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  • 1.
    Blomberg, Karin
    et al.
    Örebro University, School of Health Sciences.
    Carlsson, Agneta Anderzén
    Faculty of Health, Science and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Jonsson, Östen
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Leissner, Lena
    Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Quality of life and trust among young people with narcolepsy and their families, after the Pandemrix® vaccination: Protocol for a case-control study2017In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 17, no 1, article id 183Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The extensive vaccination programme against swine flu resulted in an increased incidence of narcolepsy among children and adolescents. There is a need to explore if these young persons' experiences have affected their trust in healthcare, their willingness to participate in future prevention programmes, and their contacts with the healthcare system. The overall aim is to identify factors important for the life-situation of children and adolescents with narcolepsy and their families, and factors that correlate with trust in healthcare.

    METHODS/DESIGN: Data will be collected via questionnaires from all available children with narcolepsy following the vaccination and their families, as well as a control group of children with diabetes and their families. Longitudinal descriptive interviews will also be conducted with a selection of 20-25 children and their families. Techniques from media research will be used for Internet-based data collection and analysis of information relating to narcolepsy from social media.

    DISCUSSION: This project will use the situation of young persons with narcolepsy after the swine flu vaccination as a case to build a model that can be used in situations where trust in healthcare is essential. This model will be based on findings from the included studies on how trust is influenced by support, quality of life, burden of disease, impact on family, and use of social media. The model developed in this project will be beneficial in future situations where trust in healthcare is essential, such as new pandemic outbreaks but also for "everyday" adherence to health advice.

  • 2.
    Dahlberg, Karuna
    et al.
    Örebro University, School of Health Sciences.
    Philipsson, Anna
    Örebro University, School of Health Sciences. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Hälleberg Nyman, Maria
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Cost-effectiveness of a systematic e-assessed follow-up of postoperative recovery after day surgery: a multicentre randomized trial2017In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 119, no 5, p. 1039-1046Article in journal (Refereed)
    Abstract [en]

    Background: Most surgeries are done on a day-stay basis. Recovery assessment by phone points (RAPP) is a smartphonebased application (app) to evaluate patients after day surgery. The aim of this study was to estimate the cost-effectiveness of using RAPP for follow-up on postoperative recovery compared with standard care.

    Methods: This study was a prospective parallel single-blind multicentre randomized controlled trial. Participants were randomly allocated to the intervention group using RAPP or the control group receiving standard care. A cost-effectiveness analysis was performed based on individual data and included costs for the intervention, health effect [quality-adjusted life-years (QALYs)], and costs or savings in health-care use.

    Results: The mean cost for health-care consumption during 2 weeks after surgery was estimated at e37.29 for the intervention group and e60.96 for the control group. The mean difference was e23.66 (99% confidence interval 46.57 to0.76; P¼0.008). When including the costs of the intervention, the cost-effectiveness analysis showed net savings of e4.77 per patient in favour of the intervention. No difference in QALYs gained was seen between the groups (P¼0.75). The probability of the intervention being cost-effective was 71%.

    Conclusions: This study shows that RAPP can be cost-effective but had no effect on QALY. RAPP can be a cost-effective toolin providing low-cost health-care contacts and in systematically assessing the quality of postoperative recovery.

    Clinical trial registration:NCT02492191

  • 3.
    Duberg, Anna
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden; Örebro County Council, Örebro, Sweden.
    Hagberg, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden; Örebro County Council, Örebro, Sweden.
    Sunvisson, Helena
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Möller, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital, Örebro, Sweden.
    Influencing self-rated health among adolescent girls with dance intervention: a randomized controlled trial2013In: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211, Vol. 167, no 1, p. 27-31Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate whether dance intervention influenced self-rated health for adolescent girls with internalizing problems.

    Design: Randomized controlled intervention trial with follow-up measures at 8, 12, and 20 months after baseline.

    Setting: A Swedish city with a population of 130 000.

    Participants: Girls aged 13 to 18 years with internalizing problems, ie, stress and psychosomatic symptoms. A total of 59 girls were randomized to the intervention group and 53 were randomized to the control group.

    Intervention: The intervention comprised dance classes twice weekly during 8 months. Each dance class lasted 75 minutes and the focus was on the joy of movement, not on performance.

    Main Outcome Measures: Self-rated health was the primary outcome; secondary outcomes were adherence to and experience of the intervention.

    Results: The dance intervention group improved their self-rated health more than the control group at all follow-ups. At baseline, the mean score on a 5-point scale was 3.32 for the dance intervention group and 3.75 for the control group. The difference in mean change was 0.30 (95% CI, −0.01 to 0.61) at 8 months, 0.62 (95% CI, 0.25 to 0.99) at 12 months, and 0.40 (95% CI, 0.04 to 0.77) at 20 months. Among the girls in the intervention group, 67% had an attendance rate of 50% to 100%. A total of 91% of the girls rated the dance intervention as a positive experience.

