| 1. |
- Alinaghizadeh, Hassan, Statistiker, 1961-
(author)
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Radioactive fall-out from the Chernobyl nuclear power plant accident in 1986 and cancer rates in Sweden, a 25-year follow up
- 2019
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Licentiate thesis (other academic/artistic)abstract
- Aim: The current research aimed to study the association between exposure to low-dose radiation fallout after the Chernobyl accident in 1986 and the incidence of cancer in Sweden.Methods: A nationwide study population, selecting information from nine counties out of 21 in Sweden for the period from 1980 – 2010.In the first study, an ecological design was defined for two closed cohorts from 1980 and 1986. A possible exposure response pattern between the exposure to 137Cs on the ground and the cancer incidence after the Chernobyl nuclear power plant accident was investigated in the nine northernmost counties of Sweden (n=2.2 million). The activity of 137Cs at the county, municipality and parish level in 1986 was retrieved from the Swedish Radiation Safety Authority (SSI) and used as a proxy for received dose of ionizing radiation. Information about diagnoses of cancer (ICD-7 code 140-209) from 1958 – 2009 were received from the Swedish Cancer Registry, National Board of Health and Welfare (368,244 cases were reported for the period 1958 to 2009). The incidence rate ratios were calculated by using Poisson Regression for pre-Chernobyl (1980 – 1986) and post-Chernobyl (1986 – 2009) using average deposition of 137Cs at three geographical levels: county (n=9), municipality (n=95), and parish level (n=612). Also, a time trend analysis with age standardized cancer incidence in the study population and in the general Swedish population was drawn from 1980 – 2009.In the second study, a closed cohort was defined as all individuals living in the three most contaminated counties in mid-Sweden in 1986. Fallout of 137Cs was retrieved as a digital map from the Geological Survey of Sweden, demographic data from Statistics Sweden, and cancer diagnosis from the Swedish Cancer Registry, National Board of Health and Welfare. Individuals were assigned an annual 137Cs exposure based on their place of residence (1986 through 1990), from which 5-year cumulative 137Cs exposures were calculated, accounting for the physical decay of 137Cs and changing residencies. Hazard ratios for having cancer during the follow-up period, adjusted for age, sex, rural/non-rural residence, and pre-Chernobyl total cancer incidence, were calculated.Results: No obvious exposure-response pattern in the age-standardized total cancer incidence rate ratios could be seen in the first study. However, a spurious association between the fallout and cancer incidence was present, where areas with the lowest incidence of cancer before the accident coincidentally had the lowest fallout of cesium-137. Increasing the geographical resolution of exposure from the average values of nine counties to the average values of 612 parishes resulted in two to three times higher degree of variance explanation by regression model. There was a secular trend, with an increase in age standardized incidence of cancer from 1980 – 2009. This trend was stronger in the general Swedish population compared to the nine counties of the present study.In the second study, 734,537 people identified were divided into three exposure categories: the first quartile was low exposure (0.0 to 45.4 kBq/m2), the second and third quartiles were intermediate exposure (45.41 to 118.8 kBq/m2), and the fourth quartile was highest exposure (118.81 to 564.71 kBq/m2). Between 1991 and 2010, 82,495 cancer cases were registered in the three counties. Adjusted HRs (95% CI) were 1.03 (1.01 to 1.05) for intermediate exposure, and 1.05 (1.03 to 1.07) for the highest exposure, when comparing to the reference exposure.Conclusion: Using the ecological data, there was no exposure response trend; however, after refining the data to the individual level of exposure, there was an overall exposure response pattern. Nonetheless, due to the time dependency, these results were restricted to the age group of 25 – 49 among males. Using register-based data only, for determining the association between low-dose exposure to radiation and the risk of developing cancer, is difficult since we cannot control for other significant factors that are associated with cancer.
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| 2. |
- Aronsson, Gunnar, et al.
