| 1. |
- Englund, Martin, et al.
(author)
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Prevalence and incidence of rheumatoid arthritis in southern Sweden 2008 and their relation to prescribed biologics.
- 2010
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In: Rheumatology (Oxford, England). - : Oxford University Press (OUP). - 1462-0332 .- 1462-0324. ; 49, s. 1563-1569
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Journal article (peer-reviewed)abstract
- Objectives. To gain updated estimates of prevalence and incidence of RA and proportion on biological treatment in southern Sweden. Methods. Inpatient and outpatient health care provided to residents in the southernmost county of Sweden (1.2 million inhabitants) is registered in the Skåne Health Care Register (SHCR). We identified residents aged >/=20 years who had received a diagnosis of RA at least twice during 2003-08. Valid point prevalence estimates by 31 December 2008 were obtained by linkage to the Swedish population register, and information on biological treatment was obtained from the South Swedish Arthritis Treatment Group register. We also tested our estimates of RA occurrence in a series of sensitivity analyses to investigate the effect of altered case criteria and the uncertainty generated by clinical visits without diagnoses. Results. The prevalence of RA in adults was estimated to 0.66% (women = 0.94%, men = 0.37%). The prevalence peaked at age 70-79 years (women = 2.1%, men = 1.1%) before dropping in those aged >/=80 years. Of prevalent cases, 20% had ongoing biological treatment, a percentage that was highest in women aged 40-49 years (36%). The incidence of RA in 2008 was estimated as 50/100 000 (women = 68/100 000, men = 32/100 000). Conclusions. When compared with a previous report from southern Sweden, the prevalence of RA seems not to have declined in the last decade. The proportion of patients with ongoing biological treatment was slightly higher in women than men. SHCR data are promising additions to other methods to gain frequency estimates of clinically important disease in a timely and cost-efficient manner.
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| 2. |
- Jordan, Kelvin P., et al.
(author)
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International comparisons of the consultation prevalence of musculoskeletal conditions using population-based healthcare data from England and Sweden
- 2014
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In: Annals of the Rheumatic Diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 73:1, s. 212-218
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Journal article (peer-reviewed)abstract
- Objectives To assess the consultation prevalence of musculoskeletal (MSK) conditions as presented in different healthcare systems, and to determine the feasibility of comparing prevalence figures between nations. Methods The settings were an English regional database (Consultations in Primary Care Archive (CiPCA)) and the Swedish Skane County Health Care Register. Case definitions, data extraction and analysis procedures were harmonised. The number of people consulting per 10000 registered population in primary care, and in primary or secondary care, in the year 2010 (annual consultation prevalence) were determined for doctor-diagnosed osteoarthritis (OA), rheumatoid arthritis (RA), low back pain, and spondyloarthritis including psoriatic arthritis and ankylosing spondylitis (AS). Seven-year period consultation prevalences were also determined. Results Combining primary and secondary care, annual consultation prevalences of any MSK condition (2143 vs 1610/10000) and low back pain (587 vs 294/10000) were higher in England than in Sweden, but higher for RA, spondyloarthritis and psoriatic arthritis in Sweden. Annual primary care prevalence figures for OA (176 vs 196/10000), RA (25 vs 26/10000), spondyloarthritis (both 8/10000) and psoriatic arthritis (5 vs 3/10000) were similar between England and Sweden. AS was rarely recorded in Swedish primary care. These patterns were also observed for 7-year period consultation prevalences. Conclusions A rigorous methodological approach allowed feasible comparison of MSK consultation prevalence between England and Sweden. Differences in prevalence of inflammatory and unspecific pain conditions may be partially explained by known variations in healthcare systems and recording practice. Routine healthcare data offers potential for investigating variations in occurrence and outcome of MSK conditions between nations.