    Conclusions: An 8-month dance intervention can improve self-rated health for adolescent girls with internalizing problems. The improvement remained a year after the intervention

  • 4.
    Duberg, Anna
    et al.
    Örebro University, School of Health Sciences.
    Jutengren, Göran
    University of Borås.
    Hagberg, Lars
    Örebro University, School of Health Sciences.
    Möller, Margareta
    Örebro University, School of Health Sciences.
    Dance Intervention for Adolescent Girls: Effects on Somatic Symptoms, Emotional Distress, and Use of Medication. A Randomized Controlled TrialManuscript (preprint) (Other academic)
  • 5.
    Ericson, Jenny
    et al.
    Högskolan Dalarna, Falun, Sweden.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Hellström-Westas, Lena
    Uppsala universitet, Uppsala, Sweden.
    Hagberg, Lars
    Örebro University Hospital. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Hoddinott, Pat
    University of Stirling, Stirling, UK.
    Flacking, Renée
    Högskolan Dalarna, Falun, Sweden.
    The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants: study protocol for a randomized controlled trial2013In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 13, p. 1-9, article id 73Article in journal (Refereed)
    Abstract [en]

    Background:

    Although breast milk has numerous benefits for infants’ development, with greater effects in those born preterm (at < 37 gestational weeks), mothers of preterm infants have shorter breastfeeding duration than mothers of term infants. One of the explanations proposed is the difficulties in the transition from a Neonatal Intensive Care Unit (NICU) to the home environment. A person-centred proactive telephone support intervention after discharge from NICU is expected to promote mothers’ sense of trust in their own capacity and thereby facilitate breastfeeding.

    Methods/design:

    A multicentre randomized controlled trial has been designed to evaluate the effectiveness and cost-effectiveness of person-centred proactive telephone support on breastfeeding outcomes for mothers of preterm infants. Participating mothers will be randomized to either an intervention group or control group. In the intervention group person-centred proactive telephone support will be provided, in which the support team phones the mother daily for up to 14 days after hospital discharge. In the control group, mothers are offered a person-centred reactive support where mothers can phone the breastfeeding support team up to day 14 after hospital discharge. The intervention group will also be offered the same reactive telephone support as the control group. A stratified block randomization will be used; group allocation will be by high or low socioeconomic status and by NICU. Recruitment will be performed continuously until 1116 mothers (I: 558 C: 558) have been included. Primary outcome: proportion of mothers exclusively breastfeeding at eight weeks after discharge. Secondary outcomes: proportion of breastfeeding (exclusive, partial, none and method of feeding), mothers satisfaction with breastfeeding, attachment, stress and quality of life in mothers/partners at eight weeks after hospital discharge and at six months postnatal age. Data will be collected by researchers blind to group allocation for the primary outcome. A qualitative evaluation of experiences of receiving/providing the intervention will also be undertaken with mothers and staff.

    Discussion:

    This paper presents the rationale, study design and protocol for a RCT providing person-centred proactive telephone support to mothers of preterm infants. Furthermore, with a health economic evaluation, the cost-effectiveness of the intervention will be assessed. 

  • 6.
    Ericsson, Jenny
    et al.
    Uppsala universitet, Uppsala, Sweden; Högskolan Dalarna, Falun, Sweden.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hellström-Westas, Lena
    Uppsala universitet, Uppsala, Sweden.
    Hagberg, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Flacking, Renée
    Högskolan Dalarna, Falun, Sweden.
    Is proactive breastfeeding effective?: study protocol for a randomized controlled trial2014Conference paper (Refereed)
  • 7.
    Floodeen, Hannah
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Hallböök, Olof
    Linköping University Hospital, Linköping, Sweden; Linköping University, Linköping, Sweden.
    Hagberg, Lars
    Örebro County Council, Örebro, Sweden.
    Matthiessen, Peter
    Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden.
    Costs and Resource Use following Defunctioning Stoma in Low Anterior Resection: A long-term analysis of a randomized multicenter trialManuscript (preprint) (Other academic)
  • 8.
    Fredriksson, Carin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hermansson, Liselotte
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hagberg, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Pettersson, Ingvor
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Elderly spouses experiences of powered scooters used by their next of kinManuscript (preprint) (Other academic)
  • 9.
    Fredriksson, Carin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hermansson, Liselotte M. N.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hagberg, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Pettersson, Ingvor
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    The value of a powered wheelchair: spouses´ perspective2013In: Association for the Advancement of Assistive Technology in Europe Conference 2013 (AAATE 2013) / [ed] P Encarnação et al, Amsterdam, Netherlands: Elsevier, 2013, p. 222-225Conference paper (Refereed)
    Abstract [en]

