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Falk, Magnus
Publications (10 of 27) Show all publications
Lyth, J., Falk, M., Maroti, M., Eriksson, H. & Ingvar, C. (2017). Prognostic risk factors of first recurrence in patients with primary stages I-II cutaneous malignant melanoma - from the population-based Swedish melanoma register. Journal of the European Academy of Dermatology and Venereology, 31(9), 1468-1474
Open this publication in new window or tab >>Prognostic risk factors of first recurrence in patients with primary stages I-II cutaneous malignant melanoma - from the population-based Swedish melanoma register
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2017 (English)In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 31, no 9, p. 1468-1474Article in journal (Refereed) Published
Abstract [en]

Background Prognostic factors in patients with localized primary cutaneous malignant melanoma (CMM) are well described. However, prognostic factors for recurrence are less documented. Objectives The aim of this study was to identify prognostic risk factors for first recurrence in patients with localized stages I-II CMM using population-based data. Methods This study included 1437 CMM patients registered in one region of Sweden during 1999-2012 follow-up through 31 December 2012. To identify first recurrence of CMM disease, data from a care data warehouse, the pathology and radiology department registries were used. Patients were also followed through a census register and the national Cause of Death Register. Results The 5- and 10-year recurrence-free survival (RFS) were 85.7% and 81.2%, respectively. The most common site of first recurrence was regional lymph node metastasis closely followed by distant metastasis. After adjusting for all prognostic factors, women had 50% lower risk of recurrence than men (HR = 0.5, 95% CI 0.4-0.7) and patients = 70 had higher risk compared to patients 55-69 years (HR = 1.7, 95% CI 1.2-2.5). Other significant prognostic factors for risk of recurrence were tumour thickness, presence of ulceration, Clarks level of invasion and histogenetic type. Conclusion Tumour thickness was found to be the predominant risk factor for recurrence. The prognostic factors for recurrence coincided with prognostic factors for CMM death. The most common site of first recurrence in stages I-II CMM is regional lymph node (42.8%) closely followed by distant metastases (37.6%), a fact which has to be taken into consideration when choosing follow-up strategies.

Place, publisher, year, edition, pages
WILEY, 2017
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:liu:diva-143954 (URN)10.1111/jdv.14280 (DOI)000417421400042 ()28419674 (PubMedID)
Available from: 2017-12-29 Created: 2017-12-29 Last updated: 2018-05-03
Rådholm, K., Festin, K., Falk, M., Midlöv, P., Mölstad, S. & Östgren, C. J. (2016). Blood pressure and all-cause mortality: a prospective study of nursing home residents. Age and Ageing, 45(6), 826-832
Open this publication in new window or tab >>Blood pressure and all-cause mortality: a prospective study of nursing home residents
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2016 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 45, no 6, p. 826-832Article in journal (Refereed) Published
Abstract [en]

Aim: To explore the natural course of blood pressure development and its relation to mortality in a nursing home cohort.

Methods: A cohort of 406 nursing home residents in south east Sweden was followed prospectively for 30 months. Participants were divided into four groups based on systolic blood pressure (SBP) at baseline. Data were analysed using a Cox regression model with all-cause mortality as the outcome measurement; paired Student t-tests were used to evaluate blood pressure development over time.

Results: During follow-up, 174 (43%) people died. Participants with SBP <120 mmHg had a hazard ratio for mortality of 1.56 (95% confidence interval, 1.08–2.27) compared with those with SBP 120–139 mmHg, adjusted for age and sex. Risk of malnutrition or present malnutrition was most common in participants with SBP <120 mmHg; risk of malnutrition or present malnutrition estimated using the Mini Nutritional Assessment was found in 78 (71%). The levels of SBP decreased over time independent of changes in anti-hypertensive medication.

Conclusions: In this cohort of nursing home residents, low SBP was associated with increased all-cause mortality. SBP decreased over time; this was not associated with altered anti-hypertensive treatment. The clinical implication from this study is that there is a need for systematic drug reviews in elderly persons in nursing homes, paying special attention to those with low SBP.

