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  • 1.
    Chtziarsenis, M
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Lionis, C
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Makri, E
    Sapouna, K
    Fioretos, M
    Faresjö, Tomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Mavromanolakis, M
    Vlachonikolis, J
    Trell, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Bringing community involvement into a Cretan primary/hospital care centrel.1999In: Journal of medical systems, ISSN 0148-5598, E-ISSN 1573-689X, Vol. 23, 123-131 p.Article in journal (Refereed)
  • 2.
    Chtziarsenis, M
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Miyakis, S
    Faresjö, Tomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Fioretos, M
    Trell, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Lionis, C
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Is there room for General Practice in Penitentiary Instituions? Screening and vaccinating high risk groups against hepatitis.1999In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 16, 366-368 p.Article in journal (Refereed)
  • 3.
    Davidson, Kristina
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Trell, Erik
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Lionis, C
    University of Crete, Heraklion, Greece .
    Koutis, A
    University of Crete, Heraklion, Greece .
    Faresjö, Tomas
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Fioretos, M
    University of Crete, Heraklion, Greece .
    Following the thread of Ariadne to the health of women1996In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 17, no 3, 201-208 p.Article in journal (Refereed)
    Abstract [en]

    The health of women has risen to a priority position in medical research. Comparative studies of female morbidity are called for as an intermediary stage for generation of hypotheses and design of deeper studies of determinants, such as social, ecological, and individual factors. In previous studies, we have noted differences in female hospitalization between Heraklion in Greece and Linköping in Sweden. They were related to age and to urban versus rural dwelling, and fit projections for a more archaic and a more technocratic society, respectively. This paper aims at showing how the study of women's health may proceed from relevant hospitalization observations to the next level, of exploring already available indicators of self‐perceived health in elderly females.

  • 4.
    Falk, Magnus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Olsen Faresjö, Åshild
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Sun Exposure Habits and Health Risk-related Behaviours Among Individuals with Previous History of Skin Cancer2013In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 33, no 2, 631-638 p.Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the present study was to investigate possible associations between UV exposure and other health risk behaviours in different social environments and in regard to previous history of skin cancer. Patients and Methods: In two closely-located, equally-sized cities in Sweden, representing different social environments (blue collar and white collar), patients aged 55-69 years, diagnosed with skin cancer (study group, n=489) or seborrhoeic keratosis (control group, n=664), were identified through a regional Health Care Register, and were given a questionnaire mapping for sun habits, tobacco smoking, alcohol use, and physical activity. Results: A previous history of skin cancer was associated with reduced UV exposure (pandlt;0.01) and increased UV protection (pandlt;0.00.1), higher alcohol consumption (pandlt;0.05), and higher level of physical activity (pandlt;0.05). Smoking was more common among subjects frequently sunbathing and rarely using sunscreen, but frequent sunbathing was positively associated with physical activity (pandlt;0.05). Daily smoking and risky drinking habits were more common in the blue collar social environment, while no differences were seen for sun habits in this respect. Conclusion: A previous history of skin cancer appears to promote increased UV protection. In contrast to alcohol/smoking habits, no association between social environment and sun habits was found.

  • 5.
    Faresjö (Olsen), Åshild
    et al.
    Linköping University, Department of Medicine and Health Sciences, Primary Care . Linköping University, Faculty of Health Sciences.
    Anastasiou, Foteini
    Clinic of Social and Family Medicine, School of Medicine, University of Crete, Greece.
    Lionis, Christos
    Clinic of Social and Family Medicine, School of Medicine, University of Crete, Greece.
    Johansson, Saga
    Cardiovascular Institute, University of Gothenburg, Gothenburg, Sweden.
    Wallander, Mari-Ann
    Dept of Public Health and Caring Science, Uppsala University, Uppsala, Sweden.
    Faresjö, Tomas
    Linköping University, Department of Medicine and Health Sciences, Primary Care . Linköping University, Faculty of Health Sciences.
    Health related quality of life of irritable bowel syndrome patients in different cultural settings2006In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 4, no 21, 4-21 p.Article in journal (Refereed)
    Abstract [en]

    Background

    Persons with Irritable bowel syndrome (IBS) are seriously affected in their everyday life. The effect across different cultural settings of IBS on their quality of life has been little studied. The aim was to compare health-related quality of life (HRQOL) of individuals suffering from IBS in two different cultural settings; Crete, Greece and Linköping, Sweden.

    Methods

    This study is a sex and age-matched case-control study, with n = 30 Cretan IBS cases and n = 90 Swedish IBS cases and a Swedish control group (n = 300) randomly selected from the general population. Health-related quality of life, measured by SF-36 and demographics, life style indicators and co-morbidity, was measured.

    Results

    Cretan IBS cases reported lower HRQOL on most dimensions of SF-36 in comparison to the Swedish IBS cases. Significant differences were found for the dimensions mental health (p < 0.0001) and general health (p = 0.05) even after adjustments for educational level and co-morbidity. Women from Crete with IBS scored especially low on the dimensions general health (p = 0.009) and mental health (p < 0.0001) in comparison with Swedish women with IBS. The IBS cases, from both sites, reported significantly lower scores on all HRQOL dimensions in comparison with the Swedish control group.

    Conclusion

    The results from this study tentatively support that the claim that similar individuals having the same disease, e.g. IBS, but living in different cultural environments could perceive their disease differently and that the disease might affect their everyday life and quality of life in a different way. The Cretan population, and especially women, are more seriously affected mentally by their disease than Swedish IBS cases. Coping with IBS in everyday life might be more problematic in the Cretan environment than in the Swedish setting.

  • 6.
    Faresjö, Tomas
    Linköping University, The Tema Institute. Linköping University, Faculty of Arts and Sciences.
    Social skiktning och ohälsa i Studien 1913 års män1989Doctoral thesis, monograph (Other academic)
    Abstract [en]

    The main objective of this thesis is to elucidate the relationship between social stratification and a broad spectrum of health problems covering subjective ill-health, serious illness and mortality. Against the background of a social-epidemiological frame of reference, special attention is alsopaid to other social factors that are related to occupation and stratification and its effect on health.

    The empirical material used is data from the Study of Men Born in 1913, a clinical-epidemiological prospective population study that begun in 1963 with a sample of 50-year old men from the general population of  Gothenburg, Sweden. These men have been followed up by repeated health-examinations and records. In the present study, which is a type of secondary analysis of the Gothenburg material, the men are followed between the ages of 50 and 71.

    In a modern welfare society such as that of Sweden, with comprehensive public health care, one should not expect to find any appreciable differences between the social strata with regard to ill-health. The study indicates that differences are most in evidence with regard to perceivedhealth and being on the sick-list. In both these respects the lower social strata are worse off then the higher. The differences concerning perceived ailments tend to even out after retirement. When it comes to serious illness and mortality there is a certain tendency of differences concerningmyocardial infarction and survival after it. The lower social strata appear to be rather more at risk than the higher, but apart from this the differences were small.

    Constituting a main group of social-epidemiological factors that are both conceptually and empirically related to social stratification arc various circumstances to do with occupation. It is evident from the study that such factors- which can be designated life-events and which comprise first and foremost unemployment, change of occupation and change in earnings- indicate increased risk of suffering myocardial infarction and death. There are also a number of connections between on the one hand various indicators of ill-health, and on the other hand social phenomena such as status incongruence and social mobility across the generations.

    Many of the social factors that are of interest from the social epidemiological point of view prove to be strongly intercorrelated and form very complex patterns. 1t is a challenge to sqcialepidemiologicalresearch (which in-many respects is still in its initial stage) to elucidate the complex connections between ill-health and various social conditions, life-style and physiological factors.

  • 7.
    Faresjö, Tomas
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Arvidsson, Lina
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Boberg, Pontus
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Hagert, Britt
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Gursky, Elin A
    ANSER, Arlington, Virginia, USA.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Swedish nursing and medical students high vaccination adherence during the influenza A (H1N1) pandemic 2009: Insights for pandemic preparedness2012In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 44, no 3, 237-241 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to analyze Swedish health science student decision-making regarding vaccination against pandemic influenza during a national mass vaccination campaign. A questionnaire was distributed to 430 students during the influenza A (H1N1) pandemic in 2009. The data from medical and nursing students were compared and a multiple logistic regression model was applied to identify items independently associated with the decision to be vaccinated. The overall survey response rate was 90%. More medical (93.2%) than nursing students (84.8%) reported that they had received the vaccine (p andlt; 0.01). Only the perception that benefits can outweigh possible side effects was significantly (p andlt; 0.001) associated with the decision to get vaccinated. We recommend that, during pandemics, health science universities focus vaccination information for students on objective risk communication. It should be taken into account that the pandemic information provided by authorities to the general public also affects health care students.

  • 8.
    Faresjö, Tomas
    et al.
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Faresjö, Åshild
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    To Match or Not to Match in Epidemiological Studies-Same Outcome but Less Power2010In: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, ISSN 1660-4601, Vol. 7, no 1, 325-332 p.Article in journal (Refereed)
    Abstract [en]

    This study aimed to analyze the possible resemblance or difference in outcome in a case-control study of quality of life for IBS patients compared to controls free from the disease, when a matching procedure for age and sex was applied for the control group compared to when all participating subjects were included in the control group. The main result was that almost the same and identical results were found irrespective of whether matching or not matching was applied in this epidemiological case-control study. The matching procedure however, slightly diminished the statistical power of the results.