    Research concerning the significance of assistive technology to spouses of persons who uses technology is sparse and the impact of a powered wheelchair on spouses' activity and participation is not at all researched. Thus, the aim was to explore how spouses experience the significance of a powered wheelchair prescribed to and used by their next of kin. A descriptive design with a qualitative approach focusing on the experiences of the spouses was used. The sample comprised of 10 spouses of elderly people that have been prescribed a powered wheelchair. Semi-structured interviews were conducted with the ten spouses (nine women and one man). The participants were 65-86 years of age. The questions posed during the interview concerned: i) the significance of the powered scooter for personal everyday activities, participation and quality of life; ii) the significance of the scooter for shared activity and participation; and iii) the significance of the next of kin using a scooter, from the perspective of the spouse. Interviews were transcribed verbatim and analyzed using qualitative content analysis. The results showed that the spouses experienced that their everyday life and life situation had changed in a positive way as their next of kin received a powered wheelchair. They experienced a sense of freedom that had an impact on their own activities as well as on the activities they performed together with their next of kin. The spouses expressed that they now to a larger extent shared responsibility for different tasks in the home and also how the powered wheelchair had made it possible to spontaneously do things together again and to do things with more ease. In conclusion, the narratives of the spouses of the elderly powered wheelchair users were to a great extent positive. The powered wheelchair was of great value and brought freedom to everyday life.

  • 10.
    Hagberg, Lars A.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Science, Örebro University, Örebro, Sweden.
    Brekke, Hilde K.
    Dept Internal Med & Clin Nutr, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Bertz, Fredrik
    Dept Internal Med & Clin Nutr, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Winkvist, Anna
    Dept Internal Med & Clin Nutr, Sahlgrenska Academy, Univ Gothenburg, Gothenburg, Sweden.
    Cost-utility analysis of a randomized controlled weight loss trial among lactating overweight/obese women2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, article id 38Article in journal (Refereed)
    Abstract [en]

    Background: Overweight and obesity among young, adult women are increasing problems in Sweden as in many other countries. The postpartum period may be a good opportunity to improve eating habits and lose weight in a sustainable manner. The aim was to make a cost-utility analysis of a dietary behavior modification treatment alongside usual care, compared to usual care alone, among lactating overweight and obese women.

    Methods: This study was a cost-utility analysis based on a randomized controlled and longitudinal clinical diet intervention. Between 2007-2010, 68 women living in Sweden were, after baseline measurement at 8-12 weeks postpartum, randomly assigned to a 12-week dietary behavior modification treatment or control group.

    Inclusion criteria were: self-reported pre-pregnancy body mass index (BMI) 25-35 kg/m(2), non-smoker, singleton term delivery, birth weight > 2500 g, intention to breastfeed for 6 mo and no diseases (mother and child). The women in the intervention group received 1.5 hour of individual counseling at study start and 1 hour at follow-up home visits after 6 weeks of intervention, with support through cell phone text messages every two wk. Dietary intervention aimed to reduce dietary intake by 500 kcal/day. The control group received usual care. Weight results have previously been reported. Here we report on analyses carried out during 2012-2013 of cost per quality adjusted life years (QALY), based on the changes in quality of life measured by EQ-5D-3 L and SF-6D. Likelihood of cost-effectiveness was calculated using Net Monetary Benefit method.

    Results: Based on conservative assumptions of no remaining effect after 1 year follow-up, the diet intervention was cost-effective. Costs per gained QALY were 8 643 - 9 758 USD. The likelihood for cost-effectiveness, considering a willingness to pay 50 000 USD for a QALY, was 87-93%.

    Conclusions: The diet intervention is cost-effective.

  • 11.
    Hagberg, Lars
    et al.
    Örebro University Hospital. Örebro University, School of Health Sciences.
    Hermansson, Liselotte M.
    Örebro University, School of Health Sciences.
    Fredriksson, Carin
    Örebro University, School of Health Sciences.
    Pettersson, Ingvor
    Örebro University, School of Health Sciences.
    Cost-effectiveness of powered mobility devices for elderly people with disability2017In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 12, no 2, p. 115-120Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to analyse the cost-effectiveness of prescribing powered mobility devices (PMDs) to elderly users.

    Methods: Forty-five persons participated in the preand post-intervention study with a follow-up at four months. All participants were prescribed a scooter model and were offered individual support to get started using the PMD. In the analysis, the use of the PMD was compared to the situation prior to its use. The cost-utility analysis takes a societal perspective and considers costs, savings and quality of life (QoL) using answers to the EQ-5D questionnaire.

    Results: Costs for the first year with the PMD were 1395 USD and then 592 USD per subsequent year. There was a significant decrease in transportation costs and in relatives' time use, but the increase in QoL of 0.041 was not significant. Costs per gained quality adjusted life year (QALY) were 12 400-14 700 USD/QALY if the value of time saved not was considered and 600-2900 USD/QALY when an hour was valued at 3.6 USD.

    Conclusion: Prescription of PMDs to elderly users might be cost-effective. However, there are shortcomings in measuring QALY gains from the use of a PMD, and it is unclear how time savings among relatives should be valued.

    Implications for Rehabilitation

    • Prescription of powered mobility devices for the elderly with disability seems to be cost effective and should be a standard intervention.