Place, publisher, year, edition, pages
Oxford University Press, 2016
Keywords
older people, prospective study, nursing home, hypertension, hypotension, all-cause mortality
National Category
General Practice Other Health Sciences
Identifiers
urn:nbn:se:liu:diva-121283 (URN)10.1093/ageing/afw122 (DOI)000392702200018 ()
Note

Funding agencies| Health Research Council in south east Sweden (FORSS-8888, FORSS-11636 and FORSS-31811); the County of Östergötland (LIO-11877, LIO-31321 and LIO-79951); the Family Janne Elgqvist Foundation; King Gustaf V and Queen Victoria Freemason Foundation.

At the time for thesis presentation publication was in status: Manuscript

Available from: 2015-09-11 Created: 2015-09-11 Last updated: 2018-01-11Bibliographically approved
Moberg, A. B., Taleus, U., Garvin, P., Fransson, S. G. & Falk, M. (2016). Community-acquired pneumonia in primary care: clinical assessment and the usability of chest radiography. Scandinavian Journal of Primary Health Care, 34(1), 21-27
Open this publication in new window or tab >>Community-acquired pneumonia in primary care: clinical assessment and the usability of chest radiography
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2016 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 34, no 1, p. 21-27Article in journal (Refereed) Published
Abstract [en]

Objectives: To investigate the diagnostic value of different clinical and laboratory findings in pneumonia and to explore the association between the doctors degree of suspicion and chest X-ray (CXR) result and to evaluate whether or not CXR should be used routinely in primary care, when available. Design: A three-year prospective study was conducted between September 2011 and December 2014. Setting: Two primary care settings in Linkoping, Sweden. Subjects: A total of 103 adult patients with suspected pneumonia in primary care. Main outcome measures: The physicians recorded results of a standardized medical physical examination, including laboratory results, and rated their suspicion into three degrees. The outcome of the diagnostic variables and the degree of suspicion was compared with the result of CXR. Results: Radiographic pneumonia was reported in 45% of patients. When the physicians were sure of the diagnosis radiographic pneumonia was found in 88% of cases (p&lt;0.001), when quite sure the frequency of positive CXR was 45%, and when not sure 28%. Elevated levels of C-reactive protein (CRP)50mg/L were associated with the presence of radiographic pneumonia when the diagnosis was suspected (p&lt;0.001). Conclusion: This study indicates that CXR can be useful if the physician is not sure of the diagnosis, but when sure one can rely on ones judgement without ordering CXR.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2016
Keywords
Chest radiography; clinical assessment; community-acquired pneumonia; C-reactive protein; general practice; primary care; Sweden
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-127062 (URN)10.3109/02813432.2015.1132889 (DOI)000372023200005 ()26849394 (PubMedID)
Note

Funding Agencies|County Council of ostergotland

Available from: 2016-04-13 Created: 2016-04-13 Last updated: 2018-03-19
Rendek, Z., Falk, M., Grodzinsky, E., Wahlin, K., Kechagias, S., Svernlöv, R. & Hjortswang, H. (2016). Effect of oral diclofenac intake on faecal calprotectin. Scandinavian Journal of Gastroenterology, 51(1), 28-32
Open this publication in new window or tab >>Effect of oral diclofenac intake on faecal calprotectin
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2016 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 51, no 1, p. 28-32Article in journal (Refereed) Published
Abstract [en]