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| 3. |
- Jöud, Anna
(author)
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Back and neck pain: Patterns in healthcare consultations
- 2013
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Doctoral thesis (other academic/artistic)abstract
- Musculoskeletal disorders are very common and affects the individual by pain and functional impairment, and the society through work disability and healthcare utilisation. To what extent is less studied. Routinely collected healthcare registers is a potential resource for epidemiological studies of musculoskeletal disorders. Skåne region, as opposed to nationally in Sweden, has healthcare registers, covering all care including primary care. he overall aim of this thesis was to incorporate healthcare registers in the epidemiological research of consultation prevalence, healthcare consultation and sick leave patterns in patients with musculoskeletal disorders. he thesis comprises four studies in which the Skåne Healthcare Register was linked with national registers on sick leave, prescribed drugs, and socioeconomic status. Additionally, the thesis include a comparative study between data from the Skåne Healthcare Register with that of an United Kingdom (UK) consultation database. he main variables under study are in Paper I–III disease, consultations, and sick leave and in Paper IV education, income, and work status. he consultation prevalence of low back pain was estimated to 3–4% in the Skåne region while the figure was larger in the UK. People having low back pain had increased levels of healthcare consultations in general, and more pain diagnoses in particular. People diagnosed with whiplash associated neck injury had higher healthcare consultation rates already three years before the neck injury and the postinjury consultation level was associated with the preinjury consultation levels. Low socioeconomic status was associated with being diagnosed with chronic pain. It was feasible to use routinely collected databases in the studies of the burden of disease from musculoskeletal disorders, thus potentially also for other public health disorders. While there are vast potentials with register data, it is also important to bear in mind limitations due to e.g., missing data and misclassification which may introduce bias. My main findings indicate a need for early interventions after initial pain and neck injury to prevent the pain to becoming chronic. Stratification-based management is especially suggested.
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| 4. |
- Jöud, Anna, et al.
(author)
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Feasibility of a computerized male urethral catheterization simulator.
- 2010
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In: Nurse Education in Practice. - : Elsevier BV. - 1471-5953 .- 1873-5223. ; 10:2, s. 70-75
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Journal article (peer-reviewed)abstract
- Catheterization of the male urethra might cause harm and discomfort for the patient. Computer-based simulator training might improve the skills of students as well as professional nurses. This study aims to study the feasibility of a new portable computer-based male urethral catheterization simulator, Urecath (Melerit Urecath Vision). The simulator consists of three software modules: teaching (explains the different procedures in the catheterization), learning (game settings with practice and self-assessments tests), and simulator module that is connected to a box with a model of a penis where syringes and the urinary catheter can be inserted. Registered nurses (n=23), nurse assistants (n=14), nurse students (n=12), and a nurse assistant student (n=1) participated in a simulation session and answered 30 questions about the feasibility of the simulator. The participants appreciated the different modules, particularly the teaching and learning modules. The simulator module was appreciated for its cross-sectional views and feedback but was found to lack a tactile component; there was too little and no varying resistance when inserting the catheter. The participants perceived the present prototype of Urecath as a valuable education tool. The male urethral catheterization simulator prototype Urecath has advantages in its present shape but to be an alternative to existing training options for practicing male urethral catheterization, it should be complemented with a tactile mode and degrees of difficulty.
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| 5. |
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| 6. |
- Jöud, Anna, et al.
(author)
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Low back pain - epidemiology of consultations.