  • 9.
    Faresjö, Tomas
    et al.
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Karalis, Ioannis
    University of Crete.
    Prinsback, Erik
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Kroon, Katarina
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Lionis, Christos
    University of Crete.
    Sense of coherence in Crete and Sweden: key findings and messages from a comparative study.2009In: The European journal of general practice, ISSN 1751-1402, Vol. 15, no 2, 95-98 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVE: The concept of ''sense of coherence'' (SOC) was introduced in 1987 by Aaron Antonovsky to describe a dispositional orientation, ''a way of seeing the world'', which is presumed to enhance health. This study reports on the results of the first implementation of SOC in rural Crete and discusses the findings, with a view to the potential impact on primary care delivery in rural Crete. METHODS: This study forms part of a follow-up project initially established in 1988 in the rural area of Spili, Crete. All participants of the initial study still living in the area (n = 248) were eligible. Data were obtained from 200 subjects (91 males and 109 females) aged 28-92 years, resulting in a second-phase participation rate of 80.7%. The SOC scales (both the SOC-29 and SOC-13 forms) were recorded for 175 (87.1%) of the participants. RESULTS: Comparing the SOC scores among Cretan males and females, there is a statistically significant difference (p < 0.0001), with men reporting a higher sense of coherence than women, regardless of the form of the questionnaire used. Cretan women seem to score significantly lower than their Swedish counterparts (p < 0.0001), while Cretan men tend to report a higher SOC compared to their matched Swedish reference population (p = 0.07). DISCUSSION: The study introduces other issues worthy of additional research, particularly with regard to the significantly lower SOC scores obtained by Cretan women, compared to Cretan men. These low SOC scores raise the issue of a potential increase of psychiatric morbidity in the area, leading to a high impact on primary care services. Future investigation into the health impact of SOC factors could be of value to primary care physicians located in rural Crete.

  • 10.
    Faresjö, Tomas
    et al.
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Rahmqvist, Mikael
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Educational level is a crucial factor for good perceived health in the local community2010In: SCANDINAVIAN JOURNAL OF PUBLIC HEALTH, ISSN 1403-4948, Vol. 38, no 6, 605-610 p.Article in journal (Refereed)
    Abstract [en]

    Aims: Educational level is a strong determinant of perceived health, and also an important component in the socioeconomic concept. The aim of this study was to analyze a number of social conditions and lifestyle factors that might explain differences in self-reported health between the populations in two different social environments, one white-collar city and one blue-collar city. These "twin cities" are served by the same healthcare organisation, but differ in terms of social history and current social structure. Methods: The material consisted of responses to a community-based survey of individuals aged between 20 and 64 years, with an overall response rate of 49%. Differences in self-reported health status were tested with chi-square tests and regression analysis. Results: We found significant differences in perceived health between the two populations. These differences in self-reported health could not be explained by differences in demographic factors, lifestyles, or living conditions. However, when the educational level of the respondents was taken into account, the differences in perceived health diminished. Conclusions: Public health in local communities tends to reflect the social history and social heritage of the population. In this study, we found that educational level appears to be a vital factor for good perceived health of the individual in a community.

  • 11.
    Faresjö, Tomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Roel, Eduardo
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Olsen Faresjö, Å
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Kjellman, Max
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    Astma hos barn blir allt vanligare. Journalstudie visar en fördubbling under en tioårsperiod. 1999In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 96, 5368-6369 p.Article in journal (Other (popular science, discussion, etc.))
  • 12.
    Faresjö, Tomas
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Söderquist, Johan
    Linköping University, Department of Social and Welfare Studies, Hälsa - utbildning - välfärdsinstitutioner (HUV) . Linköping University, Faculty of Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Grodzinsky, Ewa
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Nilsson, Hans
    Linköping University, Department for Studies of Social Change and Culture, Centre for Local History. Linköping University, Faculty of Arts and Sciences.
    Tvillingstäder med stora sociala skillnader i folkhälsa - ett samhällsmedicinskt experiment inleds i Norrköping och Linköping: [Twin cities with big social differences when it comes to public health. A sociomedical "experiment" introduced in Norrkoping and Linkoping]2007In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 23, 1788-1790 p.Article in journal (Refereed)
    Abstract [en]

    An interdisciplinary research group entitled ”Twincities Research Group” has been initiated at Linköping University. The term twin cities refer to the Swedish cities Linköping and Norrköping, neighbours that are nearly equal in size. These two cities, located within a distance of only 40 km, are governed by the same county council and consequently have the same health care structure. However, health is remarkably different in these twin cities. The comparison of public health in these two cities during the development from the industrial to the post-industrial era has a design similar to classical experiments with a control and an experiment group, since the social history and the socio-economic structures of the cities are radically different. Through an interdisciplinary research design including historical, epidemiological and clinical competence we have a unique opportunity to increase our understanding of how social environment may affect public health.

  • 13.
    Faresjö, Tomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine.
    Wilhelmsson, Margaretha
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Pelling, Staffan
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Dahlgren, Lars-Ove
    Linköping University, Department of Behavioural Sciences and Learning, Studies in Adult, Popular and Higher Education. Linköping University, Faculty of Educational Sciences.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Does interprofessional education jeopardize medical skills?2007In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 21, no 5, 573-576 p.Article in journal (Refereed)
  • 14.
    Faresjö, Åshild
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Johansson, Saga
    Astra Zeneca R&D, Mölndal .
    Faresjö, Tomas
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Roos, Susanne
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Hallert, Claes
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, Department of Internal Medicine VHN.
    Sex differences in dietary coping with gastrointestinal symptoms2010In: EUROPEAN JOURNAL OF GASTROENTEROLOGY and HEPATOLOGY, ISSN 0954-691X, Vol. 22, no 3, 327-333 p.Article in journal (Refereed)
    Abstract [en]

    Aim Nutritional changes are often considered first-line treatment in public health diseases that apply to many gastrointestinal (GI) disorders, as different food and beverages may modulate GI motor and sensory functions, and may provoke GI symptoms. The aim of this study was to examine dietary coping and possible changes in food and beverage intake in relation to GI symptoms reported by identified irritable bowel syndrome (IBS) patients compared with healthy controls, and whether any sex differences were observed in these respects. Methods A population-based case-control design was used. Three primary healthcare centres were selected in the city of Linko ping in Sweden. The IBS patients were recruited from the studied primary healthcare centers on the basis of diagnoses from computerized medical records. The controls were randomly selected from the general population in the same region. A questionnaire was used with specific questions about self-reported food and beverage increase or decrease of GI symptoms and self-reported changes in dietary habits. Results Female IBS patients seem to be more willing to change dietary habits because of their GI problems than men. Effects of these nutritional behaviour changes were reported for almost all participants that had made dietary adjustments. Fatty food, certain vegetables, dairy products and eggs were significantly more reported to cause GI complaints among IBS patients compared with their controls. Conclusion Female IBS patients reported more changes in their dietary habits because of GI problems than men with the disease. The majority of both women and men who changed their dietary habits because of GI problems experienced improvement in their symptoms.

  • 15.
    Fioretos, Michael
    et al.
    University of Crete, Heraklion, Greece.
    Davidson, Kristina
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Faresjö, Tomas
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Alamanos, Yannis
    University of Crete, Heraklion, Greece.
    Koutis, Antonis
    University of Crete, Heraklion, Greece.
    Lionis, Christos
    University of Crete, Heraklion, Greece.
    Trell, Erik
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Tsamandouraki, Kiki
    University of Crete, Heraklion, Greece.
    Hospital admissions in two European landscapes - comparison between Heraklion, Greece and Linköping1993In: International Journal of Health Sciences, ISSN 0924-2287, Vol. 4, 33-39 p.Article in journal (Refereed)
    Abstract [en]

    The study describes a comparison of hospital admissions during a two-year period between a regional hospital in Heraklion (Greece) and a regional hospital in Linköping (Sweden). The findings are considered mainly in terms of health care delivery and utilization in relation to various types of demographic factors.

    The results indicate that despite the different cultural and socio-economic environments in the studied districts, there are important similarities of hospitalisation pattern in the urban areas. However, there are also notable differences. The hospitalisation pattern seems to be more equally distributed between sexes and between urban and rural areas in Linköping (Sweden) than in Heraklion (Greece), where it appeared that the rural population, and women in particular, did not get hospital care according to their needs.

  • 16.
    Gjessing, Kristian
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Exploring factors that affect hospital referral in rural settings: a case study from Norway2009In: Rural and remote health, ISSN 1445-6354, Vol. 9, no 1, 975- p.Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: A patients needs and the seriousness of the disease are not the only factors that determine referral to hospital. The objective of this study was to analyse whether locum doctors (LDs) have a different pattern of referral to hospital from regular GPs (RGPs).

    METHODS: All hospital referrals for one year (n = 5566 patients) from two Norwegian rural primary health care (PHC) centres to the nearby district hospital were analysed with regard to ICD-10 diagnosis groups. A major difference between the PHCs was that one had a continuous supply of LDs while the other had a stable group of RGPs. The equal-sized communities were demographically and socio-culturally similar.

    RESULTS: The PHC centre mainly operated by short-term LDs referred a relatively high number of patients to the district hospital within the diagnosis groups of chapter VI Diseases of the nervous system (proportionate referral rate 210%; p = 0.010), and chapter IX Diseases of the circulatory system (proportionate referral rate 130%; p = 0.048), and a comparatively low number of patients for the diagnostic groups in chapter X Diseases of the respiratory system (p = 0.018), and chapter XIV Diseases of the genitourinary system (p = 0.039), compared with the norm of the district hospitals total population. The number and proportion of the total number of referrals, adjusted for population size, did not differ between the two rural communities. The LD-run PHC centre differed significantly from the total norm in 5 out of 19 ICD chapters, equal to 41% of the patients.

    CONCLUSIONS: Only one significant difference in hospital referrals related to ICD-diagnoses groups were found between the studied rural PHC centres, but the LD-run PHC differed from the total norm. These differences could neither be explained from the districts consumption of somatic hospital care nor the demographical differences, but were related to staffing at the PHC, that is LDs or RGPs. The analysis also revealed that possible under- and/or over-diagnosing of certain diseases occurred, both having potential medical consequences for the patient, as well as increasing healthcare expenditure.

