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  • 1.
    Akner, Gunnar
    et al.
    Linnéuniversitetet, Kalmar, Sweden.
    Järhult, Bengt
    Ekonomiska incitament ska inte kopplas till den enskilde patienten2016Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, artikkel-id D4TPArtikkel i tidsskrift (Fagfellevurdert)
  • 2.
    Ali, DK
    et al.
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Dalal, Koustuv
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Yousefzade-Chabok, S
    Trauma Research Center, Guilan University of Medical Science, Rasht, Iran.
    Jansson, B
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Mohammadi, R
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Costs related to drowning and near drowning in northern Iran (Guilan province)2011Inngår i: Ocean and Coastal Management, ISSN 0964-5691, E-ISSN 1873-524X, Vol. 54, nr 3, s. 250-255Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In Iran and many other low- and middle-income countries, few  studies have been carried out in order to assess which cost analysis methods should be  undertaken at the household and community level in relation to incidences of drowning. In this study, we have attempted to develop a model for  estimating the impact of the economic burden that drowning and near drowning events incur for victims’ families in the Guilan province in the north of  Iran by  using an  incidence approach. During the financial year of March 2007 to 2008,  the following cost-related aspects of  drowning episodes were evaluated: (note: main cost elements were income adjusted by family and years) medical costs, productivity loss  costs and death costs. A total of 137 drowning fatalities and 104 near drowning incidents were recorded. Males in the age  span of  10e29  years constitute a  majority of  the epidemiology and economy data. When the number of variables included in cost analysis was expanded, the estimated burden of economic duress increased dramatically; however, drowning cost for  one drowned victim was equivalent to 17  times the country’s  gross domestic product(GDP) per capital. Identification of  injured person-based costs in  this study will  enable development of  more effective prevention programs and provide indicators of  other costs related to drowning episodes such as  property damage and the impact of  these accidents on community services and the public health care system.

  • 3.
    Andersson, Henrik
    et al.
    Toulouse School of Economics (LERNA, UT1C, CNRS), Toulouse, France.
    Hole, Arne Risa
    University of Sheffield, Sheffield, United Kingdom.
    Svensson, Mikael
    Örebro universitet, Handelshögskolan vid Örebro Universitet. Karlstad University, Karlstad, Sweden; Health Metrics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Valuation of small and multiple health risks: A critical analysis of SP data applied to food and water safety2016Inngår i: Journal of Environmental Economics and Management, ISSN 0095-0696, E-ISSN 1096-0449, Vol. 75, s. 41-53Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study elicits individual risk preferences in the context of an infectious disease using choice experiments. A main objective is to examine scope sensitivity using a novel approach. Our results suggest that the value of a mortality risk reduction (VSL) is highly sensitive to the survey design. Our results cast doubt on the standard scope sensitivity tests in choice experiments, but also on the validity and reliability of VSL estimates based on stated-preference studies in general. This is important due to the large empirical literature on non-market evaluation and the elicited values' central role in policy making.

  • 4.
    Anrys, Charlotte
    et al.
    Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
    Van Tiggelen, Hanne
    Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
    Verhaeghe, Sofie
    Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department Health Care, VIVES University College, Roeselare, Belgium.
    Van Hecke, Ann
    Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Nursing Department, Ghent University Hospital, Ghent, Belgium.
    Beeckman, Dimitri
    Örebro universitet, Institutionen för hälsovetenskaper. Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
    Independent risk factors for pressure ulcer development in a high-risk nursing home population receiving evidence-based pressure ulcer prevention: Results from a study in 26 nursing homes in Belgium2019Inngår i: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 16, nr 2, s. 325-333Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to identify independent risk factors for pressure ulcer (PU) development in a high-risk nursing home population receiving evidence-based PU prevention. This study was part of a randomised controlled trial examining the (cost-)effectiveness of static air support surfaces compared with alternating pressure air mattresses. The sample consisted of 308 residents at a high risk of PU development (presence of non-blanchable erythema, Braden score ≤ 12 or Braden subscale "mobility" ≤ 2). PU incidence was monitored for 14 days. Demographic variables; functional, physical, and psychological characteristics; and data on skin assessment were collected. Independent risk factors were identified using multiple logistic regression analysis. The overall PU incidence (category II-IV) was 8.4% (n = 26), and 1.9% (n = 6) of the residents developed a deep PU (category III-IV). PUs (category II-IV) were significantly associated with non-blanchable erythema, a lower Braden score, and pressure area-related pain in high-risk residents even if preventive care was provided. These results highlight the need of a systematic risk assessment, including pain assessment and skin observations, in order to determine and tailor preventive care to the needs of high-risk individuals.

  • 5.
    Appelros, Peter
    et al.
    Region Örebro län. Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Jonsson, Fredrik
    Riks-Stroke, Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Åsberg, Signild
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Asplund, Kjell
    Riks-Stroke, Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Glader, Eva-Lotta
    Riks-Stroke, Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Åsberg, Kerstin Hulter
    Department of Medicine, Enköping Hospital, Enköping, Sweden.
    Norrving, Bo
    Department of Neurology, Lund University Hospital, Lund, Sweden.
    Stegmayr, Birgitta
    Riks-Stroke, Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Terént, Andreas
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Trends in stroke treatment and outcome between 1995 and 2010: observations from Riks-Stroke, the Swedish stroke register2014Inngår i: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 37, nr 1, s. 22-29Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Continuous changes in stroke treatment and care, as well as changes in stroke characteristics, may alter stroke outcome over time. The aim of this paper is to describe time trends for treatment and outcome data, and to discuss if any such changes could be attributed to quality changes in stroke care.

    METHODS: Data from Riks-Stroke, the Swedish stroke register, were analyzed for the time period of 1995 through 2010. The total number of patients included was 320,181. The following parameters were included: use of computed tomography (CT), stroke unit care, thrombolysis, medication before and after the stroke, length of stay in hospital, and discharge destination. Three months after stroke, data regarding walking, toileting and dressing ability, as well social situation, were gathered. Survival status after 7, 27 and 90 days was registered.

    RESULTS: In 1995, 53.9% of stroke patients were treated in stroke units. In 2010 this proportion had increased to 87.5%. Fewer patients were discharged to geriatric or rehabilitation departments in later years (23.6% in 2001 compared with 13.4% in 2010), but more were discharged directly home (44.2 vs. 52.4%) or home with home rehabilitation (0 vs. 10.7%). The need for home help service increased from 18.2% in 1995 to 22.1% in 2010. Regarding prevention, more patients were on warfarin, antihypertensives and statins both before and after the stroke. The functional outcome measures after 3 months did improve from 2001 to 2010. In 2001, 83.8% of patients were walking independently, while 85.6% were independent in 2010. For toileting, independence increased from 81.2 to 84.1%, and for dressing from 78.0 to 80.4%. Case fatality (CF) rates after 3 months increased from 18.7% (2001) to 20.0% (2010). This trend is driven by patients with severe strokes.

    CONCLUSIONS: Stroke outcomes may change over a relatively short time period. In some ways, the quality of care has improved. More stroke patients have CT, more patients are treated in stroke units and more have secondary prevention. Patients with milder strokes may have benefited more from these measures than patients with severe strokes. Increased CF rates for patients with severe stroke may be caused by shorter hospital stays, shorter in-hospital rehabilitation periods and lack of suitable care after discharge from hospital.

  • 6.
    Axén, Iben
    et al.
    Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    The Nordic maintenance care program: the clinical use of identified indications for preventive care2013Inngår i: Chiropractic and Manual Therapies, ISSN 2045-709X, E-ISSN 2045-709X, Vol. 21, nr 1, artikkel-id 10Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Low back pain (LBP) is a prevalent condition and has been found to be recurrent and persistent in a majority of cases. Chiropractors have a preventive strategy, maintenance care (MC), aimed towards minimizing recurrence and progression of such conditions. The indications for recommending MC have been identified in the Nordic countries from hypothetical cases. This study aims to investigate whether these indications are indeed used in the clinical encounter.

    Methods: Data were collected in a multi-center observational study in which patients consulted a chiropractor for their non-specific LBP. Patient baseline information was a) previous duration of the LBP, b) the presence of previous episodes of LBP and c) early improvement with treatment. The chiropractors were asked if they deemed each individual patient an MC candidate. Logistic regression analyses (uni– and multi-level) were used to investigate the association of the patient variables with the chiropractor’s decision.

    Results: The results showed that “previous episodes” with LBP was the strongest predictor for recommending MC, and that the presence of all predictors strengthens the frequency of this recommendation. However, there was considerable heterogeneity among the participating chiropractors concerning the recommendation of MC.

    Conclusions: The study largely confirms the clinical use of the previously identified indications for recommending MC for recurrent and persistent LBP. Previous episodes of LBP was the strongest indicator.

  • 7.
    Axén, Iben
    et al.
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, The Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, The Karolinska Institutet, Stockholm, Sweden.
    Bergström, Gunnar
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, The Karolinska Institutet, Stockholm, Sweden.
    Halasz, Laszlo
    Private practise, Lund, Sweden.
    Lange, Fredrik
    Private practise, Stockholm, Sweden.
    Lövgren, Peter W.
    Private practise, Stockholm, Sweden.
    Rosenbaum, Annika
    Private practise, Linköping, Sweden.
    Leboeuf-Yde, Charlotte
    Institute of Regional Health Research, Spine Centre of Southern Denmark, Hospital Lillebælt, University of Southern Denmark, Kolding, Denmark.
    Jensen, Irene
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, The Karolinska Institutet, Stockholm, Sweden.
    Clustering patients on the basis of their individual course of low back pain over a six month period2011Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 12, artikkel-id 99Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Several researchers have searched for subgroups in the heterogeneous population of patients with non-specific low back pain (LBP). To date, subgroups have been identified based on psychological profiles and the variation of pain.

    Methods: This multicentre prospective observational study explored the 6- month clinical course with measurements of bothersomeness that were collected from weekly text messages that were sent by 176 patients with LBP. A hierarchical cluster analysis, Ward's method, was used to cluster patients according to the development of their pain.