Background. NSAIDs are a known source of increased faecal calprotectin (FC) levels. Currently, there is a lack of knowledge about how long it takes for an increased FC level to return to normal after NSAID intake. Objective. The aim was to investigate how oral diclofenac intake affects FC levels and assess how long it takes for an increased FC level to return to normal after oral diclofenac intake. Material and methods. Thirty healthy volunteers received diclofenac 50 mg three times daily for 14 days. Participants provided a stool sample on Days 0, 2, 4, 7, 14 during intake and Days 17, 21, 28 after discontinuation. FC levels were then followed at 7-day intervals until normalization. Results. During diclofenac intake, eight participants (27%) had FC levels exceeding the upper limit of normal (median, 76 mu g/g; range, 60-958 mu g/g), corresponding to 8.3% of measurements. FC was not constantly increased and became normal in most participants during diclofenac intake. FC levels were on average significantly higher during intake (M = 9.5, interquartile range (IQR) = 13.4) than on baseline (M = 7.5, IQR = 0.0), p = 0.003. After discontinuation, two participants had increased FC on Days 17 and 21, respectively. No significant differences in FC levels were found between baseline and measurements after discontinuation. Two weeks after discontinuation, all participants had normal FC levels. Conclusions. Short-term oral diclofenac intake is associated with increased FC levels. However, the likelihood of an increased test result is low. Our results suggest that 2 weeks of diclofenac withdrawal is sufficient to get an uninfluenced FC test result.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2016
Keywords
intestinal inflammation; proton pump inhibitors; NSAIDs; non-steroidal anti-inflammatory agents; diclofenac; calprotectin
National Category
Physiology Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-127586 (URN)10.3109/00365521.2015.1066421 (DOI)000373621900005 ()26200803 (PubMedID)
Note

Funding Agencies|County Council of Ostergotland, Sweden

Available from: 2016-05-03 Created: 2016-05-03 Last updated: 2018-03-22
Al-Karkhi, I., Al-Rubaiy, R., Rosenqvist, U., Falk, M. & Nyström, F. H. (2015). Comparisons of automated blood pressures in a primary health care setting with self-measurements at the office and at home using the Omron i-C10 device. Blood Pressure Monitoring, 20(2), 98-103
Open this publication in new window or tab >>Comparisons of automated blood pressures in a primary health care setting with self-measurements at the office and at home using the Omron i-C10 device
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2015 (English)In: Blood Pressure Monitoring, ISSN 1359-5237, E-ISSN 1473-5725, Vol. 20, no 2, p. 98-103Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: We aimed to compare blood pressure (BP) levels recorded using the semiautomatic oscillometric Omron i-C10 BP device in patients with or without hypertension in three different settings: (a) when used by a doctor or a nurse at the office (OBP); (b) when used for self-measurement by the patient at the office (SMOBP); and (c) when used for 7 consecutive days at home (HBP).

MATERIALS AND METHODS: A total of 247 individuals were invited to participate, but 78 of these individuals declined and a further seven were excluded, leaving a final cohort of 162 participants.

RESULTS: The mean OBP was higher than HBP (difference 8.1±14/3.1±8.8 mmHg, P<0.0001) and so was SMOBP compared with HBP (difference 7.0±13/4.2±7.3 mmHg, P<0.0001). Sixteen participants (9.9%) had at least 10 mmHg higher systolic SMOBP than OBP and 28 (17%) participants had at least 10 mmHg lower systolic SMOBP than OBP. Participants who were current smokers had a larger mean difference between systolic OBP and SMOBP than nonsmokers (OBP-SMOBP in smokers: 6.6±9.4 mmHg, OBP-SMOBP in nonsmokers: 0.5±9.2 mmHg, P=0.011 between groups).

CONCLUSION: Self-measurement of BP in the office does not preclude an increase in BP when levels in the individual patients are compared with HBP using the same equipment. Thus, SMOBP with a semiautomatic device does not lead to a reduction in the white-coat effect in the same manner as fully automatic devices.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2015
Keywords
home blood pressure; hypertension; office blood pressure; oscillometric; smoking.
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-112735 (URN)10.1097/MBP.0000000000000088 (DOI)000350894300008 ()25341027 (PubMedID)
Available from: 2014-12-10 Created: 2014-12-10 Last updated: 2017-12-05
Falk, M., Sjödahl, R., Wiréhn, A.-B., Lagerfelt, M., Woisetschläger, M., Ahlström, U. & Myrelid, P. (2015). Modifierad brittisk modell kortade ledtid till datortomografi av kolon. Läkartidningen, 112
Open this publication in new window or tab >>Modifierad brittisk modell kortade ledtid till datortomografi av kolon
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2015 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112Article in journal (Refereed) Published
Abstract [en]