  • 17.
    Gjessing, Kristian
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Torgé, Cristina Joy
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Dahlberg, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Improvement of quality and safety in health care as a new interprofessional learning module – evaluation from students2014In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, no 7, 341-347 p.Article in journal (Refereed)
    Abstract [en]

    Background: Interprofessional teamwork is in many ways a norm in modern health care, and needs to be taught during professional education.

    Description: This study is an evaluation of a newly introduced and mandatory learning module where students from different health profession programs used Improvement of Quality and Safety as a way to develop interprofessional competence in a real-life setting. The intention of this learning module was to integrate interprofessional teamwork within the students' basic education, and to give students a basic knowledge about Improvement of Quality and Safety. This report focuses on evaluations from the participating students (n=222), mainly medical and nursing students.

    Materials and methods: To evaluate this new learning module, a questionnaire was developed and analyzed using a mixed methods design, integrating both qualitative and quantitative methods. The evaluation addressed learning concepts, learning objectives, and interprofessional and professional development.

    Results and conclusion: A majority of students responded positively to the learning module as a whole, but many were negative towards specific parts of the learning module and its implementation. Medical students and male students were less positive towards this learning module. Improvements and alterations were suggested. 

  • 18.
    Grodzinsky, Ewa
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Hallert, Claes
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Bergfors, Elisabet
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Olsen Faresjö, Åshild
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Could gastrointestinal disorders differ in two close but divergent social environments?2012In: International Journal of Health Geographics, ISSN 1476-072X, E-ISSN 1476-072X, Vol. 11, no 5Article in journal (Refereed)
    Abstract [en]

    Background: Many public health problems in modern society affect the gastrointestinal area. Knowledge of the disease occurrence in populations is better understood if viewed in a psychosocial context including indicators of the social environment where people spend their lives. The general aim of this study was to estimate the occurrence in the population and between sexes of common gastrointestinal conditions in two neighborhood cities representing two different social environments defined as a "white-collar" and a "blue-collar" city. less thanbrgreater than less thanbrgreater thanMethods: We conducted a retrospective register study using data of diagnosed gastrointestinal disorders (cumulative incidence rates) derived from an administrative health care register based on medical records assigned by the physicians at hospitals and primary care. less thanbrgreater than less thanbrgreater thanResults: Functional gastrointestinal diseases and peptic ulcers were more frequent in the white-collar city, while diagnoses in the gallbladder area were significantly more frequent in the blue-collar city. Functional dyspepsia, irritable bowel syndrome, and unspecified functional bowel diseases, and celiac disease, were more frequent among women while esophageal reflux, peptic ulcers, gastric and rectal cancers were more frequent among men regardless of social environment. less thanbrgreater than less thanbrgreater thanConclusions: Knowledge of the occurrence of gastrointestinal problems in populations is better understood if viewed in a context were the social environment is included. Indicators of the social environment should therefore also be considered in future studies of the occurrence of gastrointestinal problems.

  • 19.
    Kamekis, A.
    et al.
    University of Crete, Greece.
    Bertsias, A.
    University of Crete, Greece.
    Moschandreas, J.
    University of Crete, Greece.
    Petelos, E.
    University of Crete, Greece.
    Papadakaki, M.
    University of Crete, Greece.
    Tsiantou, V.
    University of Crete, Greece; National School Public Heatlh, Greece.
    Saridaki, A.
    University of Crete, Greece.
    Symvoulakis, E. K.
    University of Crete, Greece.
    Souliotis, K.
    National School Public Heatlh, Greece; University of Peloponnese, Greece; University of Crete, Greece.
    Papadakis, N.
    University of Crete, Greece.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Olsen Faresjö, Åshild
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Martinez, L.
    Pierre and Marie Curie University, France.
    Agius, D.
    Mediterranean Institute Primary Care, Malta.
    Uncu, Y.
    Uludag University, Turkey.
    Sengezer, T.
    Ankara Numune Training and Research Hospital, Turkey.
    Samoutis, G.
    University of Nicosia, Cyprus.
    Vlcek, J.
    Charles University of Prague, Czech Republic.
    Abasaeed, A.
    Charles University of Prague, Czech Republic.
    Merkouris, B.
    Greek Assoc Gen Practitioners, Greece.
    Lionis, C.
    University of Crete, Greece.
    Patients intention to consume prescribed and non-prescribed medicines: A study based on the theory of planned behaviour in selected European countries2018In: Journal of Clinical Pharmacy and Therapeutics, ISSN 0269-4727, E-ISSN 1365-2710, Vol. 43, no 1, 26-35 p.Article in journal (Refereed)
    Abstract [en]

    What is known and objectivePolypharmacy has a significant impact on patients health with overall expenditure on over-the-counter (OTC) medicines representing a substantial burden in terms of cost of treatment. The aim of this study, which was conducted within the framework of a European Project funded by the European Union under the Seventh Framework Programme and was entitled OTC-SOCIOMED, was to report on possible determinants of patient behaviour regarding the consumption of medicines, and particularly OTCs, in the context of primary care. MethodsA multicentre, cross-sectional study was designed and implemented in well-defined primary healthcare settings in Cyprus, the Czech Republic, France, Greece, Malta and Turkey. Patients completed a questionnaire constructed on the basis of the theory of planned behaviour (TPB), which was administered via face-to-face interviews. Results and discussionThe percentage of patients who had consumed prescribed medicines over a 6-month period was consistently high, ranging from 79% in the Czech Republic and 82% in Turkey to 97% in Malta and 100% in Cyprus. Reported non-prescribed medicine consumption ranged from 33% in Turkey to 92% in the Czech Republic and 97% in Cyprus. TPB behavioural antecedents explained 43% of the variability of patients intention to consume medicines in Malta and 24% in Greece, but only 3% in Turkey. Subjective norm was a significant predictor of the intention to consume medicines in all three countries (Greece, Malta and Turkey), whereas attitude towards consumption was a significant predictor of the expectation to consume medicines, if needed. What is new and conclusionThis study shows that parameters such as patients beliefs and influence from family and friends could be determining factors in explaining the high rates of medicine consumption. Factors that affect patients behavioural intention towards medicine consumption may assist in the formulation of evidence-based policy proposals and inform initiatives and interventions aimed at increasing the appropriate use of medicines.

  • 20.
    Kamwendo, K
    et al.
    Örebro.
    Faresjö, Tomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Gustavsson, U
    Norrköping.
    Jansson, M
    Norrtälje.
    Adherence to healthy lifestyles - A comparison of nursing and physiotherapy students2000In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 2, no 2, 63-74 p.Article in journal (Refereed)
    Abstract [en]

    For nurses as well as physiotherapists, there is increasing emphasis on patient education. It is a challenge for health science educational institutions to motivate students to healthy lifestyles and prepare them for their role as health educators. In the present study we compare first-term nursing and physiotherapy students on a number of lifestyle and health indicators, musculoskeletal problems and measures taken to prevent and treat back pain. A questionnaire was distributed to physiotherapy (n = 92) and nursing students (n = 115) at three different universities in Sweden. The results show that physiotherapy students are more physically active, smoke less, and eat fewer sweets and unhealthy snacks compared to nursing students. Both groups reported high back pain prevalences, and both groups favoured relaxation techniques, massage, rest and heat as treatment for back pain. The study questions the credibility of the students as role models. In order to help students adhere to healthy lifestyles and strengthen their efficacy as health educators, educational institutions need to pay attention to students' own lifestyles.

  • 21.
    Karlén, Jerker
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Could the social environment trigger the induction of diabetes related autoantibodies in young children?2012In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no 2, 177-182 p.Article in journal (Refereed)
    Abstract [en]

    Aims: The onset and progression of the autoimmune process leading to type 1 diabetes is partly dependent on genetic predisposition and partly on environmental factors. We have implemented a study design where 1-year-old children, from two equally sized, neighbouring but socioeconomically different cities, were compared for the induction of beta-cell autoantibodies. Methods: This study comprises 2448 newborn infants, all living in the urban parts of the twin cities, followed prospectively with regular biological samples and questionnaires in a major population-based study. Of these, a random sample of 1497 children were tested for tyrosine phosphatase (IA-2A) and 1409 children for glutamic acid decarboxylase (GADA). Other documented risk factors of beta-cell autoimmunity and type 1 diabetes, such as family characteristics, dietary factors, and psychosocial factors were also included in the analysis. Results: The risk for diabetes-related autoantibodies, both against GADA and IA-2A (andgt; 95% cut off), was significantly higher (p andlt; 0.0001) among children from the blue-collar than from the white-collar city. This difference persisted still after adjustment for other previously documented risk factors. Some of these previously known risk factors remained significant in the multivariate analysis as independent explanatory factors, in addition to living in a blue-collar city. Conclusions:Factors in the social environment could trigger the induction of diabetes-related autoantibodies in 1-year-old children. These results point out that our present knowledge of factors influencing the autoimmune process might be widen to also include factors in the social environment of the community.