    Results: Four clusters with distinctly different clinical courses were described and further validated against clinical baseline variables and outcomes. Cluster 1, a "stable" cluster, where the course was relatively unchanged over time, contained young patients with good self- rated health. Cluster 2, a group of "fast improvers" who were very bothered initially but rapidly improved, consisted of patients who rated their health as relatively poor but experienced the fewest number of days with bothersome pain of all the clusters. Cluster 3 was the "typical patient" group, with medium bothersomeness at baseline and an average improvement over the first 4-5 weeks. Finally, cluster 4 contained the "slow improvers", a group of patients who improved over 12 weeks. This group contained older individuals who had more LBP the previous year and who also experienced most days with bothersome pain of all the clusters.

    Conclusions: It is possible to define clinically meaningful clusters of patients based on their individual course of LBP over time. Future research should aim to reproduce these clusters in different populations, add further clinical variables to distinguish the clusters and test different treatment strategies for them.

  • 8.
    Axén, Iben
    et al.
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Bergström, Gunnar
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Halasz, Laszlo
    Lange, Fredrik
    Lövgren, Peter W.
    Rosenbaum, Annika
    Leboeuf-Yde, Charlotte
    Spine Centre of Southern Denmark, Hospital Lillebalt, University of Southern Denmark, Odense, Denmark.
    Jensen, Irene
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    The use of weekly text messaging over 6 months was a feasible method for monitoring the clinical course of low back pain in patients seeking chiropractic care2012Inngår i: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 65, nr 4, s. 454-461Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: This study critically evaluates a new method of collecting frequent data using mobile phones and text messages. Fluctuating conditions such as low back pain (LBP) need frequent monitoring to describe the clinical course in detail and to account for individual and subgroup variations.

    Study Design and Setting: In this multicentre prospective observational study, 262 subjects with nonspecific LBP were followed with weekly text messages for 6 months, with the question “How many days this previous week has your low back pain been bothersome?” The text replies were instantly recorded in a data file to be merged with baseline and follow up data (age, gender, pain intensity, duration, and self- rated health) collected through ordinary questionnaires. The response rate, user-friendliness, and compliance of this method were evaluated.

    Results: The mean response rate for the text messages throughout the study was 82.5% and was unaffected by season. The method was found to be user friendly. Dropout was not affected by age and gender, but compliance was possibly somewhat affected by outcome.

    Conclusion: Weekly text messages are a useful method of data collection to examine the clinical course of LBP in the primary care sector.

  • 9.
    Axén, Iben
    et al.
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Kongsted, Alice
    Clinical Locomotion Network, Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.
    Wedderkopp, Niels
    Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark.
    Jensen, Irene
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Bergström, Gunnar
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Analyzing repeated data collected by mobile phones and frequent text messages: An example of Low back pain measured weekly for 18 weeks2012Inngår i: BMC Medical Research Methodology, ISSN 1471-2288, E-ISSN 1471-2288, Vol. 12, artikkel-id 105Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Repeated data collection is desirable when monitoring fluctuating conditions. Mobile phones can be used to gather such data from large groups of respondents by sending and receiving frequently repeated short questions and answers as text messages.

    The analysis of repeated data involves some challenges. Vital issues to consider are the within-subject correlation, the between measurement occasion correlation and the presence of missing values.

    The overall aim of this commentary is to describe different methods of analyzing repeated data. It is meant to give an overview for the clinical researcher in order for complex outcome measures to be interpreted in a clinically meaningful way.

    Methods: A model data set was formed using data from two clinical studies, where patients with low back pain were followed with weekly text messages for 18 weeks. Different research questions and analytic approaches were illustrated and discussed, as well as the handling of missing data. In the applications the weekly outcome “number of days with pain” was analyzed in relation to the patients’ “previous duration of pain” (categorized as more or less than 30 days in the previous year).

    Research questions with appropriate analytical methods

    1: How many days with pain do patients experience? This question was answered with data summaries.

    2: What is the proportion of participants “recovered” at a specific time point? This question was answered using logistic regression analysis.

    3: What is the time to recovery? This question was answered using survival analysis, illustrated in Kaplan-Meier curves, Proportional Hazard regression analyses and spline regression analyses.

    4: How is the repeatedly measured data associated with baseline (predictor) variables? This question was answered using generalized Estimating Equations, Poisson regression and Mixed linear models analyses.

    5: Are there subgroups of patients with similar courses of pain within the studied population?A visual approach and hierarchical cluster analyses revealed different subgroups using subsets of the model data.

    Conclusions: We have illustrated several ways of analysing repeated measures with both traditional analytic approaches using standard statistical packages, as well as recently developed statistical methods that will utilize all the vital features inherent in the data.

  • 10.
    Bassford, Christopher R.
    et al.
    Warwick Medical School, University of Warwick, Coventry, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom.
    Krucien, Nicolas
    Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
    Ryan, Mandy
    Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
    Griffiths, Frances E.
    Warwick Medical School, University of Warwick, Coventry, United Kingdom.
    Svantesson, Mia
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center.
    Fritz, Zoe
    Warwick Medical School, University of Warwick, Coventry, United Kingdom; The Healthcare Improvement Studies (THIS) Institute, Cambridge University, Cambridge, United Kingdom.
    Perkins, Gavin D.
    Warwick Medical School, University of Warwick, Coventry, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Birmingham, United Kingdom.
    Quinton, Sarah
    University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Birmingham, United Kingdom.
    Slowther, Anne-Marie
    Warwick Medical School, University of Warwick, Coventry, United Kingdom.
    U.K. Intensivists' Preferences for Patient Admission to ICU: Evidence From a Choice Experiment2019Inngår i: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 47, nr 11, s. 1522-1530Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: Deciding whether to admit a patient to the ICU requires considering several clinical and nonclinical factors. Studies have investigated factors associated with the decision but have not explored the relative importance of different factors, nor the interaction between factors on decision-making. We examined how ICU consultants prioritize specific factors when deciding whether to admit a patient to ICU.

    DESIGN: Informed by a literature review and data from observation and interviews with ICU clinicians, we designed a choice experiment. Senior intensive care doctors (consultants) were presented with pairs of patient profiles and asked to prioritize one of the patients in each task for admission to ICU. A multinomial logit and a latent class logit model was used for the data analyses.

    SETTING: Online survey across U.K. intensive care.

    SUBJECTS: Intensive care consultants working in NHS hospitals.

    MEASUREMENTS AND MAIN RESULTS: Of the factors investigated, patient's age had the largest impact at admission followed by the views of their family, and severity of their main comorbidity. Physiologic measures indicating severity of illness had less impact than the gestalt assessment by the ICU registrar. We identified four distinct decision-making patterns, defined by the relative importance given to different factors.

    CONCLUSIONS: ICU consultants vary in the importance they give to different factors in deciding who to prioritize for ICU admission. Transparency regarding which factors have been considered in the decision-making process could reduce variability and potential inequity for patients.

  • 11.
    Bejerot, Eva
    et al.
    Psykologiska institutionen, Stockholms universitet, Stockholm, Sweden.
    Aronsson, Gunnar
    Psykologiska institutionen, Stockholms universitet, Stockholm, Sweden.
    Hasselbladh, Hans
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Bejerot, Susanne
    Karolinska institutet, Stockholm, Sweden.
    Läkarkåren - en profession med allt mindre stöd och inflytande. Enkätstudie av svenska läkares arbetsmiljö 1992 och 2010: [The medical profession, a profession with less and less support and influence. A questionnaire study the occupational environment of Swedish physicians in 1992 and 2010]2011Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, nr 50, s. 2652-2656Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [sv]

    Syftet med studien var att undersöka förändringar i läkares arbetsvillkor med särskild inriktning på ledning, styrning och stöd. Jämförelser gjordes av enkätdata från två slumpmässiga urval 1992 (n = 390) och 2010 (n = 1 937). Stora förändringar framkom i flera avseenden. Andelen läkare som upplever sig ha något verksamhetsansvar har minskat med 45 procentandelar, från 76 till 31 procent. Mycket stora försämringar framkom vad gäller stöd i arbetet. Tiden som läggs på fortbildning/inläsning och forskning har minskat. Utnyttjandet av läkarnas högsta kompetens har minskat.

  • 12. Bejerot, Susanne
    ST-handledare - ett omöjligt uppdrag?: [Internship supervisor--an impossible mission?]2010Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, nr 29-31, s. 1785-1786Artikkel i tidsskrift (Fagfellevurdert)
  • 13.
    Berg, Marie
    et al.
    Centre for Person-Centred Care (GPCC), Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Linden, Karolina
    Centre for Person-Centred Care (GPCC), Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Adolfsson, Annsofie
    Örebro universitet, Institutionen för hälsovetenskaper.
    Sparud Lundin, Carina
    Centre for Person-Centred Care (GPCC), Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ranerup, Agneta
    Department of Applied Information Technology, University of Gothenburg, Gothenburg, Sweden.
    Web-Based Intervention for Women With Type 1 Diabetes in Pregnancy and Early Motherhood: Critical Analysis of Adherence to Technological Elements and Study Design2018Inngår i: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, nr 5, artikkel-id el60Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Numerous Web-based interventions have been implemented to promote health and health-related behaviors in persons with chronic conditions. Using randomized controlled trials to evaluate such interventions creates a range of challenges, which in turn can influence the study outcome. Applying a critical perspective when evaluating Web-based health interventions is important.

    Objective: The objective of this study was to critically analyze and discuss the challenges of conducting a Web-based health intervention as a randomized controlled trial.

    Method: The MODIAB-Web study was critically examined using an exploratory case study methodology and the framework for analysis offered through the Persuasive Systems Design model. Focus was on technology, study design, and Web-based support usage, with special focus on the forum for peer support. Descriptive statistics and qualitative content analysis were used.