    • In economic evaluations of powered mobility devices and other assistive devices, the commonly used analyses methods are not always appropriate and therefore need to be adjusted.

  • 12.
    Hagberg, Lars
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hermansson, Liselotte M. N.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Fredriksson, Carin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Pettersson, Ingvor
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Värdet av en eldriven rullstol: hälsoekonomisk analys av förskrivning av eldrivna rullstolar till äldre personer med funktionsnedsättning2013Report (Other academic)
    Abstract [sv]

    Delresultat från en studie där man utvärderat om förskrivning av eldrivna rullstolar för äldre personer med bestående funktionsnedsättning och betydande förflyttningssvårigheter är kostnadseffektiv.

  • 13.
    Hermansson, Liselotte M. N.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hagberg, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Fredriksson, Carin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Pettersson, Ingvor
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    The impact of powered wheelchairs on activity, participation and health related quality of life in older people2013In: Special Session Power mobility: User experiences and Outcomes, Association for the Advancement of Assistive Technology in Europe , 2013Conference paper (Refereed)
  • 14.
    Hälleberg-Nyman, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Orthopaedics, Örebro University Hospital, Örebro, Sweden.
    Gustafsson, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Langius-Eklöf, Ann
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Johansson, Jan-Erik
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Urology, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Norlin, Rolf
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Orthopaedics, Örebro University Hospital, Örebro, Sweden.
    Hagberg, Lars
    Centre for Health Care Science, Örebro County Council, Örebro, Sweden.
    Intermittent versus indwelling urinary catheterisation in hip surgery patients: a randomised controlled trial with cost-effectiveness analysis2013In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 12, p. 1589-1598Article in journal (Refereed)
    Abstract [en]

    Background Hip surgery is associated with the risk of postoperative urinary retention. To avoid urinary retention hip surgery patients undergo urinary catheterisation. Urinary catheterisation, however, is associated with increased risk for urinary tract infection (UTI). At present, there is limited evidence for whether intermittent or indwelling urinary catheterisation is the preferred choice for short-term bladder drainage in patients undergoing hip surgery.

    Objectives The aim of the study was to investigate differences between intermittent and indwelling urinary catheterisation in hip surgery patients in relation to nosocomial UTI and cost-effectiveness.

    Design Randomised controlled trial with cost-effectiveness analysis.

    Setting The study was carried out at an orthopaedic department at a Swedish University Hospital.

    Methods One hundred and seventy hip surgery patients (patients with fractures or with osteoarthritis) were randomly allocated to either intermittent or indwelling urinary catheterisation. Data collection took place at four time points: during stay in hospital, at discharge and at 4 weeks and 4 months after discharge.

    Results Eighteen patients contracted nosocomial UTIs, 8 in the intermittent catheterisation group and 10 in the indwelling catheterisation group (absolute difference 2.4%, 95% CI −6.9–11.6%) The patients in the intermittent catheterisation group were more often catheterised (p < 0.001) and required more bladder scans (p < 0.001) but regained normal bladder function sooner than the patients in the indwelling catheterisation group (p < 0.001). Fourteen percent of the patients in the intermittent group did not need any catheterisation. Cost-effectiveness was similar between the indwelling and intermittent urinary catheterisation methods.

    Conclusions Both indwelling and intermittent methods could be appropriate in clinical practice. Both methods have advantages and disadvantages but by not using routine indwelling catheterisation, unnecessary catheterisations might be avoided in this patient group.

  • 15.
    Jansson, Markus
    et al.
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology.
    Larsson, Per-Göran
    Department of Obstetrics and Gynecology, Skaraborgs Hospital, Skövde, Sweden.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Cost-effectiveness of antibiotic prophylaxis in elective cesarean section2018In: Cost Effectiveness and Resource Allocation, ISSN 1478-7547, E-ISSN 1478-7547, Vol. 16, article id 66Article in journal (Refereed)
    Abstract [en]

    Background: The proportion of pregnant women delivered by cesarean section has increased steadily during the past three decades. The risk of infection is 10-fold augmented after elective cesarean section compared to vaginal delivery. Antibiotic prophylaxis may reduce endometritis by 62% and superficial wound infection by 38% after elective cesarean section. International guidelines recommend antibiotic prophylaxis in elective cesarean section, but this procedure is not routinely followed in Sweden. Studies of costs of antibiotic prophylaxis in cesarean section show conflicting results and are based on substantially different incidence of postoperative infections. No study of costs of antibiotic prophylaxis in elective cesarean section in a Swedish or Nordic context has been pursued. The aim of this study was to investigate if antibiotic prophylaxis is cost-reducing in elective cesarean section in orebro County, Sweden.