  • 22.
    Karlén, Jerker
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Frostell, Anneli
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Health Sciences.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Maternal Influence on Child HPA Axis: A Prospective Study of Cortisol Levels in Hair2013In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 132, no 5, E1333-E1340 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate cortisol concentrations in hair as biomarker of prolonged stress in young children and their mothers and the relation to perinatal and sociodemographic factors. less thanbrgreater than less thanbrgreater thanMETHODS: Prospective cohort study of 100 All Babies In Southeast Sweden study participants with repeated measures at 1, 3, 5, and 8 years and their mothers during pregnancy. Prolonged stress levels were assessed through cortisol in hair. A questionnaire covered perinatal and sociodemographic factors during the childs first year of life. less thanbrgreater than less thanbrgreater thanRESULTS: Maternal hair cortisol during the second and third trimester and child hair cortisol at year 1 and 3 correlated. Child cortisol in hair levels decreased over time and correlated to each succeeding age, between years 1 and 3 (r = 0.30, P = .002), 3 and 5 (r = 0.39, P andlt; .001), and 5 and 8 (r = 0.44, P andlt; .001). Repeated measures gave a significant linear association over time (P andlt; .001). There was an association between high levels of hair cortisol and birth weight (beta = .224, P = .020), nonappropriate size for gestational age (beta = .231, P = .017), and living in an apartment compared with a house (beta = .200, P = .049). In addition, we found high levels of cortisol in hair related to other factors associated with psychosocial stress exposure. less thanbrgreater than less thanbrgreater thanCONCLUSIONS: Correlation between hair cortisol levels in mothers and their children suggests a heritable trait or maternal calibration of the childs hypothalamic-pituitary-adrenocortical axis. Cortisol output gradually stabilizes and seems to have a stable trait. Cortisol concentration in hair has the potential to become a biomarker of prolonged stress, especially applicable as a noninvasive method when studying how stress influences childrens health.

  • 23.
    Karlén, Jerker
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Lowert, Yvonne
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Chatziarsenis, KM
    Clinic of Social and Family Medicine, School of Medicine, University of Crete, Greece.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Fälth-Magnusson, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Are children from Crete abandoning a Mediterranean diet?2008In: Rural and remote health, ISSN 1445-6354, Vol. 8, no 4, 1034- p.Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    Mediterranean countries such as Greece have experienced rapid social change in the last decade. These community changes affect nutritional habits and there is a tendency for the traditional healthy Mediterranean diet to be abandoned.

    METHODS:

    The parents of children from one rural Greek village on Crete (Neapolis), and one rural village in Sweden (Kisa) were invited to their primary health care centers for an interview and to fill in a validated nutrition questionnaire, KidMed.

    RESULTS:

    There were no differences (p = 0.48) in total KidMed score between the Cretan and Swedish children, adjusted for gender and age. However, there were some significant differences in scores on certain KidMed questions. Parents of the Cretan children reported significantly higher daily use of olive oil at home and more regular nut consumption, but also more commercially baked goods or pastries for breakfast. The parents of Swedish children reported significantly higher use of cereals, grains or bread for breakfast. The mean BMIs were similar for the Cretan (Neapolis mean 16.8, 95% CI 13.5-23.0) and for the Swedish children (Kisa mean 17.4, 95% CI 13.7-25.5)

    CONCLUSION:

    The results suggest the possibility of changing nutritional habits, measurable among young children in rural areas. The study raises the question of whether Cretan children may have abandoned some aspects of the traditional Mediterranean diet. It may also be that Swedish children have changed their diet in favor of a more Mediterranean food choice. The major limitation of the study is the small sample size, and further, larger studies are warranted.

  • 24.
    Karlén, Jerker
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Frostell, Anneli
    Linköping University, Department of Behavioural Sciences and Learning, Cognition, Development and Disability. Linköping University, Faculty of Health Sciences.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Cortisol in hair measured in young adults - a biomarker of major life stressors?2011In: BMC Clinical Pathology, ISSN 1472-6890, E-ISSN 1472-6890, Vol. 11, no 1, 12- p.Article in journal (Refereed)
    Abstract [en]

    Background Stress as a cause of illness has been firmly established. In public health and stress research a retrospective biomarker of extended stress would be an indispensible aid. The objective of this pilot study was to investigate whether concentrations of cortisol in hair correlate with perceived stress, experiences of serious life events, and perceived health in young adults. Methods Hair samples were cut from the posterior vertex area of (n = 99) university students who also answered a questionnaire covering experiences of serious life events, perceived Stress Scale and perceived health during the last three months. Cortisol was measured using a competitive radioimmunoassay in methanol extracts of hair samples frozen in liquid nitrogen and mechanically pulverised. Results Mean cortisol levels were significantly related to serious life events (p = 0.045), weakly negatively correlated to perceived stress (p = 0.025, r = -0.061) but nor affected by sex, coloured/permed hair, intake of pharmaceuticals or self-reported health. In a multiple regression model, only the indicator of serious life events had an independent (p = 0.041) explanation of increased levels of cortisol in hair. Out of four outliers with extremely high cortisol levels two could be contacted, both reported serious psychological problems. Conclusions These findings suggest that measurement of cortisol in hair could serve as a retrospective biomarker of increased cortisol production reflecting exposure to major life stressors and possibly extended psychological illness with important implications for research, clinical practice and public health. Experience of serious life events seems to be more important in raising cortisol levels in hair than perceived stress.

  • 25.
    Karlén, Jerker
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Hedmark, Max
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Olsen Faresjö, Åshild
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Early Psychosocial Exposures, Hair Cortisol Levels, and Disease Risk2015In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 135, no 6, E1450-E1457 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Early psychosocial exposures are increasingly recognized as being crucial to health throughout life. A possible mechanism could be physiologic dysregulation due to stress. Cortisol in hair is a new biomarker assessing long-term hypothalamic-pituitary-adrenal axis activity. The objective was to investigate whether early-life adverse psychosocial circumstances influence infant cortisol levels in hair and health outcomes in children prospectively until age 10. METHODS: A cohort study in the general community using a questionnaire covering 11 psychosocial items in the family during pregnancy and the cumulative incidence of diagnoses until age 10 years in 1876 children. Cortisol levels in hair were measured by using a radioimmunoassay in those with sufficient hair samples at age 1, yielding a subsample of n = 209. RESULTS: Children with added psychosocial exposures had higher infant cortisol levels in hair (B = 0.40, P less than .0001, adjusted for gender and size for gestational age) in a cumulative manner and were significantly more often affected by 12 of the 14 most common childhood diseases, with a general pattern of increasing odds ratios. CONCLUSIONS: The findings support the model of physiologic dysregulation as a plausible mechanism by which the duration and number of early detrimental psychosocial exposures determine health outcomes. The model indicates that the multiplicity of adversities should be targeted in future interventions and could help to identify children who are at high risk of poor health. Furthermore, given the prolonged nature of exposure to a stressful social environment, the novel biomarker of cortisol in hair could be of major importance.

  • 26.
    Karlén, Jerker
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care in Central County.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Hedmark, Max
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Olsen Faresjö, Åshild
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Impact of prenatal psychosocial exposures on hair cortisol levels and child health: cohort study2014Manuscript (preprint) (Other academic)
    Abstract [en]

    Background Early psychosocial exposures are increasingly recognized as crucial for health throughout life. A possible mechanism could be physiologic dysregulation due to stress. Cortisol in hair is a new biomarker, assessing long-term HPA axis activity. The objective was to investigate whether prenatal adverse psychosocial circumstances influence infant cortisol levels in hair and health outcome in children prospectively until age 10.

    Methods True prospective cohort study in the general community with a questionnaire covering 11 psychosocial items in the family during pregnancy formed a composite scale of prenatal psychosocial vulnerability, and cumulative incidence of diseases through diagnoses until age 10 in n=1876 children. At age 1, cortisol levels in hair were measured using a competitive radioimmunoassay on a subsample of n=209.

    Results Children with added prenatal psychosocial exposures had higher infant cortisol levels in hair (B=0.40, p<0.0001, adjusted for gender and size for gestational age) in a cumulative manner and were more often (p≤0.05) affected by 12 of the 14 most common childhood diagnoses with a general pattern of rising ORs.

    Conclusions These findings support the model of physiologic dysregulation as a plausible mechanism in how the duration and number of early detrimental psychosocial exposures determine health outcome. It indicates that the multiplicity of adversities should be targeted in future interventions and could help to identify children who are at high risk of poor health. Furthermore, given the prolonged nature of exposure to a stressful social environment, the novel biomarker of cortisol in hair could be of major importance.

  • 27.
    Klimkova, M
    et al.
    Charles University of Prague.
    Vlcek, J
    Charles University of Prague.
    Moschandreas, J
    University of Crete.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Martinez, L
    Soc Francaise Medical Gen.
    Lionis, C
    University of Crete.
    Role of pharmacists in rational recommendation of OTC drugs-Europe multicentre study and role of pharmaceutical care education in self medication at Charles University in INTERNATIONAL JOURNAL OF CLINICAL PHARMACY, vol 34, issue 1, pp 214-2142012In: INTERNATIONAL JOURNAL OF CLINICAL PHARMACY, Springer Science and Business Media , 2012, Vol. 34, no 1, 214-214 p.Conference paper (Refereed)
    Abstract [en]

    n/a

  • 28.
    Kristjansson, I
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Faresjö, Tomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Lionis, C
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Nosratabadi, Ali Reza
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Gudmundsson, K
    Halling, A
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Förebygg.med.
    Tagesson, Christer
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Östergötlands Läns Landsting, Pain and Occupational Centre, Occupational and Environmental Medicine Centre.
    Assessment of aluminium in human deciduous teeth2000In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 16, no 3, 231-233 p.Article in journal (Refereed)
    Abstract [en]

    The possible role of environmental aluminium exposure in the pathogenesis of various diseases has highlighted the need for methods by which the long-term exposure to aluminium can be assessed. Therefore, we have further developed a method to determine aluminium in human deciduous teeth and applied this method for studying populations in Sweden, Crete and Iceland.