    Results: The persuasive content and technological elements in the design of the randomized controlled trial included all four categories of the Persuasive Systems Design model, but not all design principles were implemented. The study duration was extended to a period of four and a half years. Of 81 active participants in the intervention group, a maximum of 36 women were simultaneously active. User adherence varied greatly with a median of 91 individual log-ins. The forum for peer support was used by 63 participants. Although only about one-third of the participants interacted in the forum, there was a fairly rich exchange of experiences and advice between them. Thus, adherence in terms of social interactions was negatively affected by limited active participation due to prolonged recruitment process and randomization effects. Lessons learned from this critical analysis are that technology and study design matter and might mutually influence each other. In Web-based interventions, the use of design theories enables utilization of the full potential of technology and promotes adherence. The randomization element in a randomized controlled trial design can become a barrier to achieving a critical mass of user interactions in Web-based interventions, especially when social support is included. For extended study periods, the technology used may need to be adapted in line with newly available technical options to avoid the risk of becoming outdated in the user realm, which in turn might jeopardize study validity in terms of randomized controlled trial designs. Conclusions: On the basis of lessons learned in this randomized controlled trial, we give recommendations to consider when designing and evaluating Web-based health interventions.

  • 14.
    Bergdahl, Elisabeth
    et al.
    Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
    Ternestedt, Britt-Marie
    Department of Health Care Science/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.
    Berterö, Carina
    Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Andershed, Birgitta
    Department of Health Care Science/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden; Faculty of Health, Care and Nursing, Norwegian University of Science and Technology, Gjøvik, Norway.
    The theory of a co-creative process in advanced palliative home care nursing encounters: A qualitative deductive approach over time2019Inngår i: Nursing Open, E-ISSN 2054-1058, Vol. 6, nr 1, s. 175-188Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims and objectives: The aim of this study was to test the theoretical conceptualization of the co-creative process in home care nursing encounters over time.

    Method and design: This was a multiple case study with a deductive analysis of qualitative data over time, using interviews and observations collected from three cases.

    Results: The co-creative process was complex and contained main, sub- and micro-processes. Time was important and valuable, giving the patient and relatives space to adjust the process to their own pace. Some processes were worked on more intensively in accordance with the patients' and relatives' needs, and these are considered the main-process. The further developed theory of the co-creative process and its main, sub- and microprocesses can be understood as a concretization of how good nursing care can be performed within caring relationships in the context of advanced palliative home care.

  • 15.
    Bergström, Gunnar
    et al.
    Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
    Lohela-Karlsson, M.
    Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Kwak, L.
    Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Jensen, I.
    Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Torgén, Margareta
    Department of Medical Science, Uppsala University, Uppsala, Sweden.
    Nybergh, L.
    Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden..
    Preventing sickness absenteeism among employees with common mental disorders or stress-related symptoms at work: Design of a cluster randomized controlled trial of a problem-solving based intervention versus care-as-usual conducted at the Occupational Health Services2017Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, nr 1, artikkel-id 436Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Common mental disorders (CMDs) are among the leading causes of sick leave in Sweden and other OECD countries. They result in suffering for the individual and considerable financial costs for the employer and for society at large. The occupational health service (OHS) can offer interventions in which both the individual and the work situation are taken into account. The aim of this paper is to describe the design of a study evaluating the effectiveness of an intervention given at the OHS to employees with CMDs or stress-related symptoms at work. In addition, intervention fidelity and its relation to the outcome will be assessed in a process analysis.

    Methods: The study is designed as a cluster randomized trial in which the participating OHS consultants are randomized into either delivering the intervention or performing care as usual. Employees with CMDs or stress-related symptoms at work are recruited consecutively by the OHS consultants. The intervention aims to improve the match between the employee and the job situation. Interviews are held individually with the employee and the nearest supervisor, after which a joint meeting with both the employee and the supervisor takes place. A participatory approach is applied by which the supervisor and the employee are guided by the OHS consultant and encouraged to actively take part in problem solving concerning the work situation. Outcomes will be assessed at baseline and at six and 12 months. A long-term follow-up at 3 years will also be performed. The primary outcome is registered sickness absence during a 1-year period after study inclusion. Secondary outcomes are mental health and work ability. The intervention's cost effectiveness, compared to treatment as usual, both for society and for the employer will be evaluated. A process evaluation by both the OHS consultants and the employee will be carried out.

    Discussion: The study includes analyses of the effectiveness of the intervention (clinical and economic) as well as an analysis of its implementation at the participating OHSs. Possible methodological challenges such as selection bias and risk of contamination between OHS consultants delivering the experimental condition and consultants giving usual care are discussed.

  • 16.
    Biswas, Animesh
    et al.
    Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), Mohakhali Dhaka, Bangladesh.
    Abdullah, Abu Sayeed Md
    Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), Mohakhali Dhaka, Bangladesh.
    Dalal, Koustuv
    Örebro universitet, Institutionen för hälsovetenskaper. Department of Public Health Science.
    Deave, Toity
    Centre for Child and Adolescent Health, Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom.
    Rahman, Fazlur
    Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), Mohakhali Dhaka, Bangladesh; Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh.
    Mashreky, Saidur Rahman
    Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), Mohakhali Dhaka, Bangladesh; Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh.
    Exploring perceptions of common practices immediately following burn injuries in rural communities of Bangladesh2018Inngår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, artikkel-id 467Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Burns can be the most devastating injuries in the world, they constitute a global public health problem and cause widespread public health concern. Every year in Bangladesh more than 365,000 people are injured by electrical, thermal and other causes of burn injuries. Among them 27,000 need hospital admission and over 5600 people die. Immediate treatment and medication has been found to be significant in the success of recovering from a burn. However, common practices used in the treatment of burn injuries in the community is not well documented in Bangladesh. This study was designed to explore the perception of local communities in Bangladesh the common practices used and health-seeking behaviors sought immediately after a burn injury has occurred.

    Methods: A qualitative study was conducted using Focus Group Discussions (FGD) as the data collection method. Six unions of three districts in rural Bangladesh were randomly selected and FGDs were conducted in these districts with six burn survivors and their relatives and neighbours. Data were analyzed manually, codes were identified and the grouped into themes.

    Results: The participants stated that burn injuries are common during the winter in Bangladesh. Inhabitants in the rural areas said that it was common practice, and correct, to apply the following to the injured area immediately after a burn: egg albumin, salty water, toothpaste, kerosene, coconut oil, cow dung or soil. Some also believed that applying water is harmful to a burn injury. Most participants did not know about any referral system for burn patients. They expressed their dissatisfaction about the lack of available health service facilities at the recommended health care centers at both the district level and above.

    Conclusions: In rural Bangladesh, the current first-aid practices for burn injuries are incorrect; there is a widely held belief that using water on burns is harmful.

  • 17. Björkelund, Cecilia
    et al.
    Hasselgren, Mikael
    Primary Care Research Centre, County Council of Värmland, Karlstad, Sweden; Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    [Psychiatry and primary health care have common responsibility]2011Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, nr 14, s. 786-786Artikkel i tidsskrift (Fagfellevurdert)
  • 18.
    Blomqvist, Suzanne
    et al.
    Psychiatric Research Centre, Örebro County Council, Örebro, Sweden.
    Engström, Ingemar
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Interprofessional psychiatric teams: is multidimensionality evident in treatment conferences?2012Inngår i: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 26, nr 4, s. 289-296Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Interprofessional teamwork is practised when the care needs of patients are complex. Little is known about the extent to which team competence really determines patient interventions. The aim of the study was to examine the degree of multidimensionality in patient discussions in psychiatry, and to how different professions contribute. Psychiatric teams were observed during 30 team meetings. A content analysis was used to examine the amount of attention given to medical, psychological and social aspects. The results indicated difficulties in achieving multidimensionality in patient discussions during team meetings. The descriptive element of the discussion was dominated by the social aspect, to which all professions contributed. The analytical element was dominated by the psychological aspect, also to which all the professions contributed. In suggesting interventions, medical interventions were emphasized, principally by the physicians. Decisions on interventions concerned equally medical, social and psychological aspects. An interprofessional composition of teams offers no guarantee that interventions will be of a multidimensional nature. The results are discussed in relation to previous research and practical implications.

  • 19. Blusi, Madeleine
    et al.
    Dalin, Rolf
    Näslund, Pär
    Palmgren, Katarina
    Scandurra, Isabella
    Department of information technology, Uppsala university, Uppsala, Sweden.
    Test av användbarheten hos innovationen SenseSoft i äldreomsorgen i Sundsvalls kommun2014Rapport (Annet vitenskapelig)
  • 20.
    Blusi, Madeleine
    et al.
    R&D Department, The Association of Local Authorities in Västernorrland County, Härnösand, Sweden.
    Dalin, Rolf
    R&D Department, The Association of Local Authorities in Västernorrland County, Härnösand, Sweden.
    Näslund, Pär
    Palmgren, Katarina
    Scandurra, Isabella
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Test av användbarheten hos innovationen TENA Identifi på Viktoriagården i Kramfors2015Rapport (Annet vitenskapelig)
    Abstract [sv]

    Norrlandicus är ett ”Living Lab” med syfte att i en verklig testmiljö inom äldreomsorgen testa innovationer i form av produkter, tjänster och arbetssätt för att se om de tillför ett ökat värde i en vård- och omsorgsprocess och om innovationen möter slutanvändarens faktiska behov. En utgångspunkt för Norrlandicus testmetod är Socialstyrelsens riktlinjer om värdegrunder i omsorgen av äldre, om äldres värdighet och välbefinnande.

    På ett äldreboende i Kramfors kommun har SCA Hygiene Products innovation för inkontinensutredning testats. Under tre dygn deltog ett antal utvalda äldre personer i en inkontinensutredning där man använde ny teknik med sensorer i inkontinensskyddet för att samla in information kring tidpunkt och ungefärlig urinmängd av läckage.

    I testet ingår först och främst att utvärdera innovationens användbarhet. Detta sker utifrån personalens användning och uppfattning kring verktyget. Det resultatet kan i viss mån även belysa nyttoeffekter av verktyget i en vård- och omsorgsprocess. Vilka effekter kan innovationen få för den äldre och vilken nytta kan den ge personalen? Enkäter och strukturerade intervjuer har utförts med personal och intervjuer har efter samtycke utförts med de berörda äldre. Användningen har även observerats och Norrlandicus-teamet har deltagit praktiskt i alla testets faser.