    Methods: All women undergoing elective cesarean in the Region orebro County health care system during 2011-2012 were eligible for inclusion. Postoperative infections and risk factors for infections were registered. A hypothetical situation in which all participants had received antibiotic prophylaxis was compared to the actual situation, in which none of them had received antibiotic prophylaxis. The reduction in the risk of postoperative infections resulting from antibiotic prophylaxis was based on a meta-analysis. Costs for in-patient care of postoperative infections were extracted from the accounting system, and costs for out-patient care were calculated according to standard costs. Costs for antibiotic prophylaxis were calculated and compared with the cost reduction that would be implied by the introduction of such prophylaxis.

    Results: The incidences of deep and superficial surgical site infection were 3.5% and 1.3% respectively. Introduction of antibiotic prophylaxis would reduce health care costs by 31 Euro per cesarean section performed (95% credible interval 4-58 Euro). The probability of cost-saving was 99%.

    Conclusions: Antibiotic prophylaxis in elective cesarean section is cost-reducing in this health care setting. Our results indicate that the introduction of antibiotic prophylaxis in elective cesarean section can also be cost-saving in low infection rate settings.

    Trial registration Ethical approval was given by the Regional Ethical Review Board in Uppsala (registration number 2013/484).

  • 16.
    Lundqvist, Stefan
    et al.
    Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Närhälsan Rehabilitation FaR- teamet central and western Gothenburg, Region Västra Götaland, Gothenburg, Sweden.
    Börjesson, Mats
    Department of Food and Nutrition and Sport Science, Faculty of Education, University of Gothenburg, Gothenburg, Sweden; Institute of Neurosc ience and Physiology, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Larsson, Maria E. H.
    Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. Univ Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Cider, Åsa
    Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Physical Activity on Prescription (PAP), in patients with metabolic risk factors: A 6-month follow-up study in primary health care2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 4, article id e0175190Article in journal (Refereed)
    Abstract [en]

    There is strong evidence that inadequate physical activity (PA) leads to an increased risk of lifestyle-related diseases and premature mortality. Physical activity on prescription (PAP) is a method to increase the level of PA of patients in primary care, but needs further evaluation. The aim of this observational study was to explore the association between PAP-treatment and the PA level of patients with metabolic risk factors and the relationship between changes in the PA level and health outcomes at the 6 month follow-up. This study included 444 patients in primary care, aged 27-85 years (56% females), who were physically inactive with at least one component of metabolic syndrome. The PAP-treatment model included: individualized dialogue concerning PA, prescribed PA, and a structured follow-up. A total of 368 patients (83%) completed the 6 months of follow-up. Of these patients, 73% increased their PA level and 42% moved from an inadequate PA level to sufficient, according to public health recommendations. There were significant improvements (p <= 0.05) in the following metabolic risk factors: body mass index, waist circumference, systolic blood pressure, fasting plasma glucose, cholesterol, and low density lipoprotein. There were also significant improvements regarding health-related quality of life, assessed by the Short Form 36, in: general health, vitality, social function, mental health, role limitation-physical/emotional, mental component summary, and physical component summary. Regression analysis showed a significant association between changes in the PA level and health outcomes. During the first 6-month period, the caregiver provided PAP support 1-2 times. This study indicates that an individual-based model of PAP-treatment has the potential to change people's PA behavior with improved metabolic risk factors and self-reported quality of life at the 6 month follow-up. Thus, PAP seems to be feasible in a clinical primary care practice, with minimum effort from healthcare professionals.

  • 17.
    Molin, M.
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Centre for Eating Disorders, Research & Development, Stockholm, Sweden.
    von Hausswolff-Juhlin, Yvonne Linné
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Centre for Eating Disorders, Research & Development, Stockholm, Sweden.
    Norring, Claes E. A.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Centre for Eating Disorders, Research & Development, Stockholm, Sweden.
    Hagberg, Lars Axel
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Case management at an outpatient unit for severe and enduring eating disorder patients at Stockholm Centre for Eating Disorders: a study protocol2016In: International Journal of Eating Disorders, ISSN 0276-3478, E-ISSN 1098-108X, Vol. 4, article id 24Article in journal (Refereed)
    Abstract [en]

    Background: Patients with severe and enduring eating disorders (SEED) are seriously ill and have a low quality of life. Case management (CM), originally developed for adult patients with severe mental disabilities, has been shown to enhance social functioning and improve quality of life, while reducing the number and length of hospitalizations. In 2014, a special unit based on CM, for patients with SEED (the Eira unit) was started at Stockholm Centre for Eating Disorders, Sweden.

    Method/Design: This study aims to investigate if CM can improve SEED patients' quality of life, and reduce their eating disorder symptoms as well as their health care consumption. Methods for data collection are a semi-structured diagnostic interview, self-report questionnaires, and a qualitative interview. The diagnostic interview and the self-report assessments will be done at start of treatment and at follow-ups after 1, 2, and 3years. The qualitative interview will be conducted 1 year after start of treatment. The study is approved by the ethical review board in Stockholm in compliance with the Helsinki Declaration.

