions(constructed using the synthetic control method as well as neighboring municipalities). The results highlight pre-booked appointments as a strategy for increasing vaccination rates in populations with low perceived risk.
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| 20. |
- Bonander, Carl, 1988-, et al.
(author)
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When do default nudges work?
- 2023
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In: Oxford Open Economics. - : Oxford University Press. - 2752-5074. ; 2
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Journal article (peer-reviewed)abstract
- Nudging is a burgeoning topic in science and in policy, but evidence on the effectiveness of nudges among differentially incentivized groups is lacking. This paper exploits regional variations in the rollout of the Covid-19 vaccine in Sweden to examine the effect of a nudge on groups whose intrinsic incentives are different: 16- to 17-year-olds, for whom Covid-19 is not dangerous, and 50- to 59-year-olds, who face a substantial risk of death or severe disease. We find a significantly stronger response in the younger group compared with the older (11.7 vs 3.6 percentage point increase in our study period), consistent with the theory that nudges are more effective for choices that are not meaningful to the individual.
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| 21. |
- Chauca Strand, Gabriella, 1995, et al.
(author)
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Assessment of the clinical and cost-effectiveness evidence in the reimbursement decisions of new cancer drugs
- 2022
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In: ESMO Open. - : Elsevier. - 2059-7029. ; 7:5
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Journal article (peer-reviewed)abstract
- Background: This study aimed to describe the clinical and cost-effectiveness evidence supporting reimbursementdecisions of new cancer drugs and analyze the influence of trial characteristics and the cost per quality-adjusted lifeyears (QALYs) on the likelihood of reimbursement in Sweden.Patients and methods: Data were extracted from all appraisal dossiers for new cancer drugs seeking reimbursement inSweden and claiming added therapeutical value between the years 2010 and 2020. The data were analyzed usingdescriptive statistics, and logistic regression models were also used with the cost per QALY, study design,comparator, and evidence on final outcomes in the clinical trials as predictors of reimbursement.Results: All 60 included appraisals were based on trial evidence that assessed at least one final outcome (overallsurvival [OS] or quality of life [QoL]), although rarely as a primary outcome. Of the appraisals with a final decision(n ¼ 58), 79% were approved for reimbursement. Among the reimbursed drugs, only half had trial evidencedemonstrating improved OS or QoL. Only one drug had trial evidence supporting improvements in both OS andQoL. The average cost per QALY for reimbursed cancer drugs was estimated to be 748 560 SEK (V73 583). A highercost per QALY was found to decrease the likelihood of reimbursement by 9.4% for every 100 000 SEK (V9830)higher cost per QALY (P ¼ 0.03). For cost-effectiveness models without direct evidence of improvements in finaloutcomes, a larger QALY gain was observed compared with those with evidence mainly relying on intermediate andsurrogate outcomes.Conclusions: There are substantial uncertainties in the clinical and cost-effectiveness evidence underlyingreimbursement decisions of new cancer drugs. Decision makers should be cautious of the limited evidence onpatient-centered outcomes and the implications of allocating resources to expensive treatments with uncertainvalue for money.
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| 22. |
- Davidsson, Åsa
(author)
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Natural Hazards as Windows of Opportunity for Change : Character and Time Perspectives on Environmental Opportunities and Preparedness
- 2023
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Doctoral thesis (other academic/artistic)abstract
- In the aftermath of natural hazards, opportunities often arise for society to make changes that prevent future losses. These changes can also have environmental impacts, increase preparedness, and contribute to sustainable development. Due to the loss of biodiversity and land degradation, there is an urgent need for actions promoting positive environmental changes. Reversing the trend of land degradation and biodiversity loss is motivated by various reasons, such as preserving ecosystem functions and services that offer protection against natural hazards and reducing drivers of climate change. However, due to land degradation, loss of ecosystems, and human settlements in hazard-prone areas, it is also necessary to take actions that reduce the risk of tsunamis by improving preparedness. Improved preparedness from a people-centered perspective is a crucial aspect of sustainable development.The four papers that make up this thesis present and apply two new frameworks— one to assess the environmental effect of human-made societal changes, and one to evaluate the maintenance of a TEWS (Tsunami Early Warning System) over time. The two frameworks capture two aspects of change after a natural hazard: i) environmental impacts and ii) Disaster Risk Reduction (DRR). The thesis focuses particularly on time, a common aspect in both frameworks.The results indicate that changes triggered by natural hazards have a dual nature in that their impact on the environment can be both positive and negative. The thesis also provides evidence that past natural hazards can create a delayed window, which can be used as an argument for nature conservation during the establishment of national parks.The framework for evaluating the maintenance of a TEWS shows how difficult it is to operate all parts of the warning chain over time, from tsunami detection to evacuation. If parts of the chain are not maintained, the warning system may not be reliable.