    Vårdpersonalens analys av data tillsammans med deras kännedom om personen underlättar för personalen att individanpassa de äldres inkontinensskydd bättre, och att bättre planera in assistans vid toalettbesök. Det ger i detta avseende möjligheter att öka de äldres välbefinnande och värdighet, vilket är i linje med äldreomsorgens nationella riktlinjer. Verktyget har även visat sig kunna förbättra inkontinensvården ur personalens synvinkel. Den information som verktyget ger är mer utförlig än den som fås från dagens utredningsmetod där inkontinensskydden vägs. Det ger stöd i besluten för vilka insatser som personen bör ha samt vilka typer av inkontinensskydd som bör användas. Dessutom slipper personalen momentet med vägning, vilket ökar de hygieniska aspekterna.

    Personalen som deltagit i testet är nöjda med utfallet och skulle gärna använda detta verktyg på rutinbasis vid inkontinensutredningar.

  • 21.
    Bodin Danielsson, Christina
    et al.
    Royal Institute of Technology, Stockholm, Sweden.
    Bodin, Lennart
    Division of Intervention and Implementation Research, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Office type in relation to health, well-being, and job satisfaction among employees: Erratum2010Inngår i: Environment and Behavior, ISSN 0013-9165, E-ISSN 1552-390X, Vol. 42, nr 6, s. 887-887Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Reports an error in "Office type in relation to health, well-being, and job satisfaction among employees" by Christina Bodin Danielsson and Lennart Bodin (Environment and Behavior, 2008[Sep], Vol 40[5], 636-668). In the original article, a symbol was missing from Table 7 on p. 654. In that table, an open circle ("o") should have been present to show that the odds ratio indicated low risk for having poor quality of sleep among those who worked in the flex office. The corrected table is present in the erratum. (The following abstract of the original article appeared in record 2008-12036-003). This article investigates the hypothesis that office type has an influence on workers' health status and job satisfaction and 469 employees in seven different types, defined by their unique setup of architectural and functional features, have rated their health status and job satisfaction. Multivariate regression models were used for analysis of these outcomes, with adjustment for age, gender, job rank, and line of business. Both health status and job satisfaction differed between the seven office types. Lowest health status was found in medium-sized and small open plan offices. Best health was among employees in cell offices and flex offices. Workers in these types of offices and in shared room offices also rated the highest job satisfaction. Lowest job satisfaction was in combi offices, followed by medium-sized open plan offices. The differences between employees could possibly be ascribed to variations in architectural and functional features of the office types. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

  • 22.
    Bohm, Katarina
    et al.
    Karolinska Institutet, Institution of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
    Kurland, Lisa
    Karolinska Institutet, Institution of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Bartholdson, Sofia
    Karolinska Institutet, Institution of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
    Castrèn, Maaret
    Karolinska Institutet, Institution of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Descriptions and presentations of sepsis: A qualitative content analysis of emergency calls2015Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 23, nr 4, s. 294-298Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Sepsis is a serious condition which requires early treatment. We often fail to recognize sepsis patients in the chain of prehospital care. Knowledge of how sepsis is expressed in calls to the emergency medical communication centre (EMCC) is limited. An increased understanding could lead to earlier identification of patients with sepsis.

    OBJECTIVE: The aim of this study was to describe the descriptions of sepsis used during communication between the caller and the emergency medical dispatcher (EMD).

    METHODS: To achieve the aim of the study, an inductive approach of qualitative content analysis was used. In total, 29 consecutive patients, who arrived at the emergency department by ambulance and received a diagnosis of sepsis according to the International Classification of Diseases (ICD)-10, were included in the study. For each case, the corresponding emergency call recording from the EMCC was transcribed verbatim. Main categories and subcategories from the text were abstracted.

    RESULTS: From fifteen subcategories, three main categories were abstracted: "Deterioration", "Physical signs and symptoms" and "Difficulties establishing satisfactory contact with the patient." The way laymen and professionals expressed themselves seemed to differ.

    CONCLUSIONS: Sepsis was described in terms of the physical symptoms, changes of condition and communication abilities of the patient. This knowledge could lead to the identification of keywords which could be incorporated in the decision tool used by the EMD to increase sepsis identification, but further research is required.

  • 23.
    Borg, S.
    et al.
    The Swedish Institute for Health Economics (IHE), Lund, Sweden.
    Näslund, Ingmar
    Surgical department, Örebro University Hospital, Region Örebro län, Örebro, Sweden.
    Persson, U.
    The Swedish Institute for Health Economics (IHE), Lund, Sweden.
    Ödegaard, K.
    The Swedish Institute for Health Economics (IHE), Lund, Sweden.
    Budget impact analysis of surgical treatment for obesity in Sweden2012Inngår i: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 101, nr 3, s. 190-197Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The recent substantial increase in the number of obese surgeries performed in Sweden has raised concerns about the budget impact.

    Objective: Our aim in this paper is to present an assessment of the budgetary impact of different policies for surgical intervention for obese and overweight subjects from a healthcare perspective in Sweden.

    Methods: The model simulates the annual expected treatment costs of obesity related diseases and surgery in patients of different sex, age and Body Mass Index (BMI). Costs evaluated are costs of surgery plus the excess treatment costs that an obese patient has over and above the treatment costs of a normal-weight patient. The diagnoses that are included for costs assessment are diabetes and cardiovascular disease since these diagnoses are the principal diagnoses associated with obesity. Four different scenarios over the number of surgical operations performed each year are simulated and compared: (1) no surgical operation, (2) 3 000 surgical operations in persons with BMI > 40, (3) 4 000 (BMI > 40), and (4) 5 000 (expanded to BMI > 38).

    Results: Comparing Scenario 2 with Scenario 1 results in a net budget impact of on average SEK 121 million per annum or SEK 40 000 per patient. This implies that 55 percent of the cost of surgery, set equal to SEK 90 000 for each patient, has been offset by a reduction in the excess treatment costs of obesity related diseases. Expanding annual surgery from 3000 to 4000 the cost-offset increased to 58%. By expanding annual surgery further from 4000 to 5000 and at the same time expanding the indication for surgery from BMI > 40 to BMI > 38, no cost-offset is obtained.

    Conclusion: A cost-minimization strategy for bariatric surgery in Sweden should not expand indication, but rather increase the number of surgeries within the currently accepted indication.

  • 24.
    Borgström, Ellinor
    et al.
    Örebro universitet, Hälsoakademin.
    Holma, Therese
    Örebro universitet, Hälsoakademin.
    Hörselrehabilitering för patienter med Alzheimers sjukdom - är det meningsfullt?: En litteraturstudie2008Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Sammanfattning

    Åldrandet kan innebära ökade svårigheter att klara det dagliga livet. Kroppen genomgår fysiska förändringar som kan orsaka ökade funktionshinder, bland annat i kommunikationssituationer. Med stigande ålder följer en naturlig degeneration av hörselsystemet och presbyacusis (åldershörselnedsättning) drabbar många äldre. Demens tillhör inte det naturliga åldrandet, men risken att drabbas av Alzheimers sjukdom (den vanligaste demensformen), ökar med stigande ålder. Den kognitiva förmågan påverkas exempelvis genom minnesstörningar och tal- och språksvårigheter, vilket innebär att den drabbade får kommunikationssvårigheter. Syftet med vår uppsats var att undersöka om forskningen funnit samband mellan Alzheimers sjukdom och hörselnedsättning, samt om hörselrehabilitering har någon betydelse för den äldre som drabbas av hörselnedsättning och Alzheimers sjukdom. Denna undersökning genomfördes som en litteraturstudie för att ta reda på kunskapsläget. Resultatet uppvisade ett visst biologiskt samband mellan Alzheimers sjukdom och hörselnedsättning i det centrala hörselsystemet, men ej i det perifera hörselsystemet. Alzheimerdrabbade patienter med hörselnedsättning blev hjälpta av hörapparatanpassning, vilket upplevdes av både patient och dess omgivning. Denna litteraturstudie uppmuntrar till vidare forskning kring hörselrehabiliteringens betydelse för personer med Alzheimers sjukdom och med hörselnedsättning samt kring samband mellan dessa två diagnoser, då forskning kring dessa frågeställningar var mycket begränsad.

  • 25.
    Brunnberg, Elinor
    et al.
    Örebro universitet, Institutionen för beteende-, social- och rättsvetenskap.
    Cedersund, ElisabetHälsohögskolan, Högskolan i Jönköping.
    Välfärdspolitik i praktiken: om perspektiv och metoder i forskning2007Collection/Antologi (Annet (populærvitenskap, debatt, mm))
    Abstract [sv]

    Förändringar av människors villkor i samhället kräver nya sätt att forska. I den här antologin presenteras olika redskap för kvalitativ forskning om välfärd. I antologin utgår forskarna från redan välkända traditioner inom samhällsvetenskaplig forskning, men argumenterar inte bara för etablerade forskningsmetoder och teoretiska perspektiv inom välfärdsforskningen utan också för nya. Antologin har arbetats fram inom ramen för Nordiska Sommaruniversitetet och därmed influerats av olika forskningstraditioner som förekommer vid universitet och högskolor i Norden.

    Nya forskningsmetoder där människornas egna utsagor och upplevelser tillvaratas kan tolkas utifrån redan etablerade teoretiska perspektiv som fenomenologi, hermeneutik och interaktionism. De forskningsansatser som presenteras möjliggör att människor även själva är med och formulerar bilden av sina livsvillkor. I antologin visas hur forskning med dessa ansatser kan ske tillsammans med människor i olika åldrar och livssituationer. I antologin visas också att komparativa ansatser kan öppna för nya insikter om olika dimensioner i välfärdsystemet som en kulturell praktik.