  • 29.
    Lewis, Kate Marie
    et al.
    UCL, England.
    Ruiz, Milagros
    UCL, England.
    Goldblatt, Peter
    UCL, England.
    Morrison, Joana
    UCL, England.
    Porta, Daniela
    Lazio Regional Health Syst, Italy.
    Forastiere, Francesco
    Lazio Regional Health Syst, Italy.
    Hryhorczuk, Daniel
    University of Illinois, IL USA.
    Zvinchuk, Oleksandr
    National Academic Medical Science Ukraine, Ukraine.
    Saurel-Cubizolles, Marie-Josephe
    Paris Descartes University, France.
    Lioret, Sandrine
    Paris Descartes University, France.
    Annesi-Maesano, Isabella
    Pierre Louis Institute Epidemiol and Public Health iPLESP, France.
    Vrijheid, Martine
    ISGlobal, Spain; UPF, Spain; Spanish Consortium Research Epidemiol and Public Health CIBE, Spain.
    Torrent, Maties
    Spanish Consortium Research Epidemiol and Public Health CIBE, Spain; IB Salut Menorca Health Area, Spain.
    Iniguez, Carmen
    Spanish Consortium Research Epidemiol and Public Health CIBE, Spain; University of Valencia, Spain.
    Larranaga, Isabel
    Public Health Department Gipuzkoa, Spain; BIODONOSTIA Health Research Institute, Spain.
    Harskamp-van Ginkel, Margreet W.
    University of Amsterdam, Netherlands.
    Vrijkotte, Tanja G. M.
    University of Amsterdam, Netherlands.
    Klanova, Jana
    Masaryk University, Czech Republic; Masaryk University, Czech Republic.
    Svancara, Jan
    Masaryk University, Czech Republic.
    Barross, Henrique
    University of Porto, Portugal; University of Porto, Portugal.
    Correia, Sofia
    University of Porto, Portugal; University of Porto, Portugal.
    Jarvelin, Marjo-Riitta
    Imperial Coll London, England; University of Oulu, Finland; Oulu University Hospital, Finland; University of Oulu, Finland.
    Taanila, Anja
    University of Oulu, Finland.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Marmot, Michael
    UCL, England.
    Pikhart, Hynek
    UCL, England.
    Mothers education and offspring asthma risk in 10 European cohort studies2017In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 32, no 9, 797-805 p.Article in journal (Refereed)
    Abstract [en]

    Highly prevalent and typically beginning in childhood, asthma is a burdensome disease, yet the risk factors for this condition are not clarified. To enhance understanding, this study assessed the cohort-specific and pooled risk of maternal education on asthma in children aged 3-8 across 10 European countries. Data on 47,099 children were obtained from prospective birth cohort studies across 10 European countries. We calculated cohort-specific prevalence difference in asthma outcomes using the relative index of inequality (RII) and slope index of inequality (SII). Results from all countries were pooled using random-effects meta-analysis procedures to obtain mean RII and SII scores at the European level. Final models were adjusted for child sex, smoking during pregnancy, parity, mothers age and ethnicity. The higher the score the greater the magnitude of relative (RII, reference 1) and absolute (SII, reference 0) inequity. The pooled RII estimate for asthma risk across all cohorts was 1.46 (95% CI 1.26, 1.71) and the pooled SII estimate was 1.90 (95% CI 0.26, 3.54). Of the countries examined, France, the United Kingdom and the Netherlands had the highest prevalences of childhood asthma and the largest inequity in asthma risk. Smaller inverse associations were noted for all other countries except Italy, which presented contradictory scores, but with small effect sizes. Tests for heterogeneity yielded significant results for SII scores. Overall, offspring of mothers with a low level of education had an increased relative and absolute risk of asthma compared to offspring of high-educated mothers.

  • 30.
    Lionis, C
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Faresjö, Tomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Fioretos, M
    Trell, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Unwinding Ariadne´s thread: some methodological and interpretative considerations on international hospital admission comparisons with special reference to cancer.1999In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 19, 1411-1418 p.Article in journal (Refereed)
  • 31.
    Lionis, c
    et al.
    Family Medicine Heraklion.
    Olsen-Faresjö, Åshild
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Anastasiou, F
    Wallander, M
    Uppsala universitet.
    Johansson, S
    Göteborgs universitet.
    Faresjö, Tomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Measuring the frequency of functional gastrointestinal disorders in rural Crete: a need for improving primary care physicians' diagnostic skills2005In: Rural and remote health, ISSN 1445-6354, Vol. 5, no 409Article in journal (Refereed)
  • 32.
    Lionis, Christos
    et al.
    University of Crete, Greece .
    Petelos, Elena
    University of Crete, Greece .
    Shea, Sue
    University of Crete, Greece .
    Bagiartaki, Georgia
    University of Crete, Greece .
    Tsiligianni, Ioanna G.
    University of Crete, Greece .
    Kamekis, Apostolos
    University of Crete, Greece .
    Tsiantou, Vasiliki
    National School Public Heatlh, Greece .
    Papadakaki, Maria
    University of Crete, Greece .
    Tatsioni, Athina
    University of Ioannina, Greece .
    Moschandreas, Joanna
    University of Crete, Greece .
    Saridaki, Aristoula
    University of Crete, Greece .
    Bertsias, Antonios
    University of Crete, Greece University of Crete, Greece .
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Olsen Faresjö, Åshild
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Martinez, Luc
    University of Paris 06, France EPAR Team, France .
    Agius, Dominic
    Mediterranean Institute Primary Care, Malta .
    Uncu, Yesim
    Turkish Assoc Family Phys TAHUD, Turkey .
    Samoutis, George
    University of Nicosia, Cyprus .
    Vlcek, Jiri
    Charles University of Prague, Czech Republic .
    Abasaeed, Abobakr
    Charles University of Prague, Czech Republic .
    Merkouris, Bodossakis
    Greek Assoc Gen Practitioners, Greece .
    Irrational prescribing of over-the-counter (OTC) medicines in general practice: testing the feasibility of an educational intervention among physicians in five European countries2014In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 15, no 34Article in journal (Refereed)
    Abstract [en]

    Background: Irrational prescribing of over-the-counter (OTC) medicines in general practice is common in Southern Europe. Recent findings from a research project funded by the European Commission (FP7), the "OTC SOCIOMED", conducted in seven European countries, indicate that physicians in countries in the Mediterranean Europe region prescribe medicines to a higher degree in comparison to physicians in other participating European countries. In light of these findings, a feasibility study has been designed to explore the acceptance of a pilot educational intervention targeting physicians in general practice in various settings in the Mediterranean Europe region. Methods: This feasibility study utilized an educational intervention was designed using the Theory of Planned Behaviour (TPB). It took place in geographically-defined primary care areas in Cyprus, France, Greece, Malta, and Turkey. General Practitioners (GPs) were recruited in each country and randomly assigned into two study groups in each of the participating countries. The intervention included a one-day intensive training programme, a poster presentation, and regular visits of trained professionals to the workplaces of participants. Reminder messages and email messages were, also, sent to participants over a 4-week period. A pre- and post-test evaluation study design with quantitative and qualitative data was employed. The primary outcome of this feasibility pilot intervention was to reduce GPs intention to provide medicines following the educational intervention, and its secondary outcomes included a reduction of prescribed medicines following the intervention, as well as an assessment of its practicality and acceptance by the participating GPs. Results: Median intention scores in the intervention groups were reduced, following the educational intervention, in comparison to the control group. Descriptive analysis of related questions indicated a high overall acceptance and perceived practicality of the intervention programme by GPs, with median scores above 5 on a 7-point Likert scale. Conclusions: Evidence from this intervention will estimate the parameters required to design a larger study aimed at assessing the effectiveness of such educational interventions. In addition, it could also help inform health policy makers and decision makers regarding the management of behavioural changes in the prescribing patterns of physicians in Mediterranean Europe, particularly in Southern European countries.

  • 33.
    Lionis, Christos
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Vlachonikolis, John
    Chatziarseni, Marios
    Faresjö, Tomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Kristjansson, Ingolfur
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Tzagournissakis, Minas
    Plaitakis, Andreas
    Trell, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Managing Alzheimer´s disease in primary care in Crete, Greece: room for improvement.2001In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 9, 16-21 p.Article in journal (Refereed)
  • 34.
    Nilsson, Hans
    et al.
    Linköping University, Department for Studies of Social Change and Culture, Centre for Local History. Linköping University, Faculty of Arts and Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Stor skillnad: om ojämlik hälsa i Linköping och Norrköping2012Report (Other academic)
    Abstract [sv]

    Östgötastäderna Linköping och Norrköping är handels- och tjänstestäder och båda är numera säten för högre utbildning. Städerna utgör navet i den östgötska regionen, är ungefär lika stora, men ändå så olika. Medellivslängden för en man är nästan två år kortare i Norrköping än i Linköping, för kvinnor är differensen cirka ett och ett halvt år.

    Vänder vi blicken bakåt i historien finner vi nästan hela tiden en högre dödlighet i Norrköping än i Linköping. Förr gällde det främst olika infektionssjukdomar. Idag är situationen mest allvarlig när det gäller hjärt–kärlsjuklighet, den vanligaste dödsorsaken. Norrköping sticker ut också om vi gör en jämförelse med andra svenska städer av samma storlek. Dessa data är alarmerande och måste tas på allvar.

    Gamla industristäder omvandlas och går nu in i en postindustriell epok. Jämförelser med andra europeiska städer blir därför högintressanta. För att understryka den internationella forskningsinriktningen har forskargruppen valt att använda en engelsk titel, Twincities Research Group.

    Forskargruppen består av forskare från flera institutioner vid Linköpings universitet. Både Hälsouniversitetet och Filosofiska fakulteten är representerade. Gruppen fokuserar på frågeställningar om människors hälsa och välfärd och de komponenter som påverkar dessa. Designen liknar i stort ett klassiskt naturvetenskapligt experiment. Genom att hålla så många inverkande faktorer som möjligt under kontroll kan man renodla inflytandet av olika faktorer och avläsa effekten på hälsan i en hel befolkning. Det är sannolikt framför allt socialhistorien, levnadsförhållandena, livsstilen och de socioekonomiska förhållanden som slår igenom på befolkningens hälsa i städerna Norrköping och Linköping.