- 2012
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In: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 64:7, s. 1084-1088
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Journal article (peer-reviewed)abstract
- OBJECTIVES: Low back pain (LBP) affects most people at some stage in life. However, the burden on the health care system is unclear. We studied: 1) the one-year consultation prevalence 2) the rate of first-time consultation for LBP and related the frequency to other musculoskeletal conditions and 3) the health care utilization of LBP patients compared to the general population. METHODS: Using the health care register in southern Sweden (population 1.2 million), including diagnoses (ICD-10) by physicians, we identified all who in 2009 were diagnosed with LBP defined as lumbago with sciatica, low back pain, or other/unspecified dorsalgia. We defined first-time consultation as a consultation in 2009 without a record of a LBP diagnosis 2004-2008. Standardized health care utilization ratios were calculated for LBP patients compared to the general population seeking care. RESULTS: The one-year consultation prevalence of LBP in the population was 3.8% (women=4.3%, men=3.3%) and increased with age. LBP had been recorded in 17.1% of all patients (women=16.5%, men=18.0%) who had been diagnosed with any musculoskeletal condition. The rate of first-time consultation was 238 per 10,000 adults (women=265, men=209). The health care utilization ratio in female and male patients with LBP was 1.74 (95% CI 1.73-1.75) and 1.81 (95% CI 1.80-1.82) respectively. CONCLUSION: LBP, diagnosed in every 6(th) patient who consulted due to a musculoskeletal problem, is a public health concern that needs structured management. LBP patients consume close to twice as much health care as the general population and this warrants more awareness. © 2012 by the American College of Rheumatology.
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| 7. |
- Jöud, Anna, et al.
(author)
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Socioeconomic status and the risk for being diagnosed with spondyloarthritis and chronic pain: a nested case-control study.
- 2014
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In: Rheumatology International. - : Springer Science and Business Media LLC. - 1437-160X .- 0172-8172. ; 34:9, s. 1291-1298
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Journal article (peer-reviewed)abstract
- Socioeconomic status could potentially impact on which type of rheumatic diagnosis a patient receives. We determined whether different socioeconomic status is a risk factor for being diagnosed with spondyloarthritis (SpA) or chronic pain. In a nested case-control study, we identified two sets of adult cases diagnosed with (i) SpA (n = 1,194) and (ii) chronic pain (n = 3,730) during 2010-2012 in Skåne region, Sweden. We randomly sampled controls matched for age and sex. Level of education, marital status, and income were identified in national registers 4 years before inclusion. We also studied health-care utilization, prescribed pharmaceuticals, and work status. We used conditional logistic regressions and included socioeconomic variables and geographic area in the models. Low (odds ratio [OR] 1.69 95 % CI 1.50-1.91) or moderate education (OR 1.43 95 % CI 1.30-1.57), and low (OR 1.40 95 % CI 1.25-1.57) or moderate income (OR 1.24 95 % CI 1.10-1.38) were associated with a chronic pain diagnosis. For a SpA diagnosis, moderate income (OR 1.25 95 % CI 1.04-1.50) was the only significant factor identified. Both case groups had a larger proportion that did not work (P < 0.001), used more health care (P < 0.001), and were more frequently prescribed NSAIDs (P < 0.001) 4 years before diagnosis than controls. We confirmed that lower levels of education and income are associated with a chronic pain diagnosis. This association may reflect a true higher incidence of chronic pain and/or increased consultation propensity for such pain in people with socioeconomic status. We found no such association for SpA.
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| 8. |
- Kristensen, Lars Erik, et al.
(author)
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Sick leave in patients with ankylosing spondylitis before and after anti-TNF therapy: a population-based cohort study.
- 2012
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In: Rheumatology (Oxford, England). - : Oxford University Press (OUP). - 1462-0332 .- 1462-0324. ; 51, s. 243-249
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Journal article (peer-reviewed)abstract
- Objective. To study levels of sick leave and disability pension before and after TNF-antagonist therapy in AS patients. Methods. Using the population-based South Swedish Arthritis Treatment Group register, we identified 139 AS patients (aged 18-58 years, 78% men), who between January 2002 and December 2008 started their first treatment with adalimumab, etanercept or infliximab. We linked data to the payment register by the Swedish Social Insurance Agency and calculated the proportion on sick leave in 30-day intervals from 12 months before treatment start until 12 months after. For each AS patient, we randomly selected four subjects from the general population matched for age, sex and area of residence. Results. One to 3 months before treatment, an average of 24% of AS patients were on sick leave. During the first 6 months after treatment start, this fraction dropped to 15%, and further declined to 12% at 12 months (P < 0.001). Comparing AS patients with the general population, the relative risk of being on sick leave 3 months before treatment, treatment start and 12 months after treatment start was 8.0 (95% CI 4.6, 13.9), 9.2 (95% CI 5.4, 15.7) and 4.0 (95% CI 2.1, 6.3), respectively. The decrease in sick leave was not substantially offset by changes in disability pension. Conclusion. There is a decline in sick leave during the first 12 months after initiation of TNF-antagonist treatment in AS patients not explained by societal factors or secular trends. The proportion of AS patients on disability pension remained unchanged during the observation period.