  • 26.
    Busch, Hillevi
    et al.
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Sweden.
    Bodin, Lennart
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Sweden.
    Bergström, Gunnar
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Sweden.
    Jensen, Irene B.
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Sweden.
    Patterns of sickness absence a decade after pain-related multidisciplinary rehabilitation2011Inngår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 152, nr 8, s. 1727-1733Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Multidisciplinary programmes using a vocational approach can enhance work return in chronic pain patients, but little is known about the long-term effects of rehabilitation. The current study examined the patterns of sickness absence 10 years after participation in 3 treatment groups (physiotherapy, cognitive behavioural therapy, and vocational multidisciplinary rehabilitation) in comparison to a control group receiving treatment-as-usual. Cost-effectiveness was also assessed. Two hundred fourteen patients participated in a randomized controlled trial and were followed-up via register data 10 years after the interventions. On average, persons in multidisciplinary rehabilitation had 42.98 fewer days on sickness absence per year compared to those treated-as-usual (95% confidence interval −82.45 to −3.52, P=0.03). The corresponding reduction of sickness absence after physiotherapy and cognitive behavioural therapy was not significantly different from the control group. The effect of rehabilitation seems to be more pronounced for disability pension than for sick leave. The economic analyses showed substantial cost savings for individuals in the multidisciplinary group compared to the control group.

  • 27.
    Carlfjord, Siw
    et al.
    Department of Medical and Health Sciences, Community Medicine, Linköping University, Linköping, Sweden.
    Nilsing-Strid, Emma
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. University Health Care Research Centre.
    Johansson, Kajsa
    Department of Medical and Health Sciences, Community Medicine, Linköping University, Linköping, Sweden.
    Holmgren, Theresa
    Department of Medical and Health Sciences, Community Medicine, Linköping University, Linköping, Sweden; Department of Orthopaedics, Region Östergötland, Linköping, Sweden.
    Öberg, Birgitta
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Practitioner experiences from the structured implementation of evidence-based practice in primary care physiotherapy: A qualitative study2019Inngår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 25, nr 4, s. 622-629Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    RATIONALE, AIMS, AND OBJECTIVES: To provide best available care, the practitioners in primary health care (PHC) must have adequate knowledge about effective interventions. The implementation of such interventions is challenging. A structured implementation strategy developed by researchers at Linköping University, Sweden, was used for the implementation of an evidence-based assessment and treatment programme for patients with subacromial pain among physiotherapists in PHC. To further develop strategies for implementation of evidence-based practices, it was deemed important to study the implementation from the practitioners' perspective. The aim of this study was to explore the practitioners' experiences from the implementation.

    METHODS: A qualitative design with focus group discussions was applied. The implementation in terms of perceptions of process and outcome was evaluated by focus group discussions with, in total, 16 physiotherapists in the target group. Data were analysed using the method qualitative content analysis.

    RESULTS: The components of the strategy were viewed positively, and the applicability and evidence base behind the programme were appreciated. The programme was perceived to be adopted, and the practitioners described a changed behaviour and increased confidence in handling patients with subacromial pain. Both patient- and provider-related challenges to the implementation were mentioned.

    CONCLUSIONS: The practitioners' experiences from the implementation were mainly positive. A strategy with collaboration between academy and practice, and with education and implementation teams as facilitators, resulted in changes in practice. Critical voices concerned interprofessional collaboration and that the programme was focused explicitly on the shoulder, not including other components of physical function.

  • 28.
    Carling, Anna
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. University Health Care Research Centre; Department of Physiotherapy.
    Nilsagård, Ylva
    Health Care Management, Region Örebro County, Örebro, Sweden.
    Forsberg, Anette
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Making it work: experience of living with a person who falls due to multiple sclerosis2018Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, s. 1-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: The purpose of this study was to describe how everyday life is experienced by next of kin sharing residence with a person who falls due to multiple sclerosis (MS).

    METHODS: Twenty face-to-face interviews were analysed using a qualitative content analysis.

    RESULTS: The overall theme "Making it work" represents the next of kin's struggle to make life work. It comprises three themes: "Taking responsibility", "Making adjustments", and "Standing aside for someone else". The two first themes reflect what relatives do to make the situation work, and the last theme represents what they give up.

    CONCLUSION: Next of kin who share residence and everyday life with a person with MS are affected by that person's occasional falls. They often take on the responsibility of preventing such falls and adapt their lives practically and emotionally. However, adaptation is neither always enough or always possible. In these cases, relatives often deprioritize their own needs and free time to make everyday life in the home work. Implications for rehabilitation By highlighting that next of kin also are affected by the falls of their cohabiting person with multiple sclerosis enhances the importance of fall prevention activities that should include the next of kin. Next of kin to people who occasionally fall due to multiple sclerosis can be in need of both practical and emotional support from the health care system. Enhanced information from the health care system can empower and help them to take care of themselves while managing to live with, care for, and protect the person with multiple sclerosis from falls.

  • 29.
    Carlsson, Gunilla
    et al.
    Centre for Ageing and Supportive Environments (CASE), Lund University, Lund, Sweden.
    Pettersson, Cecilia
    Centre for Ageing and Supportive Environments (CASE), Lund University, Lund, Sweden.
    Kylberg, Marianne
    Centre for Ageing and Supportive Environments (CASE), Lund University, Lund, Sweden.
    Iwarsson, Susanne
    Centre for Ageing and Supportive Environments (CASE), Lund University, Lund, Sweden.
    Patientprocesser inom projektet Hälsostaden Ängelholm: Erfarenheter frånmultisjuka äldre, närstående och personal2016Rapport (Annet vitenskapelig)
  • 30.
    Castrén, Maaret
    et al.
    Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Kurland, Lisa
    Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Liljegard, Sofia
    Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Djärv, Therese
    Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Emergency Department, Karolinska University Hospital, Solna, Sweden.
    Non-specific complaints in the ambulance; predisposing structural factors2015Inngår i: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 15, artikkel-id 8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The pre-hospital assessment non-specific complaint (NSC) often applies to patients whose diagnosis does not match any other specific assessment correlating to particular symptoms or diseases, though some previous studies have found them to be related to serious underlying conditions. The aim was to identify whether the structural factors such as urgency according to the dispatch priority of the Emergency Medical Communication Centre (EMCC) or work load in the Emergency Medical Services (EMS) are predisposing factors for the assessment of NSC instead of a specific assessment.

    METHODS: All patients with assessed condition NSCs by the EMS to Södersjukhuset during 2011 (n = 493) were compared with gender- and age-matched controls (n = 493), which were randomly drawn from all patients with specific conditions in the EMS, regarding day of week, time of day and priority set by EMCC with chi-squared tests and multivariate logistic regression models.

    RESULTS: Among patients with NSCs, more were females (58 %) and the median age was 82. Almost all patients were categorized with NSCs during the daytime (8 a.m. to 9 p.m.), i.e. 450 (91 %) as compared to 373 (75 %) of those with specific conditions (p < 0.01). The risk of having an EMS dispatched as low priority by the EMCC was almost doubled among patients with NSCs compared to controls (OR 1.97, 95 % CI 1.38-2.79).

    CONCLUSIONS: Since patients with NSCs appear most frequently during the hours with most transportations for the EMS, i.e. 10 a.m. to 2 p.m., and the risk of having the assessment NSC was doubled if the EMCC dispatched EMS as low priority, structural factors might be predisposing factors for the assessment.

  • 31.
    Celik, Daniel H.
    et al.
    Academic and Community Emergency Specialists, Uniontown Ohio, USA; Summa Health System, Akron Ohio, USA.
    Mencl, Francis R.
    Academic and Community Emergency Specialists, Uniontown Ohio, USA; Summa Health System, Akron Ohio, USA.
    Debacker, Michel
    Research Group on Emergency and Disaster Medicine (ReGEDiM), Vrije Universiteit Brussel, Brussels, Belgium.
    Kurland, Lisa
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Emergency Medicine.
    Wilber, Scott T.
    Summa Health System, Akron Ohio, USA.
    Frey, Jennifer A.
    Summa Health System, Akron Ohio, USA; The Ohio State University, Columbus Ohio, USA.
    Triage Performance of School Personnel Using the SALT System2019Inngår i: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 34, nr 4, s. 401-406Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: The aim of this study was to determine if school personnel can understand and apply the Sort, Assess, Life-saving interventions, Treat/Transport (SALT) triage methods after a brief training. The investigators predicted that subjects can learn to triage with accuracy similar to that of medically trained personnel, and that subjects can pass an objective-structured clinical exam (OSCE) evaluating hemorrhage control.

    Methods: School personnel were eligible to participate in this prospective observational study. Investigators recorded subject demographic information and prior medical experience. Participants received a 30-minute lecture on SALT triage and a brief lecture and demonstration of hemorrhage control and tourniquet application. A test with brief descriptions of mass-casualty victims was administered immediately after training. Participants independently categorized the victims as dead, expectant, immediate, delayed, or minimal. They also completed an OSCE to evaluate hemorrhage control and tourniquet application using a mannequin arm.

    Results: Subjects from two schools completed the study. Fifty-nine were from a private school that enrolls early childhood through grade eight, and 45 from a public school that enrolls grades seven and eight (n = 104). The average subject age was 45 years and 68% were female. Approximately 81% were teachers and 87% had prior cardiopulmonary resuscitation (CPR) training. Overall triage accuracy was 79.2% (SD = 10.7%). Ninety-six (92.3%) of the subjects passed the hemorrhage control OSCE.

    Conclusions: After two brief lectures and a short demonstration, school personnel were able to triage descriptions of mass-casualty victims with an overall accuracy similar to medically trained personnel, and most were able to apply a tourniquet correctly. Opportunities for future study include integrating high-fidelity simulation and mock disasters, evaluating for knowledge retention, and exploring the study population's baseline knowledge of medical care, among others.

  • 32.
    Dahlberg, Karuna
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Jaensson, Maria
    Örebro universitet, Institutionen för hälsovetenskaper.
    Nilsson, Ulrica
    Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden; Perioperative Medicine, Karolinska University Hospital, Stockholm, Sweden.
    “Let the patient decide” – person-centered postoperative follow-up contacts, initiated via a phone app after day surgery: secondary analysis of a randomized controlled trial2019Inngår i: International Journal of Surgery, ISSN 1743-9191, E-ISSN 1743-9159, s. 33-37Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Patients undergoing day surgery are expected to manage their recovery on their own. Follow-up routines differ, but many patients have expressed a need for more professional support during recovery. The aim of this study was to describe how many follow-up contacts were initiated, and when and why, via a digital solution. Also, we wanted to compare postoperative recovery and characteristics between patients requesting, and patients not requesting, contact.