(author)
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Associations Between Being 'locked-In' and Health - An Epidemiological Study
- 2019
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In: Nordic Journal of Working Life Studies. - : Det Kgl. Bibliotek/Royal Danish Library. - 2245-0157. ; 9:3, s. 71-85
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Journal article (peer-reviewed)abstract
- Objective. The aim of this study was to investigate associations between an individual's level of perceived control over labor market position (locked-in and not locked-in) and self-rated health and psychological well-being. Methods. A representative sample (n = 11,675) of the working population in southern Sweden responded to a questionnaire. Results. Sixty-seven percent of the respondents worked in their preferred workplace and occupation. Nineteen percent reported being in a nonpreferred workplace and nonpreferred occupation (double locked-in). Twenty-three percent reported suboptimal health compared with 31% among the double locked-in. The risk of suboptimal health was elevated in all locked-in groups also after adjustment for background variables and job strain. In the double locked-in group, the fully adjusted odds ratio for suboptimal health was 1.72 (95% confidence interval 1.49-1.99) and for suboptimal psychological well-being 2.17 (95% confidence interval 1.84-2.56). Odds ratio for the other locked-in groups was lower but still statistically significant. Conclusions. Being at a nonpreferred work-place or occupation was associated with impaired health.
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| 3. |
- Conte, Helen, et al.
(author)
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Facilitating interprofessional learning: experiences of using a digital activity for training handover of critically ill patients between a primary health care centre and ambulance services : A qualitative study
- 2024
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In: BMJ Open. - 2044-6055. ; 14:6
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To explore students' and facilitators' experiences of using a developed digital activity for interprofessional learning (IPL) focusing on critically ill patient handovers from a primary healthcare (PHC) centre to the ambulance service.DESIGN: A qualitative study design was employed, and the reporting of this study adheres to the Consolidated criteria for Reporting Qualitative research guidelines for qualitative studies.SETTING: A PHC centre and the ambulance service in Stockholm, Sweden.PARTICIPANTS: A total of 31 participants were included in the study: 22 students from five different healthcare professions, seven facilitators and two observers.INTERVENTION: A digital IPL activity was developed to overcome geographical distances, and the scenario included the handover of a critically ill patient from personnel within the PHC centre to the ambulance service personnel for transport to an emergency department. Four digital IPL activities were conducted in 2021.RESULTS: The digital IPL activity eliminated the issue of geographical distance for students and facilitators, and it enabled the students to find an interprofessional model for collaboration through reasoning, by communicating and sharing knowledge with the support of a common structure. Participants perceived the digital IPL activity and scenario as authentic, feasible and facilitated IPL. Using a case with an acute and life-threatening condition was a success factor for students to experience high realism in their IPL on patient safety, handover, care and treatment.CONCLUSION: The developed digital IPL activity facilitated the students' IPL and demonstrated potential sustainability as the digital approach supported overcoming geographical distances for both students and facilitators. By using a scenario involving an authentic case focusing on handovers of a critically ill patient, IPL, feasibility and acceptability were supported. However, it is crucial to emphasise that a comprehensive evaluation, both quantitative and qualitative, over an extended period of clinical rotations and involving a larger group of students is still warranted to ensure continuous improvement and development.
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| 4. |
- Muli, Irene, et al.
(author)
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Patients' Experiences of Initiating Video Consultations.
- 2023
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In: Studies in Health Technology and Informatics. - 0926-9630 .- 1879-8365. ; 309, s. 204-209
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Journal article (peer-reviewed)abstract
- Implementation and adoption of video consultations (VCs) in healthcare are not straightforward. Experiences of initiating a VC could increase our understanding of adoption by patients. This study aims to report patients' experiences of installing and booking a VC in primary care. Most people found it easy to find and install the VC application. Those with a higher self-reported ability and habit of using digital services and the internet found it easier than those reporting lower ability and habit. About half of our respondents had booked their recent VC themselves, most of whom had done so through a telephone call or the application "Alltid Öppet". The booking process was perceived to be easy by most but more difficult compared to installation. The easy installation process might have led to higher adoption by older people. Nevertheless, during implementation more support should be provided to people with lower digital service and internet use abilities and habits as they might find VC set-up more difficult. More attention should be given to the booking process as it may be a barrier potentially influencing adoption.
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| 5. |
- Muli, Irene, et al.