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| 9. |
- Olofsson, Tor, et al.
(author)
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Decrease in sick leave among patients with rheumatoid arthritis in the first 12 months after start of treatment with tumour necrosis factor antagonists: a population-based controlled cohort study.
- 2010
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In: Annals of the Rheumatic Diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 69, s. 2131-2136
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Journal article (peer-reviewed)abstract
- OBJECTIVE: /st> To investigate the effect of tumour necrosis factor (TNF) antagonist treatment of patients with rheumatoid arthritis (RA) on sick leave (SL) and disability pension (DP) in a population-based setting in southern Sweden. METHODS: /st> All patients with RA in the South Swedish Arthritis Treatment Group register living in the county of Skåne (population 1.2 million), who started their first treatment with a TNF antagonist between January 2004 and December 2007 and were 18-58 years at treatment start (n=365), were identified. For each patient with RA, four matched reference subjects from the general population were randomly selected. Data were linked to the Swedish Social Insurance Agency register and the point prevalence of SL and DP as well as days of SL and DP per month were calculated from 360 days before until 360 days after treatment start. RESULTS: /st> At treatment start 38.6% of the patients with RA were registered for SL. During the first 6 months this share dropped to 28.5% (decrease by 26.2%, p<0.001). This level remained stable throughout the first treatment year. Comparing patients with RA to the reference group the relative risk of being on SL was 6.6 (95% CI 5.2 to 8.5) at initiation of anti-TNF treatment and 5.2 (95% CI 4.0 to 6.8) 1 year after that. The corresponding figures for DP were 3.4 (95% CI 2.7 to 4.2) and 3.2 (95% CI 2.7 to 3.9). CONCLUSIONS: /st> There was a marked decline in SL during the first 6 months of TNF antagonist treatment in patients with RA in southern Sweden, maintained throughout the first year, which was not offset by a corresponding increase in DP.
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| 10. |
- Peat, George, et al.
(author)
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Population-wide incidence estimates for soft tissue knee injuries presenting to healthcare in southern Sweden: data from the Skane Healthcare Register
- 2014
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In: Arthritis Research and Therapy. - : Springer Science and Business Media LLC. - 1478-6362 .- 1478-6354. ; 16:4
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Journal article (peer-reviewed)abstract
- Introduction: Soft tissue knee injury is a well-established and potent risk factor for development of knee osteoarthritis. However, there is a paucity of epidemiological data from the general population. Our aim was to estimate the annual person-level incidence for a wide spectrum of clinically diagnosed soft tissue knee injuries, and their distribution by age, sex, and season. Methods: In Sweden, in-and outpatient health care is registered using each individuals' unique personal identifier including International Classification of Diseases (ICD) 10 diagnostic code(s) as determined by physicians' clinical examination. For the calendar years 2004-2012, we studied the population in southern Sweden, Skane region (approx. 1.3 million). We identified residents who had at least one visit to a physician with clinically diagnosed knee ligament, meniscal, or other soft-tissue injury (S80.0, S83 and all subdiagnoses). We then calculated the mean annual incidence over the 9-year period. As a secondary objective, we investigated potential seasonal variation. Results: The annual incidence for males and females was 766 (95% CI: 742, 789) and 676 (649, 702) per 100,000 persons/year respectively. For males and females, the peak rate occurred in 15 to 19 year-olds (1698 per 100,000 men and 1464 per 100,000 women, respectively). In women, rates were lowest in the 25 to 34 year-old age range before rising again between the ages of 35 and 49 years. We found substantial seasonal variation, greatest in men, with peaks in March-May and August-October. Conclusions: The incidence of clinically diagnosed soft-tissue knee injury peaks in adolescence and emerging adulthood. However, a range of knee injuries continue to occur across the adult lifespan including at ages when osteoarthritis is typically diagnosed and managed. The potential cumulative effect on osteoarthritis progression of these injuries may warrant further investigation.