    MATERIALS AND METHODS: This was a secondary analysis of a multicenter, two-group, parallel randomized controlled trial. Participants used a digital solution called "Recovery Assessment by Phone Points (RAPP)" for initiating follow-up contacts after day surgery. The quality of postoperative recovery was measured with the Swedish web-version of Quality of Recovery.

    RESULTS: Of 494 patients, 84 (17%) initiated contact via RAPP. The most common reasons for initiating contact were related to the surgical wound and pain. Contacts were initiated across the 14-day assessment period, with 62% (62/100) in the first postoperative week. The RAPP contact group had significantly poorer postoperative recovery on days 1-14 compared to those not requesting contact via RAPP (p < 0.001). There was a significantly higher proportion of patients who had undergone general anesthesia in the RAPP contact group (85% [71/84]) compared to the non-RAPP contact group (71% [291/410]), p = 0.003.

    CONCLUSION: Letting the patient decide him/herself whether, and when, contact and support is needed during the postoperative period, is possible and does not increase the frequency of contacts. This study investigates a digital solution, RAPP, as one example of a person-centered approach that can be implemented in day surgery follow-up.

  • 33.
    Dalal, Koustuv
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Aremu, Olatunde
    Fairness of utilizing health care facilities and out-of-pocket payment burden: evidence from Cambodia2013Inngår i: Journal of Biosocial Science, ISSN 0021-9320, E-ISSN 1469-7599, Vol. 45, nr 3, s. 345-357Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Catastrophic spending on health care through out-of-pocket payment is a huge problem in most low- and middle-income countries all over the world. The collapse of health systems and poverty have resulted in the proliferation of the private health sector in Cambodia, but very few studies have examined the fairness in ease of utilization of these services based on mode of payment. This study examined the utilization of health services for sickness or injury and identified its relationship with people's ability to pay for treatment seeking at various instances. Based on cross-sectional data from the Cambodian 2007 Demographic and Health Survey, the economic index estimated through principal component analysis and Lorenz curve was used to quantify the degree of fairness and equality in utilization and payment burden among the respondents. A distinct level of fairness was found in health care utilization and out-of-pocket payments. Specifically, use of private health care facilities and over-the-counter remedies dominate, and out-of-pocket payments cut across all socioeconomic strata. As many countries in low- and middle-income regions, and most importantly those in transition such as Cambodia, are repositioning their health systems, efforts should be made towards maintaining equitable access through adoption of finance mechanisms that make utilization of health care services fair and equitable.

  • 34.
    Dalal, Koustuv
    et al.
    Department of Public Health Science, School of Life Sciences, University of Skövde, Skövde, Sweden.
    Dawad, S
    The Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa.
    Economic cost of domestic violence: A community study in South Africa2011Inngår i: HealthMed, ISSN 1840-2291, E-ISSN 1986-8103, Vol. 5, nr 6 Suppl. 1, s. 1931-40Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The present study estimated economic costs of domestic violence against women who sought help from a community care centre in South Africa. It aimed to relate the victims’ income and victims’ family income to violence related injuries and related costs. This was a cross sectional study with face-to-ˇace interviews in a community care center in which victims of domestic violence sought various kinds of assistance. In total, 261 women were interviewed. The average economic cost of each domestic violence incidence was 691 USD while average cost for medical expenditure was 29 USD and average loss of income due to domestic violence was 2092 USD. Larger families and higher individual and family incomes were protective factors for severity of violence related injuries. Pain and discomfort due to domestic violence emerged as expensive for both medical costs and productivity losses. Considering the average monthly income of 482 USD, domestic violence averaged a cost per incident of 691 USD during the previous month, indicating a deficit in household budget. We found that domestic violence against women resulted with expensive injuries, pain and discomforts.

  • 35.
    Dalal, Koustuv
    et al.
    Karolinska Institute, Stockholm.
    Jansson, Bjarne
    Karolinska Institute, Stockholm.
    Cost calculation and economic analysis of violence in low-income country: a model for India2007Inngår i: African Safety Promotion: A Journal of Injury and Violence Prevention, ISSN 1728-774X, Vol. 5, nr 1, s. 45-56Artikkel i tidsskrift (Fagfellevurdert)
  • 36.
    Dalal, Koustuv
    et al.
    Karolinska Institutet, Division of Social Medicine, Department of Public Health Sciences, Stockholm.
    Rahman, Aminur
    Centre for Injury Prevention and Research, Mohakhali Dhaka-1206, Bangladesh.
    Out-of-pocket payments for unintentional injuries: a study in rural Bangladesh.2009Inngår i: International Journal of Injury Control and Safety Promotion, ISSN 1745-7300, E-ISSN 1745-7319, Vol. 16, nr 1, s. 41-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This paper studies the nature and extent of out-of-pocket expenses for unintentional injuries, using the context of rural Bangladesh. A cross-sectional study consisting of 23,113 people was performed through multistage cluster sampling. Chi-square analysis and pie-diagrams were used. A total of 3411 injury victims were identified in this survey. Only 14% of victims received government medical assistance while 17% of victims benefited from public health care and 13% benefited from private health care facilities. However, 94% of the injury victims have purchased drugs out-of-pocket. With a minimum of US $0.07 and maximum of US $140 their mean out-of-pocket payment for drugs was US $4 (half of the Bangladeshis are living under US $1 per day). Instead of relying on public health care facilities most rural Bangladeshi people spent money from their own pockets for treatments. Proper health care distribution with a community-based insurance scheme and safety awareness programmes are warranted to reduce both injury and economic burdens.

  • 37.
    Dalal, Koustuv
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Wang, Shumei
    School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.
    Svanström, Leif
    School of Life Sciences, University of Skövde, Skövde, Sweden; WHO CC Community Safety Promotion, Karolinska Institutet, Stockholm, Sweden.
    Intimate Partner Violence against Women in Nepal: An Analysis through Individual, Empowerment, Family and Societal Level Factors2014Inngår i: Journal of research in health sciences, ISSN 2228-7795, Vol. 14, nr 4, s. 251-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The current study estimated the national prevalence rate of intimate partner violence against women (IPVAW) in Nepal. Besides, the individual level, empowerment level, family and societal level factors were assessed to relate with the victims of IPAVW in Nepal.

    Methods: Nationally representative sample of 4210 women of reproductive age (15-49 yr) were included in the study. Household surveys using two stage sampling procedures, face to face interview with pre-tested questionnaires were performed. Emotional, physical and sexual violence were target variables. A violence variable was constructed from these three types of violence. Individual level factors were measured by age, residency, education, religion and husband's education. Empowerment factors included employment status and various decision making elements. Family and societal factors included economic status, neighborhood socioeconomic disadvantage index, history of family violence, husband's controlling behavior and other issues. Cross tabulation with chi-square tests and multivariate logistic regression were employed.

    Results: Prevalence of emotional IPVAW was 17.5%, physical IPAVW 23.4% and sexual IPAVW 14.7%. Overall the prevalence of IPVAW in Nepal was 32.4%. Joint decision making for contraception, husband's non-controlling behavior to wives and friendly feelings were emerged as less likely to be IPVAW perpetration.

    Conclusion: The findings have immense policy importance as a nationally representative study and indicating necessity of more gender equality.

  • 38.
    Djalali, Ahmadreza
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; RIMEDIM - Center for Research and Education in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy.
    Castren, Maaret
    Department of Clinical Sciences and Education and Section of Emergency Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Khankeh, Hamidreza
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Nursing Department, University of Social Welfare and Rehabilitation, Tehran, Iran.
    Gryth, Dan
    Department of Physiology and Pharmacology and Section of Anaesthesiology and Intensive care, Karolinska Institutet, Stockholm, Sweden.
    Radestad, Monica
    Department of Clinical Sciences and Education and Section of Emergency Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Öhlen, Gunnar
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Kurland, Lisa
    Department of Clinical Sciences and Education and Section of Emergency Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Hospital disaster preparedness as measured by functional capacity: a comparison between Iran and Sweden2013Inngår i: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 28, nr 5, s. 454-461Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: Hospitals are expected to continue to provide medical care during disasters. However, they often fail to function under these circumstances. Vulnerability to disasters has been shown to be related to the socioeconomic level of a country. This study compares hospital preparedness, as measured by functional capacity, between Iran and Sweden.

    METHODS: Hospital affiliation and size, and type of hazards, were compared between Iran and Sweden. The functional capacity was evaluated and calculated using the Hospital Safety Index (HSI) from the World Health Organization. The level and value of each element was determined, in consensus, by a group of evaluators. The sum of the elements for each sub-module led to a total sum, in turn, categorizing the functional capacity into one of three categories: A) functional; B) at risk; or C) inadequate.

    RESULTS: The Swedish hospitals (n = 4) were all level A, while the Iranian hospitals (n = 5) were all categorized as level B, with respect to functional capacity. A lack of contingency plans and the availability of resources were weaknesses of hospital preparedness. There was no association between the level of hospital preparedness and hospital affiliation or size for either country.

    CONCLUSION: The results suggest that the level of hospital preparedness, as measured by functional capacity, is related to the socioeconomic level of the country. The challenge is therefore to enhance hospital preparedness in countries with a weaker economy, since all hospitals need to be prepared for a disaster. There is also room for improvement in more affluent countries.

  • 39.
    Dozet, Alexander
    et al.
    Department of Healthcare Governance, Region Skåne, Malmö, Sweden.
    Ivarsson, Bodil
    Medicine Service University Trust, Department of Cardiothoracic Surgery, Skåne University Hospital, Region Skåne, Lund University, Lund, Sweden.
    Eklund, Karin
    Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden.
    Klefsgard, Rosemarie
    Hospital Management, Skåne University Hospital, Malmö, Sweden.
    Geijer, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology; Department of Clinical Sciences, Lund University, Lund, Sweden.
    Radiography on wheels arrives to nursing homes - an economic assessment of a new health care technology in southern Sweden2016Inngår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 22, nr 6, s. 994-1001Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Rationale, aims and objectives: The process of transferring older, vulnerable adults from an elder care facility to the hospital for medical care can be an emotionally and physically stressful experience. The recent development of modern mobile radiography may help to ease this anxiety by allowing for evaluation in the nursing home itself. Up until this point, no health economic evaluation of the technology has been attempted in a Swedish setting. The objective of this study was to determine whether examinations of patients in elder care facilities with mobile radiography were cost-effective from a societal perspective compared with hospital-based radiological examinations.