    Twincitiesgruppen har under ungefär sex års tid arbetat hårt för att få till stånd ett fast samarbete med de aktuella kommunerna och Landstinget i Östergötland. Vi har påvisat att städerna Linköping och Norrköping och Linköping har olika socialhistoria, men också att förutsättningarna för att förbättra hälsan skiljer städerna åt. Norrköping har ett rikare föreningsliv, en historia präglad av kollektiv sammanhållning, något som talar för att man med medvetna satsningar skulle kunna bedriva farmgångsrikt folkhälsoarbete. Linköping å andra sidan har ett bättre hälsoläge, men här är staden och dess olika delar och näringar mer splittrade.

    Forskargruppens vision för det framtida folkhälsoarbetet är att det bildas ett folkhälsocentrum för att stärka samverkan mellan aktörerna. Två viktiga uppgifter som ett sådant bör ställa sig är att samordna och öka kunskapen om hälsans fördelning och hälsans bestämningsfaktorer på både individ- och samhällsnivå. Här handlar det lika mycket om underlag för politiska beslu  som att med vetenskapliga studier öka vår kunskap om hälsans bestämningsfaktorer.

    De aktörer som kan samverka i ett regionalt folkhälsocentrum är många. Twincities Research Group vill medverka i ett nära samarbete med Landstinget, kommunerna, Östsam, Länsstyrelsen, Försäkringskassan, kyrka och religiösa organisationer, idrottsrörelsen, näringslivet och olika aktörer i civilsamhället i stort. Aktiviteterna bör utgå från ett regionalt östgötaperspektiv och exempel på teman som skulle kan stå i centrum är: vår tids hälsoproblem, utsatta grupper i samhället, barns och ungdomars hälsa, de gamlas hälsa liksom sambandet mellan hälsa och ekonomisk tillväxt.

  • 35.
    Nätt, Daniel
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences.
    Johansson, Ingela
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Thorsell, Annika
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    High cortisol in 5-year-old children causes loss of DNA methylation in SINE retrotransposons: a possible role for ZNF263 in stress-related diseases2015In: Clinical Epigenetics, E-ISSN 1868-7083, ISSN 1868-7083, Vol. 7, no 1, 91Article in journal (Refereed)
    Abstract [en]

    Background: Childhood stress leads to increased risk of many adult diseases, such as major depression and cardiovascular disease. Studies show that adults with experienced childhood stress have specific epigenetic changes, but to understand the pathways that lead to disease, we also need to study the epigenetic link prospectively in children. Results: Here, we studied a homogenous group of 48 5-year-old children. By combining hair cortisol measurements (a well-documented biomarker for chronic stress), with whole-genome DNA-methylation sequencing, we show that high cortisol associates with a genome-wide decrease in DNA methylation and targets short interspersed nuclear elements (SINEs; a type of retrotransposon) and genes important for calcium transport: phenomena commonly affected in stress-related diseases and in biological aging. More importantly, we identify a zinc-finger transcription factor, ZNF263, whose binding sites where highly overrepresented in regions experiencing methylation loss. This type of zinc-finger protein has previously shown to be involved in the defense against retrotransposons. Conclusions: Our results show that stress in preschool children leads to changes in DNA methylation similar to those seen in biological aging. We suggest that this may affect future disease susceptibility by alterations in the epigenetic mechanisms that keep retrotransposons dormant. Future treatments for stress-and age-related diseases may therefore seek to target zinc-finger proteins that epigenetically control retrotransposon reactivation, such as ZNF263.

  • 36.
    Olsen Faresjö, Åshild
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Grodzinsky, Ewa
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Johansson, Saga
    University of Gothenburg.
    Wallander, Mari-Ann
    Uppsala University.
    Faresjö, Tomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Self-Reported Use of Pharmaceuticals Among Patients With Irritable Bowel Syndrome in Primary Care2008In: Journal of Managed Care Pharmacy, ISSN 1083-4087, Vol. 14, no 9, 870-877 p.Article in journal (Refereed)
    Abstract [en]

    Background: Irritable bowel syndrome (IBS) has an estimated 10%-12% prevalence in industrial countries. Studies from the United States have shown that IBS causes notable financial losses for employers. Due to the lack of pathophysiological markers, only a fraction of the pharmacological management of IBS has focused on etiological mechanisms. We hypothesized that there is a high consumption of nonspecific drugs among patients with IBS in their attempts to manage symptoms.

    Objective: To analyze self-reported use of prescription and over-the-counter (OTC) drugs among patients with IBS in primary care compared with controls from the general population.

    Methods: A population-based case-control design was used for the study. IBS cases were identified from the electronic medical records of 3 Swedish primary health care centers from January 1, 1997, through December 31 2001. A questionnaire containing specific questions about prescription ad OTC drugs was mailed in 2003 to 5,015 working-age (18-64 years) individuals (IBS cases and controls) in the Linkoping IBS Population Study, a study of primary care patients with controls selected from the general population.

    Results: After 2 reminders, the overall response rate was 63% (3,074 respondents of 4,913 deliverable surveys); 71% responded for the IBS cases (347/486) and 57% (2,509/4,427) responded for the controls. 72.3% of the IBS respondents and 51.9% of the controls were female. Acid-suppressive agents were the most commonly cited drug category for abdominal complaints reported by IBS patients (13.3%) compared with controls (11.6%) (unadjusted odds ratio [OR] =9.20, 95% confidence interval [CI] = 5.94-14.25). Antidepressants were the most commonly cited drug category for nonabdominal complaints, reported by 13.3% of IBS patients versus 4.5% of controls (OR = 3.27, 95% CI = 2.27-4.70). An unadjusted univariate correlation analysis revealed that prescription acid-suppressive drugs, fiber and bulking laxatives, and antiflatulents and antidiarrhea drugs, as well as motility-regulating and antispasmodics drugs, were significantly more common among IBS cases compared with controls. In addition to the higher use of antidepressants, there were 3 other drug classes for nongastrointestinal complaints with a higher rate of use among IBS patients compared with controls: sedative hypnotics (OR = 2.49, CI = 1.444.29), analgesics (OR = 2.86, Cl = 1.88-4.33), and thyroid hormones (OR = 2.43, CI = 1.39-4.26).

    Conclusions: There was higher use of antidepressants among patients with IBS compared with controls from the general population. Even though they are not recommended for this patient category, the use of prescription and OTC acid-suppressive drugs is also common among IBS cases in primary care.

  • 37.
    Olsen Faresjö, Åshild
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Chatziarzenis, Marios
    Thriasson Gen Hospital Elefsina, Greece.
    Sapouna, Vasiliki
    University of Athens, Greece.
    Claesson, Hans-Peter
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Koppner, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Higher Perceived Stress but Lower Cortisol Levels Found among Young Greek Adults Living in a Stressful Social Environment in Comparison with Swedish Young Adults2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 9Article in journal (Refereed)
    Abstract [en]

    The worldwide financial crisis during recent years has raised concerns of negative public health effects. This is notably evident in southern Europe. In Greece, where the financial austerity has been especially pronounced, the prevalence of mental health problems including depression and suicide has increased, and outbreaks of infectious diseases have risen. The main objective in this study was to investigate whether different indicators of health and stress levels measured by a new biomarker based on cortisol in human hair were different amongst comparable Greek and Swedish young adults, considering that Sweden has been much less affected by the recent economic crises. In this cross-sectional comparative study, young adults from the city of Athens in Greece (n = 124) and from the city of Linkoping in Sweden (n = 112) participated. The data collection comprised answering a questionnaire with different health indicators and hair samples being analyzed for the stress hormone cortisol, a biomarker with the ability to retrospectively measure long-term cortisol exposure. The Greek young adults reported significantly higher perceived stress (p<0.0001), had experienced more serious life events (p = 0.002), had lower hope for the future (p<0.0001), and had significantly more widespread symptoms of depression (p<0.0001) and anxiety (p<0.0001) than the Swedes. But, the Greeks were found to have significantly lower cortisol levels (p<0.0001) than the Swedes, and this difference was still significant in a multivariate regression (p<0.0001), after adjustments for potential intervening variables. A variety of factors related to differences in the physical or socio-cultural environment between the two sites, might possibly explain this finding. However, a potential biological mechanism is that long-term stress exposure could lead to a lowering of the cortisol levels. This study points out a possible hypothesis that the cortisol levels of the Greek young adults might have been suppressed and their HPA-axis down-regulated after living in a stressful environment with economic and social pressure.

  • 38.
    Rahmqvist, Mikael
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Gjessing, Kristian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Influenca-like illness among children: Young children suffer, primary care takes the strain, society bears the cost2016Conference paper (Refereed)
    Abstract [en]

    Conclusions

    Our results demonstrated a significant increase in the burden of disease during the peak influenza season with increased direct medical costs, especially in primary care. The largest impact of ILI was identified among the youngest children (2-4 years). Increased absence from work due to parents' care of ill children correlates strongly with the ILI encounters in health care. This loss of productivity represents a large indirect cost for society.