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| 23. |
- Gustavsson, Johanna, 1972-, et al.
(author)
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A quasi-experimental evaluation of compliant flooring in a residential care setting
- 2018
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In: PLOS ONE. - San Francisco : PLOS. - 1932-6203. ; 13:7
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Journal article (peer-reviewed)abstract
- BackgroundFall injuries affect the lives of older people to a substantial degree. This quasi-experimental observational study investigates the potential fall injury reducing effect of a compliant flooring in a residential care setting.MethodsThe allocation of the compliant flooring was non-random. Data on fall-events and individual characteristics were collected in a residential care unit during a period of 68 months. The primary outcome was the fall injury rate per fall, and a logistic regression analysis was used to test for the effect of complaint flooring. Falls per 1000 bed days was the secondary outcome, used to measure the difference in fall risk on compliant flooring versus regular flooring.ResultsThe event dataset is an unbalanced panel with repeated observations on 114 individuals, with 70% women. The mean age was 84.9 years of age, the average Body Mass Index (BMI) was 24.7, and there was a mean of 6.57 (SD: 15.28) falls per individual. The unadjusted effect estimate showed a non-significant relative risk injury reduction of 29% per fall (RR 0.71 [95% CI: 0.46–1.09]) compared to regular flooring. Re-estimating, excluding identified outliers, showed an injury risk reduction of 63% (RR 0.37 [95% CI: 0.25–0.54]). Falls per 1000 bed days showed that individuals living in apartments with compliant flooring had a fall rate of 5.3 per 1000 bed days compared to a fall rate of 8.4 per 1000 bed days among individuals living in regular apartments. This corresponds to an incidence rate ratio (IRR) of 0.63 (95% exact Poisson CI: 0.50–0.80).ConclusionThe results of this non-randomized study indicate that compliant flooring has the potential to reduce the risk of fall injury without increasing the fall risk among older people in a Swedish residential care setting.
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| 24. |
- Gustavsson, Johanna, 1972-
(author)
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Effekter av stötdämpande golv som fallskadepreventiv åtgärd för äldre på särskilt boende
- 2018
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Doctoral thesis (other academic/artistic)abstract
- Fallskador är den vanligaste orsaken till skada i alla åldrar men är en skadetyp som blir vanligare ju äldre personen blir. Av de som läggs in på sjukhus för en skada till följd av ett fall är cirka 70 % över 65 år. Förutom det lidande som en fallskada utgör för den som drabbas finns också en utmaning kopplad till den pågående demografiska förskjutningen mot en allt äldre befolkning, vilket gör att omfattningen av problemet förutspås öka.Stötdämpande golv är en relativt ny intervention, framtagen i syfte att minska risken för fallskador bland äldre. Behovet av ett dämpande golv för att förebygga fallskador bland äldre personer på särskilda boenden bottnar i problemets stora omfattning och det faktum att det visat sig vara synnerligen svårt att förhindra fallskador i denna population. Principen att använda stötdämpande material för skademinskning har dock använts inom många områden, både länge och framgångsrikt. Genom att lägga ett dämpande material mellan kroppen och den yta som kroppen riskerar att stöta samman med minskar risken för skada.Utformning, testning och implementering av stötdämpande golv i vårdmiljöer har på senare år tagit fart, men studier i klinisk miljö är fortfarande få. Även om interventionen är teoretiskt välgrundad går det inte att fullt ut veta vilka effekter den kommer att få innan den testas i sin tänkta kontext. När det gäller stötdämpande golv finns en farhåga om att det skulle påverka balansen och på så sätt öka risken för fall. Andra aspekter är funktionen utifrån ett arbetsmiljöperspektiv och inte minst som en del av boendemiljön för de äldre. Därför är syftet med denna avhandling att undersöka den fallskadepreventiva effekten för äldre av ett stötdämpande golv på särskilt boende. Vidar undersöks också den befarade effekten på fallrisk samt eventuell effekten på arbetsmiljön för personalen och boendemiljön för de äldre.Resultaten i denna avhandling visar