    Methods: This prospective study included two groups of nursing home residents in two different areas in southern Sweden. All residents in the nursing homes were targeted for the study. Seventy-one patients were examined with hospital-based radiography at two hospitals, and 312 patients were examined using mobile radiography in nursing homes. Given that the diagnostic effects are regarded as equivalent, a cost minimization method was applied. Direct costs were estimated using prices from the county council, Region Skane, Sweden.

    Results: From a societal perspective, mobile radiography was shown to have significantly lower costs per examination compared with hospital-based radiography. The difference in health care-related costs was also significant in favour of mobile radiography.

    Conclusion: Mobile radiography can be used to examine patients in nursing homes at a lower cost than hospital-based radiography. Patients benefit from not having to transfer to a hospital for radiography, resulting in reduced anxiety for patients.

  • 40.
    Ekbäck, Maria Palmetun
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Dermatology, Örebro University Hospital, Örebro, Sweden; Department of Pharmacology and Therapeutics, Örebro County Council, Örebro, Sweden.
    Lindberg, Magnus
    Örebro universitet, Institutionen för läkarutbildning. Region Örebro län. Department of Dermatology, University Hospital Örebro, Örebro, Sweden.
    Benzein, Eva
    Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Health and Caring Science, Linnaeus University, Kalmar, Sweden.
    Årestedt, Kristofer
    Department of Health and Caring Science, Linnaeus University, Kalmar, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Palliative Research Centre, Ersta Sköndal University College and Hospital, Stockholm, Sweden .
    Social support: an important factor for quality of life in women with hirsutism2014Inngår i: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 12, artikkel-id 183Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Women with hirsutism have reported imparied health and health-related quality of life (HRQoL). Social support is a factor that might increase HRQoL in chronic diseases, but little is known about this association among women with hirsutism.

    Aim: The aim of the study was to describe social support and explore its association with HRQoL among women with hirsutism. A further aim was to compare HRQoL in women with hirsutism with a Swedish normal population.

    Methods: A questionnaire including socio-demographic questions, Short-Form Health Survey (SF-36), the Multidimensional Scale of Perceived Social Support (MSPSS), and a self-estimation of hairiness using the Ferriman-Gallway scale (F-G scale) was answered by 127 women with hirsutism.

    Results: Multiple regression analyses showed significant associations between social support and all health dimensions in the SF-36, also after the model was adjusted for age, hairiness and body mass index. Compared to the normal Swedish population, women with hirsutism reported significantly lower HRQoL in all dimensions of the SF-36 (p < 0.01).

    Conclusions: There is a significant positive association between social support and HRQoL, demonstrating its importance for the ability to adapt to problems associated with hirsutism. As women with hirsutism reported poorer HRQoL compared to the normal population, social support may be a factor to consider in clinical practice.

  • 41.
    Ekelin, Elsa
    et al.
    University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Hansson, Anders
    University Health Care Research Center, Region Örebro County, Örebro, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    The dilemma of repeat weak opioid prescriptions - experiences from swedish GPs2018Inngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, nr 2, s. 180-188Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To explore general practitioners' (GP) experiences of dealing with requests for the renewal of weak opioid prescriptions for chronic non-cancer pain conditions.

    Design: Qualitative focus group interviews. Systematic text condensation analysis.

    Setting and subjects: 15 GPs, 4 GP residents and 2 interns at two rural and two urban health centres in central Sweden.

    Main outcome measures: Strategies for handling the dilemma of prescribing weak opioids without seeing the patient.

    Results: After analysing four focus group interviews we found that requests for prescription renewals for weak opioids provoked adverse feelings in the GP regarding the patient, colleagues or the GP's inner self and were experienced as a dilemma. To deal with this, the GP could use passive as well as active strategies. Active strategies, like discussing the dilemma with colleagues and creating common routines regarding the renewal of weak opioids, may improve prescription habits and support physicians who want to do what is medically correct.

    Conclusion: Many GPs feel umcomfortable when prescribing weak opioids without seeing the patient. This qualitative study has identified strategic approaches to deal with that issue.

  • 42.
    Eklund, Andreas
    et al.
    Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden.
    Jensen, Irene
    Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden.
    Loleha-Karlsson, Malin
    Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden.
    Hagberg, Jan
    Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden.
    Leboeuf-Yde, Charlotte
    Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark.
    Kongsted, Alice
    Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
    Bodin, Lennart
    Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden.
    Axén, Iben
    Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden; Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark.
    The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain—A pragmatic randomized controlled trial2018Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, nr 9, artikkel-id e0203029Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: For individuals with recurrent or persistent non-specific low back pain (LBP), exercise and exercise combined with education have been shown to be effective in preventing new episodes or in reducing the impact of the condition. Chiropractors have traditionally used Maintenance Care (MC), as secondary and tertiary prevention strategies. The aim of this trial was to investigate the effectiveness of MC on pain trajectories for patients with recurrent or persistent LBP.

    Method: This pragmatic, investigator-blinded, two arm randomized controlled trial included consecutive patients (18–65 years old) with non-specific LBP, who had an early favorable response to chiropractic care. After an initial course of treatment, eligible subjects were randomized to either MC or control (symptom-guided treatment). The primary outcome was total number of days with bothersome LBP during 52 weeks collected weekly with text-messages (SMS) and estimated by a GEE model.

    Results: Three hundred and twenty-eight subjects were randomly allocated to one of the two treatment groups. MC resulted in a reduction in the total number of days per week with bothersome LBP compared with symptom-guided treatment. During the 12 month study period, the MC group (n = 163, 3 dropouts) reported 12.8 (95% CI = 10.1, 15.5; p = <0.001) fewer days in total with bothersome LBP compared to the control group (n = 158, 4 dropouts) and received 1.7 (95% CI = 1.8, 2.1; p = <0.001) more treatments. Numbers presented are means. No serious adverse events were recorded.

    Conclusion: MC was more effective than symptom-guided treatment in reducing the total number of days over 52 weeks with bothersome non-specific LBP but it resulted in a higher number of treatments. For selected patients with recurrent or persistent non-specific LBP who respond well to an initial course of chiropractic care, MC should be considered an option for tertiary prevention.

  • 43.
    Ekström, Andreas
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Eng-Larsson, Fredrik
    Stockholm Business School, Stockholm University, Stockholm, Sweden.
    Isaksson, Olov
    Stockholm Business School, Stockholm University, Stockholm, Sweden.
    Kurland, Lisa
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Emergency Medicine, Örebro University Hospital, Örebro, Sweden.
    Nordberg, Martin
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    The effect of a terrorist attack on emergency department inflow: an observation study using difference-in-differences methodology2019Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 27, nr 1, artikkel-id 57Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY OBJECTIVE: The objective of this study was to investigate how the terrorist attack in Stockholm, Sweden affected patient inflow to the general emergency departments (EDs) in close proximity of the attack. The study analyzed if, and to what extent, the attack impacted ED inflow during the following days and weeks.

    METHODS: In a retrospective observational study, anonymized aggregated data on ED arrivals (inflow of patients) to all seven of the EDs in the Stockholm County was analyzed using the Difference-in-Differences (DiD) estimator. The control groups were the affected hospitals in the years prior to the terrorist attack. The number of ED visits was retrieved from the Stockholm County Council administrative database.

    RESULTS: The study shows a statistically significant reduction in overall ED inflow of 7-9% following the attack. The effect was strongest initially after the attack, and ED inflow regained normal levels within approximately three weeks' time, without any significant rebound effect. The effect on ED inflow also decreased with distance from ground zero, and was not significant further away than 10 km.

    CONCLUSION: The results showed that ED inflow was significantly decreased in the weeks immediately following the Stockholm terrorist attack. The reasons for this cannot be fully explained in this observational study. However, the results suggest that some patients actively choose when, where and if they should go to the ED.

  • 44.
    Ekström, Magnus
    et al.
    Division of Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund University, Lund, Sweden.
    Sundh, Josefin
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Respiratory Medicine, Örebro University Hospital, Örebro, Sweden.
    Swedish translation and linguistic validation of the multidimensional dyspnoea profile2016Inngår i: European clinical respiratory journal, ISSN 2001-8525, Vol. 3, s. 1-4, artikkel-id 32665Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Dyspnoea, the feeling of breathing discomfort, consists of multiple dimensions that can vary in intensity, including the level of unpleasantness, qualities or descriptors of the sensation, emotional responses, and impact on function. No validated instrument for multidimensional measurement of dyspnoea is available in Swedish. The Multidimensional Dyspnea Profile (MDP) was recently developed to measure the unpleasantness, sensory qualities, and emotional responses of dyspnoea across diseases and settings. We aimed to take forward a Swedish version of the MDP.

    Methods: Translation and linguistic validation of the MDP was conducted in collaboration with a specialised company in the field (Mapi, Lyon, France). The structured process involved forward and backward translations by two independent certified translators, input from an in-country linguistic consultant, the developers, and three respiratory physicians. Understandability and acceptability were evaluated through in-depth interviews with five patients with dyspnoea in accordance with international guidelines.

    Results and Conclusion: A Swedish version of the MDP was obtained and linguistically validated. The MDP includes 11 rated items: the immediate unpleasantness of the sensation, the presence and intensity of five sensory qualities, and the intensity of five emotional responses to dyspnoea. The time period of measurement is specified by the user. The MDP is copyrighted by the developers but can be used free of charge in the context of non-funded academic research.

    Conclusion: The MDP is the first instrument for measuring multiple dimensions of dyspnoea available in Swedish and should be validated across diseases and settings. Multidimensional measurement is essential for improved assessment and management of dyspnoea in research and clinical care.