    Discussion: CM is a possible new contribution to the treatment methods for SEED. It does not aim at remission, but rather to accept life as it is, and to enhance quality of life in the presence of the ED. This study will investigate the potential benefits of this novel intervention in a special unit for SEED patients.

    Trail Registration: Clinicaltrials.gov Id: NCT02897622.

  • 18.
    Månsdotter, Anna
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Ekman, Björn
    Medical Faculty, Lund University, Lund, Sweden.
    Feldman, Inna
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden; Department of Public Health and Care Science, Uppsala University, Uppsala, Sweden.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. Health Care Research Center, Faculty of Medicine and Health.
    Hurtig, Anna-Karin
    Unit of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
    Lindholm, Lars
    Unit of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
    We Propose a Novel Measure for Social Welfare and Public Health: Capability-Adjusted Life-Years, CALYs2017In: Applied Health Economics and Health Policy, ISSN 1175-5652, E-ISSN 1179-1896, Vol. 15, no 4, p. 437-440Article in journal (Refereed)
  • 19.
    Nilsson, Ulrica
    et al.
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Dahlberg, Karuna
    Örebro University, School of Health Sciences.
    Odencrants, Sigrid
    Örebro University, School of Health Sciences.
    Grönlund, Åke
    Örebro University, Örebro University School of Business.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    RAPP, a systematic e-assessment of postoperative recovery in patients undergoing day surgery: study protocol for a mixed-methods study design including a multicentre, two-group, parallel, single-blind randomised controlled trial and qualitative interview studies2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 1, article id e009901Article in journal (Refereed)
    Abstract [en]

    Introduction: Day surgery is a well-established practice in many European countries, but only limited information is available regarding postoperative recovery at home though there is a current lack of a standard procedure regarding postoperative follow-up. Furthermore, there is also a need for improvement of modern technology in assessing patient-related outcomes such as mobile applications. This article describes the Recovery Assessment by Phone Points (RAPP) study protocol, a mixed-methods study to evaluate if a systematic e-assessment follow-up in patients undergoing day surgery is cost-effective and improves postoperative recovery, health and quality of life.

    Methods and analysis: This study has a mixed-methods study design that includes a multicentre, two-group, parallel, single-blind randomised controlled trial and qualitative interview studies. 1000 patients >17 years of age who are undergoing day surgery will be randomly assigned to either eassessed postoperative recovery follow-up daily in 14 days measured via smartphone app including the Swedish web-version of Quality of Recovery (SwQoR) or to standard care (ie, no follow-up). The primary aim is cost-effectiveness. Secondary aims are (A) to explore whether a systematic e-assessment follow-up after day surgery has a positive effect on postoperative recovery, health-related quality of life (QoL) and overall health; (B) to determine whether differences in postoperative recovery have an association with patient characteristic, type of surgery and anaesthesia; (C) to determine whether differences in health literacy have a substantial and distinct effect on postoperative recovery, health and QoL; and (D) to describe day surgery patient and staff experiences with a systematic e-assessment follow-up after day surgery.

    The primary aim will be measured at 2 weeks postoperatively and secondary outcomes (A–C) at 1 and 2 weeks and (D) at 1 and 4 months.

  • 20.
    Pettersson, Ingvor
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hagberg, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Vårdvetenskapligt forskningscentrum, Örebro Läns Landsting, Örebro, Sverige.
    Fredriksson, Carin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hermansson, Liselotte M. N.
    Vårdvetenskapligt forskningscentrum, Örebro Läns Landsting, Örebro, Sverige.
    Effekten av en eldriven rullstol (scooter) för äldre personer2015Conference paper (Refereed)
    Abstract [sv]

    Bakgrund: Att kunna förflytta sig är ofta en förutsättning för att kunna delta i olika aktiviteter, en eldriven rullstol kan bidra till detta.

    Syfte: Syftet var att undersöka effekten av en eldriven rullstol på äldre personers aktivitet, delaktighet och livskvalitet.

    Metod: Personer > 65 år som för första gången remitterats till Centrum för hjälpmedel; ÖLL, för utprovning av eldriven rullstol för utomhusbruk inkluderades konsekutivt. Mätning gjordes före förskrivning och efter 4 månaders användning av eldriven rullstol med olika instrument för aktivitet, delaktighet (Individually Prioritized Problem Assessment, IPPA och WHO-Disability Assessment Schedule, WHODAS 2.0) och hälsorelaterad livskvalitet (SF-36). Analyser genomfördes med t-test. Cohens d användes för beräkning av effektstorlek. För att klassificera deltagarnas självskattade aktivitetsproblem (IPPA) användes Klassifikation av funktionstillstånd, funktionshinder och hälsa (ICF).