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| 11. |
- Stigmar, Kjerstin, et al.
(author)
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Promoting work ability in a structured national rehabilitation program in patients with musculoskeletal disorders: outcomes and predictors in a prospective cohort study
- 2013
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In: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 14
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Journal article (peer-reviewed)abstract
- Background: Musculoskeletal disorders (MSDs) are a major reason for impaired work productivity and sick leave. In 2009, a national rehabilitation program was introduced in Sweden to promote work ability, and patients with MSDs were offered multimodal rehabilitation. The aim of this study was to analyse the effect of this program on health related quality of life, function, sick leave and work ability. Methods: We conducted a prospective, observational cohort study including 406 patients with MSDs attending multimodal rehabilitation. Changes over time and differences between groups were analysed concerning function, health related quality of life, work ability and sick leave. Regression analyses were used to study the outcome variables health related quality of life (measured with EQ-5D), and sick leave. Results: Functional ability and health related quality of life improved after rehabilitation. Patients with no sick leave/disability pension the year before rehabilitation, improved health related quality of life more than patients with sick leave/disability pension the year before rehabilitation (p = 0.044). During a period of -/+ four months from rehabilitation start, patients with EQ-5D >= 0.5 at rehabilitation start, reduced their net sick leave days with 0.5 days and patients with EQ-5D <0.5 at rehabilitation start, increased net sick leave days with 1.5 days (p = 0.019). Factors negatively associated with sick leave at follow-up were earlier episodes of sick leave/disability pension, problems with exercise tolerance functions and mobility after rehabilitation. Higher age was associated with not being on sick leave at follow-up and reaching an EQ-5D >= 0.5 at follow-up. Severe pain after rehabilitation, problems with exercise tolerance functions, born outside of Sweden and full-time sick leave/disability pension the year before rehabilitation were all associated with an EQ-5D level < 0.5 at follow-up. Conclusions: Patients with MSDs participating in a national work promoting rehabilitation program significantly improved their health related quality of life and functional ability, especially those with no sick leave. This shows that vocational rehabilitation programs in a primary health care setting are effective. The findings of this study can also be valuable for more appropriate patient selection for rehabilitation programs for MSDs.
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| 12. |
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| 13. |
- Tekavec, Eva, et al.
(author)
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Population-based consultation patterns in patients with shoulder pain diagnoses
- 2012
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In: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 13
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Journal article (peer-reviewed)abstract
- Background: To assess the annual consultation prevalence and new onset consultation rate for doctor-diagnosed shoulder pain conditions. Methods: We identified all residents in the southernmost county in Sweden who received a shoulder pain diagnosis during 2006 (ICD-10 code M75). In subjects who did not consult due to such disorders during 2004 and 2005, we estimated the new onset consultation rate. The distribution of specific shoulder conditions and the length of the period of repeated consultation were calculated. Results: Annual consultation prevalence was 103/10 000 women and 98/10 000 men. New onset consultation rate was 80/10 000 women (peak in age 50-59 at 129/10 000) and 74/10 000 men (peak in age 60-69 at 116/10 000). About one fifth of both genders continued to consult more than three months after initial presentation, but only a few percent beyond two years. Rotator cuff - and impingement syndromes were the most frequent diagnoses. Conclusion: The annual consultation prevalence for shoulder pain conditions (1%) was similar in women and men, and about two thirds of patients consulted a doctor only once. Impingement and rotator cuff syndromes were the most frequent diagnoses.
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