(author)
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Patients' Introduction to Online Video Consultations in Primary Healthcare
- 2023
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In: Caring is Sharing. - : IOS Press. - 9781643683881 - 9781643683898 ; , s. 1011-1012
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Conference paper (peer-reviewed)abstract
- This study aimed to illustrate ways primary healthcare patients were introduced to video consultations via the public online care application Alltid öppet in Region Stockholm, Sweden. The majority of patients were introduced to this by their providers or other healthcare professionals.
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| 6. |
- Muli, Irene, et al.
(author)
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To connect or not connect : long-term adoption of video consultations, and reasons for discontinuing use
- 2023
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In: Journal of Telemedicine and Telecare. - : SAGE Publications. - 1357-633X .- 1758-1109.
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Journal article (peer-reviewed)abstract
- IntroductionThis study investigates factors related to long-term and short-term adoption of video consultations (VCs) and reasons for discontinuing use among primary care patients.MethodsA sample of primary care patients using VCs with healthcare providers were invited to take a survey in a cross-sectional study. Participants were asked about their intention to continue to have video consultations in the future, and those indicating no intention to use VCs in the future (short-term adopters) were asked about their reasons for this. Prevalence and statistical differences between long-term and short-term adopters were investigated.ResultsThere were several statistically significant differences between long-term and short-term adopters (76% vs. 24%). Long-term adopters consisted of more middle-aged individuals (35?54 years) and the majority worked full-time (56%). They had more positive opinions of VCs and used VCs and video meetings for other purposes to a larger extent. They chose VCs because of the lack of time to go to the healthcare centre and because their provider offered them. The most common reason for discontinuing use was a preference for face-to-face consultations, with the youngest age group (16?34 years) reporting this to a larger extent.DiscussionYounger and older age groups may be less likely to continue the use of VCs, potentially preserving the digital divide. Additionally, disparities in using similar technologies might contribute to the digital divide. Moreover, convenience, positive opinions of VCs, and experience with VCs were related to long-term adoption. Further studies are needed to explore non-use, age?s influence, and address usability issues.
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| 7. |
- Papachristou, Panagiotis, et al.
(author)
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Evaluation of an artificial intelligence-based decision support for the detection of cutaneous melanoma in primary care: a prospective real-life clinical trial
- 2024
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In: BRITISH JOURNAL OF DERMATOLOGY. - : OXFORD UNIV PRESS. - 0007-0963 .- 1365-2133.
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Journal article (peer-reviewed)abstract
- Background Use of artificial intelligence (AI), or machine learning, to assess dermoscopic images of skin lesions to detect melanoma has, in several retrospective studies, shown high levels of diagnostic accuracy on par with - or even outperforming - experienced dermatologists. However, the enthusiasm around these algorithms has not yet been matched by prospective clinical trials performed in authentic clinical settings. In several European countries, including Sweden, the initial clinical assessment of suspected skin cancer is principally conducted in the primary healthcare setting by primary care physicians, with or without access to teledermoscopic support from dermatology clinics.Objectives To determine the diagnostic performance of an AI-based clinical decision support tool for cutaneous melanoma detection, operated by a smartphone application (app), when used prospectively by primary care physicians to assess skin lesions of concern due to some degree of melanoma suspicion.Methods This prospective multicentre clinical trial was conducted at 36 primary care centres in Sweden. Physicians used the smartphone app on skin lesions of concern by photographing them dermoscopically, which resulted in a dichotomous decision support text regarding evidence for melanoma. Regardless of the app outcome, all lesions underwent standard diagnostic procedures (surgical excision or referral to a dermatologist). After investigations were complete, lesion diagnoses were collected from the patients' medical records and compared with the app's outcome and other lesion data.Results In total, 253 lesions of concern in 228 patients were included, of which 21 proved to be melanomas, with 11 thin invasive melanomas and 10 melanomas in situ. The app's accuracy in identifying melanomas was reflected in an area under the receiver operating characteristic (AUROC) curve of 0.960 [95% confidence interval (CI) 0.928-0.980], corresponding to a maximum sensitivity and specificity of 95.2% and 84.5%, respectively. For invasive melanomas alone, the AUROC was 0.988 (95% CI 0.965-0.997), corresponding to a maximum sensitivity and specificity of 100% and 92.6%, respectively.Conclusions The clinical decision support tool evaluated in this investigation showed high diagnostic accuracy when used prospectively in primary care patients, which could add significant clinical value for primary care physicians assessing skin lesions for melanoma. We investigated the diagnostic performance of an AI-based decision support in the form of a mobile app to detect melanoma when used by primary care physicians. The app proved to have high levels of diagnostic accuracy in distinguishing melanomas from other skin lesions. We conclude that it appears to be a potentially valuable diagnostic aid for the primary care physician in the assessment of skin lesions of concern.