The British national Institute for Health and Care Excellence (NICE) has presented guidelines based on signs and symptoms which should raise a suspicion of colorectal cancer. A slightly modified version of these guidelines, adapted to Swedish conditions, named Swedish NICE (sNICE) criteria, was implemented at eight primary care centres. By following the sNICE criteria, cases with higher degree of suspicion of colorectal cancer were advised for computer tomography (CT) of the colon, whereas cases of low degree of suspicion were advised for the considerably less time and patient demanding CT of the abdomen. For patients with isolated anal symptoms without presence of sNICE criteria, active expectancy for six weeks was recommended, followed by renewed consideration. Results showed that the ratio between CT colon and CT abdomen was reduced from 2.2 to 1.1 after introduction of the sNICE criteria. Also, the proportion of patients undergoing CT colon within two weeks from admittance was increased from 3 to 25 %. We conclude that the sNICE criteria may be a useful supportive tool for the primary care physician.

Abstract [sv]

Vid misstanke om kolorektal cancer är det angeläget att patienter där misstankegraden är hög får genomgå snar utredning och diagnostik. På många håll i landet föreligger oönskat långa väntetider för sådan utredning.

Användningen av ett evidensbaserat beslutsstöd för kolonutredning, baserat på riktlinjer från brittiska NICE (National Institute for Health and Care Excellence), implementerades på 8 vårdcentraler i Östergötland.

Efter implementeringen förkortades ledtider till datortomografi av kolon, diagnos och behandling.

Beslutsstödet bidrog till att patienter där graden av misstanke om kolorektal cancer var låg kunde styras om till att genomgå datortomografi av buken i stället för av kolon.

Place, publisher, year, edition, pages
Stockholm, Sweden: Läkartidningen Förlag AB, 2015
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-126059 (URN)26485132 (PubMedID)
Available from: 2016-03-14 Created: 2016-03-14 Last updated: 2018-03-23Bibliographically approved
Hägerlind, E., Falk, M., Löfstedt, T., Lindholm-Sethson, B. & Bodén, I. (2015). Near infrared and skin impedance spectroscopy - a possible support in the diagnostic process of skin tumours in primary health care.. Skin research and technology, 21(4), 493-499
Open this publication in new window or tab >>Near infrared and skin impedance spectroscopy - a possible support in the diagnostic process of skin tumours in primary health care.
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2015 (English)In: Skin research and technology, ISSN 0909-752X, E-ISSN 1600-0846, Vol. 21, no 4, p. 493-499Article in journal (Refereed) Published
Abstract [en]

BACKGROUND/PURPOSE: The global incidence of skin cancer has increased drastically in recent decades, especially in Australia and Northern Europe. Early detection is crucial for good prognosis and high survival rates. In general, primary care physicians have considerably lower sensitivity and specificity rates for detection of skin cancer, compared to dermatologists. A probable main reason for this is that current diagnostic tools are subjective in nature, and therefore diagnostic skills highly depend on experience. Illustratively, in Sweden, approximately 155 500 benign skin lesions are excised unnecessarily every year. An objective instrument, added to the clinical examination, might improve the diagnostic accuracy, and thus promote earlier detection of malignant skin tumours, as well as reduce medical costs associated with unnecessary biopsies and excisions. The general aim of this study was to investigate the usefulness of the combination of near infrared (NIR) and skin impedance spectroscopy as a supportive tool in the diagnosis and evaluation of skin tumours in primary health care.

METHODS: Near infrared and skin impedance data were collected by performing measurements on suspect malignant, premalignant and benign tumours in the skin of patients seeking primary health care for skin tumour evaluation. The obtained data were analysed using multivariate analysis and compared with the diagnosis received by the conventional diagnostic process.