  • 45.
    Elias, Kevin M.
    et al.
    Brigham and Women’s Hospital, Harvard Medical School, Boston, USA.
    Stone, Alexander B.
    Brigham and Women’s Hospital, Harvard Medical School, Boston, USA.
    McGinigle, Katharine
    University of North Carolina School of Medicine, Chapel Hill, USA.
    Tankou, Jo'An I.
    Brigham and Women’s Hospital, Harvard Medical School, Boston, USA.
    Scott, Michael J.
    Virginia Commonwealth University Health System, Richmond, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
    Fawcett, William J.
    Royal Surrey County Hospital, Guilford, UK; University of Surrey, Guilford, UK.
    Demartines, Nicolas
    Lausanne University Hospital CHUV, Lausanne, Switzerland.
    Lobo, Dileep N
    Nottingham Digestive Diseases Centre, Nottingham, UK; National Institute for Health Research (NIHR), Nottingham, UK; Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Queen’s Medical Centre, University of Nottingham, Nottingham, UK.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Urman, Richard D.
    Brigham and Women’s Hospital, Harvard Medical School, Boston, USA.
    Eras, Society
    The Reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) Checklist: A Joint Statement by the ERAS® and ERAS® USA Societies2019Inngår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, nr 1, s. 1-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Enhanced recovery after surgery (ERAS) programs are multimodal care pathways designed to minimize the physiological and psychological impact of surgery for patients. Increased compliance with ERAS guidelines is associated with improved patient outcomes across surgical types. As ERAS programs have proliferated, an unintentional effect has been significant variation in how ERAS-related studies are reported in the literature.

    METHODS: Society launched an effort to create an instrument to assist authors in manuscript preparation. Criteria to include were selected by a combination of literature review and expert opinion. The final checklist was refined by group consensus.

    RESULTS: The Societies present the Reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) Checklist. The tool contains 20 items including best practices for reporting clinical pathways, compliance auditing, and formatting guidelines.

    CONCLUSIONS: The RECOvER Checklist is intended to provide a standardized framework for the reporting of ERAS-related studies. The checklist can also assist reviewers in evaluating the quality of ERAS-related manuscripts. Authors are encouraged to include the RECOvER Checklist when submitting ERAS-related studies to peer-reviewed journals.

  • 46.
    Elinder, Göran
    et al.
    Department of Pediatrics, Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Anders
    Department of Community Medicine and Rehabilitation, Forensic Medicine, Umeå University, Umeå, Sweden; The National Board of Forensic Medicine, Linköping, Sweden.
    Hallberg, Boubou
    Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics and Neonatology, Karolinska University Hospital, Stockholm, Sweden.
    Lynøe, Niels
    Medical Ethics, Karolinska Institutet, Stockholm, Sweden.
    Sundgren, Pia Maly
    Diagnostic Radiology, Lund University, Lund, Sweden; Department of Neuroradiology, Skåne University Hospital, Lund, Sweden.
    Rosén, Måns
    Health Technology Assessment, Karolinska Institutet, Stockholm, Sweden.
    Engström, Ingemar
    Örebro universitet, Institutionen för medicinska vetenskaper. Child and Adolecent Psychiatry, University Health Care Research Center.
    Erlandsson, Björn-Erik
    Medical Technology, Royal Institute of Technology, Stockholm, Sweden.
    Traumatic shaking: The role of the triad in medical investigations of suspected traumatic shaking2018Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, nr S472, s. 3-23Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    The Swedish Agency for Health Technology Assessment and Assesment of Social Services (SBU) is an independent national authority, tasked by the government with assessing methods used in health, medical and dental services and social service interventions from a broad perspective, covering medical, economic, ethical and social aspects. The language in SBU's reports are adjusted to a wide audience. SBU's Board of Directors has approved the conclusions in this report. The systematic review showed the following graded results:

    • There is limited scientific evidence that the triad (Three components of a whole. The triad associated with SBS usually comprises subdural haematoma, retinal haemorrhages and encephalopathy.) and therefore, its components can be associated with traumatic shaking (low-quality evidence).
    • There is insufficient scientific evidence on which to assess the diagnostic accuracy of the triad in identifying traumatic shaking (very low-quality evidence).

    Limited scientific evidence (low-quality evidence) represents a combined assessment of studies of high or moderate quality which disclose factors that markedly weaken the evidence. It is important to note that limited scientific evidence for the reliability of a method or an effect does not imply complete lack of scientific support. Insufficient scientific evidence (very low-quality evidence) represents either a lack of studies or situations when available studies are of low quality or show contradictory results. Evaluation of the evidence was not based on formal grading of the evidence according to GRADE but on an evaluation of the total scientific basis.

  • 47.
    Eriksson, Susanne
    et al.
    Örebro universitet, Hälsoakademin.
    Nordenmark, Mari
    Örebro universitet, Hälsoakademin.
    Nyttan av frekvenstransponering som teknik i hörapparater2008Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    I ett audionomperspektiv gjordes en litteraturstudie av transponering av frekvenser som teknik i hörapparater. Relevant information från vetenskapliga artiklar valdes för att beskriva när det kan vara aktuellt med denna anpassning och vilka ljudsituationer som kan förbättras. Vid frekvenstransponering flyttas inkommande frekvenser från ett frekvensområde till ett annat frekvensområde vid utsignal. Flera tidigare studier har gjorts med olika anpassningar av denna teknik och de flesta av dem visade på problematik, t ex ett alltför onaturligt ljud. Senare studier visade på att tekniken kan passa för personer med svåra diskantnedsättningar där förstärkning inte räcker till, men att det var viktigt att anpassa tekniken individuellt och att träna på användandet. Individuell anpassning innebär att transponering börjar vid en startfrekvens som motsvaras av en persons döda regioner i innerörat. Studier visade att lyssnings-situationer som fågelkvitter och musik var de situationer där personer först ansåg sig uppleva nytta med tekniken. Efter träning kunde tekniken upplevas som fördelaktig även vid tal. En hörapparat med frekvenstransponering kan vara motiverad där fungerande hörsel endast finns i basområdet. Den kan vara ett icke operativt alternativ till cochleaimplantat (CI) för vissa personer och även ett alternativ vid öppen anpassning för de med svår diskantnedsättning.

  • 48.
    Ernesäter, Annica
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Faculty of Health and Occupational Studies,University of Gävle, Gävle, Sweden.
    Winblad, Ulrika
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.
    Holmström, Inger K.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Malpractice claims regarding calls to Swedish telephone advice nursing: what went wrong and why?2012Inngår i: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 18, nr 7, s. 379-383Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We analysed the characteristics of all malpractice claims arising out of telephone calls to Swedish Healthcare Direct (SHD) during 2003-2010 (n = 33). The National Board of Health and Welfare's (NBHW) investigations describing the causes of the malpractice claims and the healthcare providers' reported measures were analysed using Qualitative Content Analysis. The original telephone calls themselves, which had been recorded, were analysed using the Roter Interaction Analysis System (RIAS). Among the 33 cases, 13 patients died and 12 were admitted to intensive care. Failure to listen to the caller (n = 12) was the most common reason for malpractice claims, and work-group discussion (n = 13) was the most common measure taken to prevent future re-occurrence. Male patients (n = 19) were in the majority, and females (n = 24) were the most common callers. The most common symptoms were abdominal (n = 11) and chest pain (n = 6). Telenurses followed up on caller understanding in six calls, and mainly used closed-ended questions. Despite the severity of these malpractice claims, the measures taken mainly addressed active failure, rather than the latent conditions. Third-party communication should be regarded as a risk. When callers make repeated contacts, telenurses need to re-evaluate their need for care.

  • 49.
    Evenhamre, Karolina
    et al.
    Department of Dermatology, Örebro University Hospital, Örebro, Sweden.
    Ekbäck, Maria Palmetun
    Region Örebro län. Department of Dermatology, Örebro University Hospital, Örebro, Sweden; Department of Medical Sciences, Faculty of Medicine, Örebro University, Örebro, Sweden.
    Lindberg, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Dermatology, Örebro University Hospital, Örebro, Sweden.
    Correlations Between Disease-specific DLQI and Generic WHOQOL-BREF Quality of Life Instruments in a Clinical Population with Mixed Dermatological Diagnoses: A Pilot Study2017Inngår i: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 97, nr 2, s. 270-272Artikkel i tidsskrift (Fagfellevurdert)
  • 50.
    Ewen, Jenny
    et al.
    Örebro universitet, Institutionen för idrott och hälsa.
    Eklund White, Alexandra
    Örebro universitet, Institutionen för idrott och hälsa. Örebro universitet, Hälsoakademin.
    "Oj, hur blev jag fet?": en kvalitativ studie av ämnet viktuppgång2009Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Inledning: En vanlig missuppfattning är att feta individer är lata och inte vill försöka uppnå viktkontroll, eller gå ner i vikt. Syfte: Identifiera faktorer, vilka respondenterna uppfattar påverkar viktuppgång som upphov till övervikt och fetma hos sig själva samt hos andra individer. Urval: Fyra kvinnor och två män i åldrarna 39-50. Ingen respondent har varit överviktig som barn, men har någon gång efter 18 års ålder upplevt fetma. Metod: Studien har en kvalitativ forskningsansats där semistrukturerade intervjuer har använts för att ta reda på respondenternas uppfattningar kring fenomenet viktuppgång. Intervjuerna transkriberades och analyserades enligt ett fenomenografiskt - hermeneutiskt perspektiv. Resultat: Intervjuerna genererade kategorierna Emotioner; Fysisk aktivitet; Bristande kunskap; Kosthållning; Socialt stöd; Förnekande; Tidsbrist, prioritering, vanor; Ålder, hormoner, ämnesomsättning; Ekonomi och Kriser. Slutsats: Viktökning och förlorad viktkontroll är en konsekvens av samverkande faktorer, och det är omöjligt att särskilja en primär kategori i denna urvalsgrupp. För begynnande viktuppgång, både hos respondenterna själva och gällande deras uppfattningar om andra individer, är kategorierna Fysisk aktivitet, Kosthållning och Tidsbrist, prioritering, vanor de dominerande. Förnekande är en betydande faktor för uppkomsten av fetma, och är bidragande för bristande viktkontroll men kan inte missförstås som lathet bland respondenterna i denna urvalsgrupp.

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