  • 39.
    Rahmqvist, Mikael
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Gjessing, Kristian
    Linköping University, Department of Medical and Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Influenza-like illness: Young children, working parents and primary care take the strain2015Conference paper (Refereed)
  • 40.
    Rahmqvist, Mikael
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Gjessing, Kristian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Influenza-related healthcare visits, hospital admissions, and direct medical costs for all children aged 2 to 17 years in a defined Swedish region, monitored for 7 years2016In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 95, no 33, UNSP e4599- p.Article in journal (Refereed)
    Abstract [en]

    Background: The seasonal variation of influenza and influenza-like illness (ILI) is well known. However, studies assessing the factual direct costs of ILI for an entire population are rare. Methods: In this register study, we analyzed the seasonal variation of ILI-related healthcare visits and hospital admissions for children aged 2 to 17 years, and the resultant parental absence fromwork, for the period 2005 to 2012. The study population comprised an open cohort of about 78,000 children per year from a defined region. ILI was defined as ICD-10 codes: J00-J06; J09-J15, J20; H65-H67. Results: Overall, the odds of visiting a primary care center for an ILI was 1.64-times higher during the peak influenza season, compared to the preinfluenza season. The corresponding OR among children aged 2 to 4 years was 1.96. On average, an estimated 20% of all healthcare visits for children aged 2 to 17 years, and 10% of the total healthcare costs, were attributable to seasonal ILI. In primary care, the costs per week and 10,000 person years for ILI varied - by season - from (sic)3500 to (sic)7400. The total ILI cost per year, including all physical healthcare forms, was (sic)400,400 per 10,000 children aged 2 to 17 years. The costs for prescribed and purchased drugs related to ILI symptoms constituted 52% of all medicine costs, and added 5.8% to the direct healthcare costs. The use of temporary parental employment benefits for caring of ill child followed the seasonal pattern of ILI (r = 0.91, P amp;lt; 0.001). Parental absence from work was estimated to generate indirect costs, through loss of productivity of 5.2 to 6.2 times the direct costs. Conclusions: Direct healthcare costs increased significantly during the influenza season for children aged 2 to 17 years, both in primary and hospital outpatient care, but not in hospital inpatient care. Primary care manages the majority of visits for influenza and ILI. Children 2 to 4 years have a larger portion of their total healthcare encounters related to ILI compared with older children. There is a clear correlation between ILI visits across the years and parental absence from work.

  • 41.
    Rajmil, Luis
    et al.
    Agència de Qualitat i Avaluació Sanitàries (AQuAS), Barcelona, Spain .
    Fernandez de Sanmamed, Maria-Jose
    General Practitioner, Barcelona, Spain.
    Choonara, Imti
    University of Nottingham, England .
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Hjern, Anders
    Stockholm University, Sweden .
    L. Kozyrskyj, Anita
    University of Alberta, Canada .
    Lucas, Patricia J.
    University of Bristol, England .
    Raat, Hein
    Erasmus University, Netherlands .
    Seguin, Louise
    University of Montreal, Canada .
    Spencer, Nick
    University of Warwick, England .
    Taylor-Robinson, David
    University of Liverpool, England .
    Impact of the 2008 Economic and Financial Crisis on Child Health: A Systematic Review2014In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 11, no 6, 6528-6546 p.Article, review/survey (Refereed)
    Abstract [en]

    The aim of this study was to provide an overview of studies in which the impact of the 2008 economic crisis on child health was reported. Structured searches of PubMed, and ISI Web of Knowledge, were conducted. Quantitative and qualitative studies reporting health outcomes on children, published since 2007 and related to the 2008 economic crisis were included. Two reviewers independently assessed studies for inclusion. Data were synthesised as a narrative review. Five hundred and six titles and abstracts were reviewed, from which 22 studies were included. The risk of bias for quantitative studies was mixed while qualitative studies showed low risk of bias. An excess of 28,000-50,000 infant deaths in 2009 was estimated in sub-Saharan African countries, and increased infant mortality in Greece was reported. Increased price of foods was related to worsening nutrition habits in disadvantaged families worldwide. An increase in violence against children was reported in the U.S., and inequalities in health-related quality of life appeared in some countries. Most studies suggest that the economic crisis has harmed childrens health, and disproportionately affected the most vulnerable groups. There is an urgent need for further studies to monitor the child health effects of the global recession and to inform appropriate public policy responses.

  • 42.
    Roel, Eduardo
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Faresjö, Åshild
    Zetterström, Olle
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Allergy Centre. Östergötlands Läns Landsting, Centre for Medicine, Allergy Centre UHL.
    Trell, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Faresjö, Tomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Clinically diagnosed childhood asthma and follow-up of symptoms in a Swedish case control study2005In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 6Article in journal (Refereed)
    Abstract [en]

    Background: Childhood asthma has risen dramatically not only in the western societies and now forms a major and still increasing public health problem. The aims of this study were to follow up at the age of ten the patterns of asthma symptoms and associations among children with a clinically diagnosed asthma in a sizeable urban-rural community and to in compare them with demographic controls using a standardised questionnaire. Methods: In a defined region in Sweden with a population of about 150 000 inhabitants, all children (n = 2 104) born in 1990 were recorded. At the age of seven all primary care and hospital records of the 1 752 children still living in the community were examined, and a group of children (n = 191) was defined with a well-documented and medically confirmed asthma diagnosis. At the age of ten, 86 % of these cases (n = 158) and controls (n = 171) completed an ISAAC questionnaire concerning asthma history, symptoms and related conditions. Results: Different types of asthma symptoms were highly and significantly over-represented in the cases. Reported asthma heredity was significantly higher among the cases. No significant difference in reported allergic rhinitis or eczema as a child was found between cases and controls. No significant difference concerning social factors or environmental exposure was found between case and controls. Among the control group 4.7 % of the parents reported that their child actually had asthma. These are likely to be new asthma cases between the age of seven and ten and give an estimated asthma prevalence rate at the age of ten of 15.1 % in the studied cohort. Conclusion: A combination of medical verified asthma diagnosis through medical records and the use of self-reported symptom through the ISAAC questionnaire seem to be valid and reliable measures to follow-up childhood asthma in the local community. The asthma prevalence at the age of ten in the studied birth cohort is considerably higher than previous reports for Sweden. Both the high prevalence figure and allowing the three-year lag phase for further settling of events in the community point at the complementary roles of both hospital and primary care in the comprehensive coverage and control of childhood asthma in the community. © 2005 Roel et al, licensee BioMed Central Ltd.

  • 43.
    Roel, Eduardo
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Olsen Faresjö, Å
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Kjellman, Max
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    Faresjö, Tomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Cumulative incidence of asthma diagnosis at the age of seven in a birth cohort. 1999In: European Journal of General Practice, ISSN 1381-4788, E-ISSN 1751-1402, Vol. 5, 71-74 p.Article in journal (Refereed)
  • 44.
    Roel, Eduardo
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences.
    Olsen Faresjö, Åshild
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Zetterström, Olle
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Allergy Centre . Linköping University, Department of Clinical and Experimental Medicine, Allergy Centre .
    Faresjö, Tomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice.
    Perinatal, social, and environmental factors and the risk for childhood asthma in a 10-year follow-up2004In: Pediatric Asthma Allergy & Immunology, ISSN 0883-1874, E-ISSN 1557-7767, Vol. 17, no 2, 136-145 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate the relative importance of perinatal, social, and environmental factors in a birth cohort for the risk of developing asthma in a 10-year follow-up. A group of children (n = 144) with medically diagnosed asthma was matched to a control group of demographic twins (n = 144) from the same birth cohort and region. In a defined region in Sweden, children with a well-documented and medically confirmed asthma diagnosis were retrospectively identified and followed from birth up to the age of 10. Asthma diagnosis, perinatal and obstetric factors, and social data for both the case and control groups were collected through medical records at all health centers in primary care, privately practicing pediatricians, and the public pediatric clinic in the region. The parents of these children answered the standardized ISAAC postal questionnaire, with an overall response rate of 87%. Family history of asthma and allergic rhinitis and low birth weight indicated an increased asthma risk. The social class of the mother and life-style factors concerning mothers smoking habits and indication of passive smoking were also related to increased asthma risk. Also residential factors like mist or mold damage, unusual odors, and dry air were found to indicate increased asthma risk. Maternal asthma, low birth weight, and exposure to passive smoking in the family were all found to be independent predictors for childhood asthma.

  • 45.
    Roel, Eduardo
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Olsen-Faresjö, Åshild
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Zetterström, Olle
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Allergy Centre. Östergötlands Läns Landsting, Centre for Medicine, Allergy Centre UHL.
    Faresjö, Tomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Perinatal, Socila, and Environmental Factors and the Risk for Childhood Asthma in a 10-Year Follow-Up2004In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 17, no 2, 146-150 p.Article in journal (Refereed)
  • 46.
    Roel, Eduardo
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Zetterström, Olle
    Linköping University, Department of Clinical and Experimental Medicine, Allergy Centre. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Allergy Center.
    Trell, Erik
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Why are some children with early onset of asthma getting better over the years? - Diagnostic failure or salutogenetic factors2009In: International Journal of Medical Sciences, ISSN 1449-1907, E-ISSN 1449-1907, Vol. 6, no 6, 348-357 p.Article in journal (Refereed)
    Abstract [en]

    Among children earlier having been identified with a hospital or primary care diagnosis of asthma at least once between 0-7 years of age, almost 40 % of their parents reported in the ISAAC-questionnaire as never having had asthma (NA). These are further analysed and compared with the persisting asthma cases (A) in this study. All these childrens medical records were scrutinized concerning their asthma diagnose retrospectively. The aim of this study was to analyse possible factors related to the outcome in an Asthma diagnosis reassessment by parental questionnaire at the age of ten of the children earlier having been identified with a hospital or primary health care diagnosis of asthma at least once between 0-7 years of age in a total birth-year cohort in a defined Swedish geographical area. A multiple logistic analysis revealed four significant and independent factors associated to the improvement/non-report of asthma at the age of ten. These factors were; not having any past experiences of allergic symptoms (pless than0.0001), only having one or two visits at the hospital for asthma diagnosis in the 0-7 interval (p=0.001), not living in a flat but a villa at the age of ten (p=0.029) and no previous perception of mist or mould damage in the house (p=0.052). In the early postnatal stage, obstructive and bronchospastic symptoms typical of asthma may be unspecific, and those cases not continuing to persisting disease tend to have identifiable salutogenetic factors of constitutional rather than environmental nature, namely, an overall reduced allergic predisposition.