RESULTS: The observed sensitivity and specificity rates were both 100%, when discriminating malignant and premalignant skin tumours from benign skin tumours, and the observed sensitivity and specificity for separating malignant skin tumours from premalignant and benign skin tumours were also 100%, respectively.

CONCLUSION: The results of this study indicate that the NIR and skin impedance spectroscopy may be a useful supportive tool for the general practitioner in the diagnosis and evaluation of skin tumours in primary health care, as a complement to the visual assessment.

National Category
General Practice Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:liu:diva-115794 (URN)10.1111/srt.12219 (DOI)000362679600014 ()25773339 (PubMedID)
Available from: 2015-03-19 Created: 2015-03-19 Last updated: 2018-01-11
Garvin, P., Jonasson, L., Nilsson, L., Falk, M. & Kristenson, M. (2015). Plasma Matrix Metalloproteinase-9 Levels Predict First-Time Coronary Heart Disease: An 8-Year Follow-Up of a Community-Based Middle Aged Population. PLoS ONE, 10(9), e0138290
Open this publication in new window or tab >>Plasma Matrix Metalloproteinase-9 Levels Predict First-Time Coronary Heart Disease: An 8-Year Follow-Up of a Community-Based Middle Aged Population
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2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 9, p. e0138290-Article in journal (Refereed) Published
Abstract [en]

Background The enzyme in matrix metalloproteinase (MMP)-9 has been suggested to be an important determinant of plaque degradation. While several studies have shown elevated levels in patients with coronary heart disease, results in prospective population based studies evaluating MMP-9 in relation to first time coronary events have been inconclusive. As of today, there are four published studies which have measured MMP-9 in serum and none using plasma. Measures of MMP-9 in serum have been suggested to have more flaws than measures in plasma. Aim To investigate the independent association between plasma levels of MMP-9 and first-time incidence of coronary events in an 8-year follow-up. Material and Methods 428 men and 438 women, aged 45-69 years, free of previous coronary events and stroke at baseline, were followed-up. Adjustments were made for sex, age, socioeconomic position, behavioral and cardiovascular risk factors, chronic disease at baseline, depressive symptoms, interleukin-6 and C-reactive protein. Results 53 events were identified during a risk-time of 6 607 person years. Hazard ratio (HR) for MMP-9 after adjustment for all covariates were HR = 1.44 (1.03 to 2.02, p = 0.033). Overall, the effect of adjustments for other cardiovascular risk factors was low. Conclusion Levels of plasma MMP-9 are independently associated with risk of first-time CHD events, regardless of adjustments. These results are in contrast to previous prospective population-based studies based on MMP-9 in serum. It is essential that more studies look at MMP-9 levels in plasma to further evaluate the association with first coronary events.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2015
National Category
Clinical Medicine Basic Medicine
Identifiers
urn:nbn:se:liu:diva-122112 (URN)10.1371/journal.pone.0138290 (DOI)000361791000022 ()26389803 (PubMedID)
Note

Funding Agencies|Swedish Research Council [2004-1881]; Swedish Heart and Lung Foundation [2004053]

Available from: 2015-10-19 Created: 2015-10-19 Last updated: 2018-01-11
Pettersson, E., Anderson, C., Henricsson, J. & Falk, M. (2015). Validation of phototesting for estimation of individual skin ultraviolet sensitivity based on a lengthwise attenuating ultraviolet B field.. Journal of Medical Engineering & Technology, 39(2), 91-8
Open this publication in new window or tab >>Validation of phototesting for estimation of individual skin ultraviolet sensitivity based on a lengthwise attenuating ultraviolet B field.
2015 (English)In: Journal of Medical Engineering & Technology, ISSN 0309-1902, E-ISSN 1464-522X, Vol. 39, no 2, p. 91-8Article in journal (Refereed) Published
Abstract [en]