    Resultat/preliminärt resultat: Fyrtiofem personer (m=78 år, 36 män, 9 kvinnor inkluderades, samtliga fick en trehjulig eldriven rullstol med manuell styrning förskriven (scooter). För hela gruppen visade resultatet en statistisk signifikant förbättring med stor effekt av scootern på personernas aktivitetsproblem (IPPA; n=164). Majoriteten av problem var inom områdena Hemliv (i huvudsak olika inköp) och Samhällsgemenskap, socialt och medborgerligt liv (rekreation och fritidsaktiviteter): För hela gruppen framkom små signifikanta förbättringar inom WHODAS 2.0 domän Delaktighet och inom SF-36 index Fysisk hälsa och delskala Fysiska roller. Vid subgruppsanalyser framkom medelstora signifikanta förbättringar för kvinnor inom domänen Delaktighet (WHODAS 2.0) och för män små förbättringar inom delskalorna Fysiska roller och Social funktion (SF-36).

    Slutsats: En eldriven scooter har ett stort positivt värde för äldre personers egna prioriterade aktiviteter och en liten effekt på hälsorelaterad livskvalitet.  

  • 21.
    Pettersson, Ingvor
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hagberg, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Fredriksson, Carin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hermansson, Liselotte M N
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    The effect of powered scooters on activity, participation and quality of life in elderly users2016In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 11, no 7, p. 558-563Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim was to explore the effect of using a powered mobility device (PMD) on older peoples’ activity, participation and quality of life (QoL).

    Method: A pre- and post-intervention design with outcome measures for activity, participation (Individually Prioritized Problem Assessment, IPPA; World Health Organization Disability Assessment Schedule, WHODAS 2.0) and QoL (SF-36) were used. T-test was used to analyse the data. The magnitude of the effects was measured by Cohen’s criteria for effect sizes (d).

    Results: The sample consisted of 45 individuals (36 men) aged 66–88 years referred for prescription of a PMD. All were prescribed a powered scooter (PS). A statistically significant improvement with a large effect on IPPA in the ICF domains of Self-care (d¼2.47), Domestic life (d¼2.40), Interpersonal interactions and relationships (d¼2.08), and Community, social, and civic life (d¼2.36) was found. Medium-sized improvement on the WHODAS 2.0 domain of Participation and small improvements in the SF-36 domains of Physical Health and Role-Physical were also found.

    Conclusion: A PS has significant effects on the areas of activity, participation and QoL in elderly people. These findings have implications for prescriptions of a PS to this population.

  • 22.
    Pettersson, Ingvor
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hermansson, Liselotte M N
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hagberg, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Larsholt, Gunilla
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Fredriksson, Carin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Värdet av en eldriven rullstol: fokus på äldre användare och anhöriga2013Report (Other academic)
    Abstract [sv]

    Undersökningen som redovisas i den här rapporten har studerat värdet av en eldriven rullstol för den primära användaren och dennes anhörige. Syftet har varit att få en djupare förståelse för hur förskrivning av en eldriven rullstol till äldre personer med funktionsnedsättning påverkar vardagen för äldre anhöriga.

  • 23.
    Philipsson, Anna
    et al.
    Department of Community Medicine and Public health, Örebro County Council, Örebro, Sweden.
    Duberg, Anna
    Örebro University Hospital. Department of Community Medicine and Public health, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Möller, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences.
    Hagberg, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Community Medicine and Public health.
    Cost-utility analysis of a dance intervention for adolescent girls with internalizing problems2013In: Cost Effectiveness and Resource Allocation, ISSN 1478-7547, E-ISSN 1478-7547, Vol. 11, no 1, p. 4-Article in journal (Refereed)
    Abstract [en]

    Background: The increasing prevalence of psychological health problems among adolescent girls is alarming. Knowledge of beneficial effects of physical activity on psychological health is widespread. Dance is a popular formof exercise that could be a protective factor in preventing and treating symptoms of depression. The aim of thisstudy was to assess the cost-effectiveness of a dance intervention in addition to usual school health services foradolescent girls with internalizing problems, compared with usual school health services alone.

    Methods: A cost-utility analysis from a societal perspective based on a randomized controlled intervention trial wasperformed. The setting was a city in central Sweden with a population of 130 000. A total of 112 adolescent girls, 13–18 years old, with internalizing problems participated in the study. They were randomly assigned to intervention (n =59) or control (n = 53) group. The intervention comprised dance twice weekly during eight months in addition to usualschool health services. Costs for the stakeholder of the intervention, treatment effect and healthcare costs wereconsidered. Gained quality-adjusted life-years (QALYs) were used to measure the effects. Quality of life was measuredwith the Health Utility Index Mark 3. Cost-effectiveness ratios were based on the changes in QALYs and net costs forthe intervention group compared with the control group. Likelihood of cost-effectiveness was calculated.

    Results: At 20 months, quality of life had increased by 0.08 units more in the intervention group than in the controlgroup (P = .04), translating to 0.10 gained QALYs. The incremental cost-effectiveness ratio was USD $3,830 per QALYand the likelihood of cost-effectiveness was 95%.

    Conclusions: Intervention with dance twice weekly in addition to usual school health services may be consideredcost-effective compared with usual school health services alone, for adolescent girls with internalizing problems.