  • 47.
    Ruiz, Milagros
    et al.
    UCL, England.
    Goldblatt, Peter
    UCL, England.
    Morrison, Joana
    UCL, England.
    Porta, Daniela
    Lazio Regional Health Syst, Italy.
    Forastiere, Francesco
    Lazio Regional Health Syst, Italy.
    Hryhorczuk, Daniel
    University of Illinois, IL USA.
    Antipkin, Youriy
    Institute Pediat Obstet and Gynecol, Ukraine.
    Saurel-Cubizolles, Marie-Josephe
    DHU Risks Pregnancy, France.
    Lioret, Sandrine
    Paris Descartes University, France.
    Vrijheid, Martine
    Centre Research Environm Epidemiol CREAL, Spain; Spanish Consortium Research Epidemiol and Public Health CIBE, Spain.
    Torrent, Maties
    Spanish Consortium Research Epidemiol and Public Health CIBE, Spain; IB Salut Menorca Health Area, Spain.
    Iniguez, Carmen
    University of Valencia, Spain.
    Larranaga, Isabel
    Public Health Department Gipuzkoa, Spain; BIODONOSTIA Health Research Institute, Spain.
    Bakoula, Chryssa
    University of Athens, Greece.
    Veltsista, Alexandra
    University of Athens, Greece.
    van Eijsden, Manon
    University of Amsterdam, Netherlands.
    Vrijkotte, Tanja G. M.
    University of Amsterdam, Netherlands.
    Andryskova, Lenka
    Masaryk University, Czech Republic.
    Dusek, Ladislav
    Masaryk University, Czech Republic.
    Barros, Henrique
    University of Porto, Portugal.
    Correia, Sofia
    University of Porto, Portugal.
    Jarvelin, Marjo-Riitta
    University of London Imperial Coll Science Technology and Med, England; University of Oulu, Finland; Oulu University Hospital, Finland; University of Oulu, Finland.
    Taanila, Anja
    University of Oulu, Finland.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Marmot, Michael
    UCL, England; UCL, England.
    Pikhart, Hynek
    UCL, England.
    Impact of Low Maternal Education on Early Childhood Overweight and Obesity in Europe2016In: Paediatric and Perinatal Epidemiology, ISSN 0269-5022, E-ISSN 1365-3016, Vol. 30, no 3, 274-284 p.Article in journal (Refereed)
    Abstract [en]

    BackgroundComparable evidence on adiposity inequalities in early life is lacking across a range of European countries. This study investigates whether low maternal education is associated with overweight and obesity risk in children from distinct European settings during early childhood. MethodsProspective data of 45 413 children from 11 European cohorts were used. Childrens height and weight obtained at ages 4-7 years were used to assess prevalent overweight and obesity according to the International Obesity Task Force definition. The Relative/Slope Indices of Inequality (RII/SII) were estimated within each cohort and by gender to investigate adiposity risk among children born to mothers with low education as compared to counterparts born to mothers with high education. Individual-data meta-analyses were conducted to obtain aggregate estimates and to assess heterogeneity between cohorts. ResultsLow maternal education yielded a substantial risk of early childhood adiposity across 11 European countries. Low maternal education yielded a mean risk ratio of 1.58 (95% confidence interval (CI) 1.34, 1.85) and a mean risk difference of 7.78% (5.34, 10.22) in early childhood overweight, respectively, measured by the RII and SII. Early childhood obesity risk by low maternal education was as substantial for all cohorts combined (RII = 2.61 (2.10, 3.23)) and (SII = 4.01% (3.14, 4.88)). Inequalities in early childhood adiposity were consistent among boys, but varied among girls in a few cohorts. ConclusionsConsiderable inequalities in overweight and obesity are evident among European children in early life. Tackling early childhood adiposity is necessary to promote childrens immediate health and well-being and throughout the life course.

  • 48.
    Tsamandouraki, Kiki
    et al.
    University of Crete, Heraklion, Greece.
    Alamanos, Yannis
    University of Crete, Heraklion, Greece.
    Faresjö, Tomas
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Davidson, Kristina
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Koutis, Antonis
    University of Crete, Heraklion, Greece.
    Lionis, Christos
    University of Crete, Heraklion, Greece.
    Trell, Erik
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Fioretos, Michael
    University of Crete, Heraklion, Greece.
    Hospital admissions for different cancer diagnosis: a comparison between two European landscapes1994In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 14, no 5B, 2167-2170 p.Article in journal (Refereed)
    Abstract [en]

    Cancer frequency has been studied in a Department of Crete and a Department of Sweden, using in-patient data collected in the Departmental Hospitals, for a two-year period. The results of the study suggest that similar trends exist in the prevalence of different forms of cancer between the two areas studied, as well as some significant differences. The differences observed concern mainly the frequency of cancers of the lung, prostate, bladder and large bowel among men and breast and large bowel among women. These findings could to a great extent be explained by life-style and environmental differences between the two areas and are consistent with data concerning the cancer mortality in the two countries.

  • 49.
    Tsiantou, V.
    et al.
    National School of Public Health, Athens, Greece.
    Shea, S.
    University of Crete, Greece .
    Martinez, L.
    Pierre et Marie Curie université, Paris, France.
    Agius, D.
    Mediterranean Institute of Primary Care, Attard, Malta.
    Basak, O.
    Turkish Association of Family Physicians, Turkey.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Moschandreas, J.
    University of Crete, Greece .
    Samoutis, G.
    University of Nicosia, Cyprus .
    Symvoulakis, E. K.
    University of Crete, Greece .
    Lionis, C.
    University of Crete, Greece .
    Eliciting general practitioners' salient beliefs towards prescribing: A qualitative study based on the Theory of Planned Behaviour in Greece2013In: Journal of Clinical Pharmacy and Therapeutics, ISSN 0269-4727, E-ISSN 1365-2710, Vol. 38, no 2, 109-114 p.Article in journal (Refereed)
    Abstract [en]

    WHAT IS KNOWN AND OBJECTIVE:

    Prescribing represents an important medical action especially in primary care. However, irrational prescribing is common and has an impact on clinical and economic outcomes. Therefore, there is a growing need to rationalize prescribing. Knowledge of influential factors is crucial for achieving this. The aim of the present study was to identify the behavioural, normative and control beliefs of GPs regarding prescribing in Greece.

    METHODS:

    Focus group sessions were conducted in three geographically defined areas in Greece. GPs working in the private and public sector in primary care settings were invited to participate. Transcripts from focus groups were content analysed using the Theory of Planned Behaviour (TPB) as the theoretical framework.

    RESULTS AND DISCUSSION:

    GPs acknowledged prescribing as the most important method for treating diseases in primary health care, with significant impact on patient's health and quality of life. The expectations of patients and their families were extremely influential during prescribing. Pharmaceutical sales representatives, other GPs and specialists, as well as public health authorities influenced prescribing. GPs admitted that factors such as the income of the patient, the limited time available and special situations such as prescribing through a third person or prescribing following patients' prescription requests for medicines that they have previously purchased over the counter through pharmacies may facilitate or hinder their prescribing decision.

    WHAT IS NEW AND CONCLUSION:

    This elicitation study shed light into GPs' beliefs regarding prescribing. Factors that are not common in the usual European setting were revealed, such as the influence of the patients' family and special situations during prescribing. Thus, various issues were highlighted that should inform the development of items for inclusion in a forthcoming TPB-based questionnaire. The results of this study revealed also certain issues that can affect the design of policies aiming at the rationalization of prescribing.

  • 50.
    Tsiantou, Vasiliki
    et al.
    National School Public Heatlh, Greece; University of Crete, Greece.
    Moschandreas, Joanna
    University of Crete, Greece.
    Bertsias, Antonis
    University of Crete, Greece.
    Papadakaki, Maria
    University of Crete, Greece.
    Saridaki, Aristoula
    University of Crete, Greece.
    Agius, Dominic
    Mediterranean Institute Primary Care, Malta.
    Alper, Zuleyha
    Uludag University, Turkey; Turkish Assoc Family Phys, Turkey.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Klimkova, Martina
    Charles University of Prague, Czech Republic.
    Martinez, Luc
    University of Paris 06, France; Soc Francaise Medical Gen, France.
    Samoutis, George
    University of Nicosia, Cyprus.
    Vlcek, Jiri
    Charles University of Prague, Czech Republic.
    Lionis, Christos
    University of Crete, Greece.
    General Practitioners intention to prescribe and prescribing patterns in selected European settings: The OTCSOCIOMED project2015In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 119, no 9, 1265-1274 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this paper is to explore general practitioners (GPs) prescribing intentions and patterns across different European regions using the Theory of Planned Behavior (TPB). A cross-sectional study was undertaken in selected geographically defined Primary Health Care areas in Cyprus, Czech Republic (CZ), France, Greece, Malta, Sweden and Turkey. Face-to-face interviews were conducted using a TPB-based questionnaire. The number of GP participants ranged from 39 to 145 per country. Possible associations between TPB direct measures (attitudes, subjective norms (SN) and perceived behavioral control (PBC)) and intention to prescribe were assessed by country. On average, GPs thought positively of, and claimed to be in control of, prescribing. Correlations between TPB explanatory measures and prescribing intention were weak, with TPB direct measures explaining about 25% of the variance in intention to prescribe in Malta and CZ but only between 3% and 5% in Greece, Sweden and Turkey. SN appeared influential in GPs from Malta; attitude and PBC were statistically significant in GPs from CZ. GPs prescribing intentions and patterns differed across participating countries, indicating that country-specific interventions are likely to be appropriate. Irrational prescribing behaviors were more apparent in the countries where an integrated primary care system has still not been fully developed and policies promoting the rational use of medicines are lacking. Demand-side measures aimed at modifying GPs prescribing behavior are deemed necessary. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

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