Conventional skin UV-sensitivity phototesting is based on semi-quantitative assessment of minimal erythema dose (MED). This study demonstrates a method for quantitative MED determination, using a lengthwise attenuating UVB-field combined with tissue viability imaging (TiVi). The study aim was to investigate the agreement between MED acquired by traditional phototest and by the new method. Forty-seven voluntary subjects underwent phototesting with a traditional phototest and with the new technique. Test reading, carried out after 24 h, showed moderate agreement between the methods when assessed with TiVi (Kappa value=0.46) and visually (Kappa value=0.48). For the new method, no systematic differences were seen between outcomes assessed with TiVi or visually (95% CI for the mean difference=-1.6-2.0). In conclusion, the results give promising support for the concept of achieving a more precise MED estimation by combining continuous attenuating UV fields with new available bioengineering technology.

National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:liu:diva-115793 (URN)10.3109/03091902.2014.980523 (DOI)25429800 (PubMedID)
Available from: 2015-03-19 Created: 2015-03-19 Last updated: 2017-12-04
Detert, H., Hedlund, S., Anderson, C., Rodvall, Y., Festin, K., Whiteman, D. C. & Falk, M. (2015). Validation of sun exposure and protection index (SEPI) for estimation of sun habits. Cancer Epidemiology, 39(6), 986-993
Open this publication in new window or tab >>Validation of sun exposure and protection index (SEPI) for estimation of sun habits
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2015 (English)In: Cancer Epidemiology, ISSN 1877-7821, E-ISSN 1877-783X, Vol. 39, no 6, p. 986-993Article in journal (Refereed) Published
Abstract [en]

Background: In both Sweden and Australia high incidence rates of skin cancer have become a major health problem. In prevention and risk communication, it is important to have reliable ways for identifying people with risky sun habits. In this study the validity and reliability of the questionnaire Sun Exposure Protection Index (SEPI), developed to assess individuals sun habits and their propensity to increase sun protection during routine, often brief, clinical encounters, has been evaluated. The aim of our study was to evaluate validity and reliability of the proposed SEPI scoring instrument, in two countries with markedly different ultraviolet radiation environments (Sweden and Australia). Method: Two subpopulations in Sweden and Australia respectively were asked to fill out the SEPI together with the previously evaluated Readiness to Alter Sun Protective Behaviour questionnaire (RASP-B) and the associated Sun-protective Behaviours Questionnaire. To test reliability, the SEPI was again filled out by the subjects one month later. Results: Comparison between SEPI and the questions in the Sun-protective Behaviours Questionnaire, analyzed with Spearmans Rho, showed good correlations regarding sun habits. Comparison between SEPI and RASP-B regarding propensity to increase sun protection showed concurrently lower SEPI mean scores for action stage, but no difference between precontemplation and contemplation stages. The SEPI test-retest analysis indicated stability over time. Internal consistency of the SEPI, assessed with Cronbachs alpha estimation showed values marginally lower than the desired &gt;0.70 coefficient value generally recommended, and was somewhat negatively affected by the question on sunscreen use, likely related to the classic "sunscreen paradox". There were some differences in the performance of the SEPI between the Swedish and Australian samples, possibly due to the influence of "available" sunlight and differing attitudes to behaviour and protection "at home" and on vacation. Conclusions: SEPI appears to be a stable instrument with an overall acceptable validity and reliability, applicable for use in populations exposed to different UVR environments, in order to evaluate individual sun exposure and protection. (C) 2015 The Authors. Published by Elsevier Ltd.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2015
Keywords
Skin cancer; Sun habits; Sun protection; Ultraviolet exposure; Questionnaire
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-124511 (URN)10.1016/j.canep.2015.10.022 (DOI)000367444300028 ()26547793 (PubMedID)
Note

Funding Agencies|County Council of Ostergotland, Sweden

Available from: 2016-02-02 Created: 2016-02-01 Last updated: 2018-01-10
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