  • 24.
    Saha, Sanjib
    et al.
    Skåne University Hospital, Malmö, Lund University/Region Skåne, Malmö, Sweden; Lund University, Lund, Sweden.
    Carlsson, Katarina Steen
    Skåne University Hospital, Malmö, Lund University/Region Skåne, Malmö, Sweden.
    Gerdtham, Ulf-G
    Skåne University Hospital, Malmö, Lund University/Region Skåne, Malmö, Sweden; Lund University, Lund, Sweden; .
    Eriksson, Margareta K.
    Department of Public Health and Department of Research, Norrbotten County Council, Luleå, Sweden; Luleå University of Technology, Luleå, Sweden.
    Hagberg, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Healthcare Science, Örebro County Council, Örebro, Sweden.
    Eliasson, Mats
    Umeå University, Umeå, Sweden.
    Johansson, Pia
    Centre for Health Economics, Informatics and Healthcare Research, Stockholm County Council, Stockholm, Sweden.
    Are Lifestyle Interventions in Primary Care Cost-Effective?: An Analysis Based on a Markov Model, Differences-In-Differences Approach and the Swedish Bjorknas Study2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 11Article in journal (Refereed)
    Abstract [en]

    Background: Lifestyle interventions affect patients' risk factors for metabolic syndrome (MeSy), a pre-stage to cardiovascular diseases, diabetes and related complications. An effective lifestyle intervention is the Swedish Bjorknas intervention, a 3-year randomized controlled trial in primary care for MeSy patients. To include future disease-related cost and health consequences in a cost-effectiveness analysis, a simulation model was used to estimate the short-term (3-year) and long-term (lifelong) cost-effectiveness of the Bjorknas study.

    Methodology/Principal Findings: A Markov micro-simulation model was used to predict the cost and quality-adjusted life years (QALYs) for MeSy-related diseases based on ten risk factors. Model inputs were levels of individual risk factors at baseline and at the third year. The model estimated short-term and long-term costs and QALYs for the intervention and control groups. The cost-effectiveness of the intervention was assessed using differences-in-differences approach to compare the changes between the groups in the health care and societal perspectives, using a 3% discount rate. A 95% confidence interval (CI), based on bootstrapping, and sensitivity analyses describe the uncertainty in the estimates. In the short-term, costs are predicted to increase over time in both groups, but less in the intervention group, resulting in an average cost saving/reduction of US$-700 (in 2012, US $ 1= six point five seven SEK) and US$-500, in the societal and health care perspectives. The long-term estimate also predicts increased costs, but considerably less in the intervention group: US$-7,300 (95% CI: US$-19,700 to US $-1,000) in the societal, and US$-1,500 (95% CI: US$-5,400 to US$ 2,650) in the health care perspective. As intervention costs were US$ 211 per participant, the intervention would result in cost saving. Furthermore, in the long-term an estimated 0.46 QALYs (95% CI: 0.12 to 0.69) per participant would be gained.

    Conclusions/Significance: The Swedish Bjorknas study appears to reduce demands on societal and health care resources and increase health-related quality of life.

  • 25.
    Wilhelmsson, Anna
    et al.
    Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Roos, Maria
    Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Hagberg, Lars
    Örebro University Hospital. Örebro University, School of Health Sciences. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Wengström, Yvonne
    Neurobiology Care Science and Society, Nursing, Karolinska Institute, Stockholm, Sweden; Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
    Blomberg, Karin
    Örebro University, School of Health Sciences.
    Motivation to uphold physical activity in women with breast cancer during adjuvant chemotherapy treatment2017In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 29, p. 17-22, article id S1462-3889(17)30039-XArticle in journal (Refereed)
    Abstract [en]

    PURPOSE: Physical activity (PA) is important for recovery after a breast cancer diagnosis; however, women's motivation to engage in PA can be impacted by disease and/or treatment, and can therefore be a challenge. This study explored factors associated with PA levels during chemotherapy among women with breast cancer.

    METHOD: The study had a cross-sectional descriptive and comparative design using a study-specific questionnaire. One hundred women with breast cancer receiving adjuvant chemotherapy were included. Data were analysed by Pearson's correlation coefficient and linear regression. The open question was subjected to manifest content analysis.

    RESULTS: Identified factors associated with engaging in PA during chemotherapy treatment were: being physically active before diagnosis, and the information given by the oncology nurse before the treatment start. The physically active women experienced higher psychological wellbeing, less fatigue, and faster recovery after treatment. They also experienced an overall feeling of fitness.

    CONCLUSION: It seems that PA is associated with less fatigue, better recovery between chemotherapy treatments, and a better mental condition leading to wellbeing. Information given by the oncology nurse may be an important factor for being physically active. Women with breast cancer need to get specific advice about and support in engaging in PA to feel better during chemotherapy treatment. Further research is required to develop guidelines for advice about and support regarding PA during chemotherapy treatment.

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