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| 8. |
- Söderberg, Daniel, et al.
(author)
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Individual Patient Factors Associated with the Use of Physical or Digital Primary Care in Sweden
- 2024
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In: Telemedicine journal and e-health. - : Mary Ann Liebert, Inc., publishers. - 1530-5627 .- 1556-3669.
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Journal article (peer-reviewed)abstract
- Introduction: Little is known about factors that influence patients' choice to use physical or digital primary care. This study aimed to compare self-rated health, internet habits, and what patients deem important when choosing health care between users of physical and digital primary health care. Methods: We recruited 2,716 adults visiting one of six physical or four digital primary health care providers in Stockholm, Sweden, October 2020 to May 2021. Participants answered a questionnaire with questions about sociodemography, self-rated health, internet habits, and what they considered important when seeking care. We used logistic regression and estimated odds ratios (ORs) for choosing digital care. Results: Digital users considered themselves healthier and used the internet more, compared with physical users (p < 0.001). Competence of health care staff was the most important factor when seeking care to both physical and digital users (90% and 78%, respectively). Patients considering it important to avoid leaving home were more likely to seek digital care (OR 29.55, 95% confidence interval [CI] 12.65?69.06), while patients valuing continuity were more likely to seek physical care (OR 0.25, 95% CI 0.19?0.32). These factors were significant also when adjusting for self-rated health and sociodemographic characteristics. Conclusion: What patients considered important when seeking health care was associated with what type of care they sought. Patient preferences should be considered when planning health care to optimize resource allocation.
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| 9. |
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| 10. |
- Taloyan, Marina, et al.
(author)
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Cardiovascular risk factors in Assyrians/Syrians and native Swedes with type 2 diabetes: a population-based epidemiological study.
- 2009
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In: Cardiovascular Diabetology. - : Springer Science and Business Media LLC. - 1475-2840. ; 8:Nov 12
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Journal article (peer-reviewed)abstract
- BACKGROUND: A large number of people throughout the world have diabetes and the prevalence is increasing. Persons with diabetes have a twice higher risk of cardiovascular disease than those without diabetes. There is a lack of studies focusing on cardiovascular risk factors in Assyrians/Syrians with type 2 diabetes. The aim of this study is to estimate the prevalence of some cardiovascular risk factors among Assyrians/Syrians and native Swedes with type 2 diabetes and to study whether the association between ethnicity and cardio-vascular risk factors remains after adjustment for age, gender, employment status and housing tenure. METHODS: In the Swedish town of Södertälje 173 Assyrians/Syrians and 181 ethnic Swedes with type 2 diabetes participated in a study evaluating cardiovascular risk factors such as increased haemoglobin A1c (HbA1c), high blood lipids (total serum cholesterol and triglycerides), hypertension and high urinary albumin. The associations between the outcome variables and sociodemographic characteristics were estimated using unconditional logistic regression. RESULTS: The prevalence of increased triglycerides in Swedish-born subjects and Assyrian-Syrians was 61.5% and 39.7% respectively. Swedes had a prevalence of hypertension 76.8% compared to 57.8% in Assyrians/Syrians. In the final logistic models adjusted for gender, age, housing and employment the odds ratio (OR) for Swedish-born subjects for increased triglycerides was 2.80 (95% CI1.61-4.87) and for hypertension 2.32 (95% CI 1.35-4.00) compared to Assyrians-Syrians. CONCLUSION: Ethnic Swedes had higher prevalence of increased triglycerides and hypertension than Assyrians/Syrians. Total cholesterol, HbA1c and urinary albumin did not differ between the two ethnic groups.
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