att stötdämpande golv har potentialen att minska risken för fallskador bland äldre på särskilt boende, en population där det hittills varit svårt att finna och implementera effektiva åtgärder. När det gäller den befarade oönskad bieffekt att golvet skulle leda till ökad fallrisk så tyder resultaten inte på någon sådan effekt, även om risken inte helt kan uteslutas.Undersköterskorna som arbetar på boendet upplever att golvet avdramatiserat fallen och att ljudnivån dämpats, aspekter de uppfattar som positiva. De upplever också att vissa utmaningar är förknippade med golvet. Främst att det tog tid att vänja sig vid att gå på det dämpande golvet och att tunga hjälpmedel (exempelvis lyftar) blev svårare att flytta. Resultaten tyder på att stötdämpande golv kan vara en framkomlig väg för fallskadeprevention riktat mot en äldre och skör population. Undersköterskorna var positiva till interventionen som påverkade deras arbetsmiljö på flera sätt, en aspekt som behöver undersökas vidare.Ett antal oväntade bieffekter uppstod som ett resultat av golvet. Från ett positivt perspektiv påverkade det dämpande golvet ljudbilden till det bättre, en faktor som underlättade implementeringen och acceptansen. Samtidigt identifierades problem som behöver lösas. Den ökade fysiska arbetsbelastning som personalen upplevde när de gick på det dämpande golvet samt det ökade rullmotståndet vid hantering av hjälpmedel behöver studeras vidare. Likaså behöver framtida utvecklingen av stötdämpande golv ta hänsyn till de unika förutsättningar som finns inom hälso- och sjukvården med avseende på slitage, hjälpmedel och hygien. I detta arbete behöver det etableras vilka dämpande egenskaper ett golv bör ha för att uppnå en optimal skademinskning i relation till annan funktionalitet.Att personalen upplever sig handfallna inför problemet med fall och fallskador, samt att de äldre är tämligen ointresserade av aktiva interventioner förstärker uppfattning om att stötdämpande golv kan ha stor potential. Framtiden får utvisa om dessa problem kan finna en lösning och om stötdämpande golv implementeras i stor skala och därmed bidra till att minska omfattningen av fallskador bland sköra äldre.
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| 25. |
- Gustavsson, Johanna, 1972-, et al.
(author)
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Individual and contextual factors associated with the use of anti-slip devices according to a Swedish national survey
- 2020
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In: Journal of Transport & Health. - : Elsevier. - 2214-1405 .- 2214-1413. ; 17, s. 1-8
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Journal article (peer-reviewed)abstract
- IntroductionWalking as a means of transportation can enforce a more active lifestyle and constitutes an environmentally friendly option to motor vehicles. However, in Northern countries, ice and snow tend to increase the risk of fall injuries among pedestrians during the winter. Therefore, the use of anti-slip devices, such as ice cleats or “studded footwear”, has been suggested as a viable intervention in promoting an active lifestyle whilst reducing injury risk. We investigate the usage of anti-slip devices, focusing on people 50 years and above living in Sweden.MethodWe used nationally representative survey data for men and women aged 18–79 years and residing in Sweden (n = 23,168), focusing primarily on middle-aged to older adults (50+ years). We used logistic regression to identify predictors of use.ResultsOverall, our estimates suggest that 28.5 (95% CI: 27.0, 29.2) percent of the Swedish population use anti-slip devices during snowy and slippery road conditions, with usage rates increasing strongly with age (from roughly 10 percent at 20 years to 60 percent at 79 years). In addition, the results show that being female, experiencing a fear of falling, living in a municipality with a high number of snow days, and using other types of personal safety equipment increases the probability of being an anti-slip device user.ConclusionsOur results imply that people at risk for outdoor fall injuries are high users. Even so, the number of pedestrian injuries due to slipping on snow and ice are still substantial and there are a several potential target groups for future intervention. More research is needed to determine if the devices are used correctly, and to determine the barriers to anti-slip device use in low-use populations.
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