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  • 1.
    Agvall, Björn
    et al.
    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 Central Östergötland.
    Borgquist, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Foldevi, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland.
    Dahlström, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Cost of heart failure in Swedish primary healthcare2005In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 23, p. 227-232Article in journal (Refereed)
    Abstract [en]

    Objectives. To calculate the cost for patients with heart failure (HF) in a primary healthcare setting. Design. Retrospective study of all available patient data during a period of one year. Setting. Two healthcare centers in Linköping in the southeastern region of Sweden, covering a population of 19 400 inhabitants. Subjects. A total of 115 patients with a diagnosis of HF. Main outcome measures. The healthcare costs for patients with HF and the healthcare utilization concerning hospital days and visits to doctors and nurses in hospital care and primary healthcare. Results. The mean annual cost for a patient with HF was SEK 37 100. There were no significant differences in cost between gender, age, New York Heart Association functional class, and cardiac function. The distribution of cost was 47% for hospital care, 22% for primary healthcare, 18% for medication, 5% for nursing home, and 6% for examinations. Conclusion. Hospital care accounts for the largest cost but the cost in primary healthcare is larger than previously shown. The total annual cost for patients with HF in Sweden is in the range of SEK 5.0–6.7 billion according to this calculation, which is higher than previously known.Read More: http://informahealthcare.com/doi/abs/10.1080/02813430500197647

  • 2.
    Agvall, Björn
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care in Central County.
    Paulsson, Thomas
    Global Health Economics and Outcomes Research, Bristol-Myers Squibb, Belgium.
    Foldevi, Mats
    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.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Alehagen, Urban
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Resource use and cost implications of implementing a heart failure program for patients with systolic heart failure in Swedish primary health care2014In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 176, p. 731-738Article in journal (Refereed)
    Abstract [en]

    Aim: Heart failure (HF) is a common but serious condition which involves a significant economic burden on the health care economy. The purpose of this study was to evaluate cost and quality of life (QoL) implications of implementing a HF management program (HFMP) in primary health care (PHC).

    Methods and results: This was a prospective randomized open-label study including 160 patientswith a diagnosis of HF from five PHC centers in south-eastern Sweden. Patients randomized to the intervention group received information about HF from HF nurses and from a validated computer-based awareness program. HF nurses and physicians followed the patients intensely in order to optimize HF treatment according to current guidelines. The patients in the control group were followed by their regular general practitioner (GP) and received standard treatment according to local management routines. No significant changes were observed in NYHA class and quality-adjusted life years (QALY), implying that functional class and QoL were preserved. However, costs for hospital care (HC) and PHC were reduced by EUR 2167, or 33%. The total cost was EUR 4471 in the intervention group and EUR 6638 in the control group.

    Conclusions: Introducing HFMP in Swedish PHC in patients with HF entails a significant reduction in resource utilization and costs, and maintains QoL. Based on these results, a broader implementation of HFMP in PHC may be recommended. However, results should be confirmed with extended follow-up to verify  long-term effects.

  • 3.
    André, Malin
    et al.
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Borgquist, Lars
    Linköping University, Department of Medicine and Health Sciences. 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.
    Foldevi, Mats
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.
    Mölstad, Sigvard
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Asking for ’rules of thumb’: a way to discover tacit knowledge in general practice2002In: Family Practice, ISSN 0263-2136, Vol. 19, no 6, p. 617-622Article in journal (Refereed)
    Abstract [en]

    Background. Research in decision-making has identified heuristics (rules of thumb) as shortcuts to simplify search and choice.

    Objective. To find out if GPs recognize the use of rules of thumb and if they could describe what they looked like.

    Methods. An explorative and descriptive study was set up using focus group interviews. The interview guide contained the questions: Do you recognize the use of rules of thumb? Are you able to give some examples? What are the benefits and dangers in using rules of thumb? Where do they come from? The interviews were transcribed and analysed using the templates in the interview guide, and the examples of rules were classified by editing analysis.

    Results. Four groups with 23 GPs were interviewed. GPs recognized using rules of thumb, producing examples covering different aspects of the consultation. The rules for somatic problems were formulated as axiomatic simplified medical knowledge and taken for granted, while rules for psychosocial problems were formulated as expressions of individual experience and were followed by an explanation. The rules seemed unaffected by the sparse objections given. A GP’s clinical experience was judged a prerequisite for applying the rules. The origin of many rules was via word-of-mouth from a colleague. The GPs acknowledged the benefits of using the rules, thereby simplifying work.

    Conclusion. GPs recognize the use of rules of thumb as an immediate and semiconscious kind of knowledge that could be called tacit knowledge. Using rules of thumb might explain why practice remains unchanged although educational activities result in more elaborate knowledge.

  • 4.
    Engström, Sven
    et al.
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.
    Foldevi, Mats
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.
    Borgquist, Lars
    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.
    Is general practice effective?: A systematic literature review2001In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, Vol. 19, no 2, p. 131-144Article in journal (Refereed)
    Abstract [en]

    Objective - To find evidence of the effectiveness of physicians working in primary care.

    Design - Systematic literature search in the Medline and Cochrane databases.

    Material - Out of 7223 titles found in the search, 45 studies, comparing, from different aspects, primary care with specialist care, were extracted.

    Main outcome measures - Health indicators, health care costs, quality of health care.

    Results - Primary care contributed to improved public health, as expressed through different health parameters, and a lower utilisation of medical care leading to lower costs. Physicians working in primary care, in comparison with other specialists, took care of many diseases without loss of quality and often at lower cost. The organisation of primary care was important in respect of reimbursement by capita tion, more group practices, higher personal continuity, and having generalists as primary care physicians.

    Conclusions - To compare the effectiveness of primary care and specialist care is a complex task and there are limitations in all studies. However, we have found evidence that increased accessibility to physicians working in primary care contributes to better health and lower total costs in the health care system. It is also clear that studies with evaluation of how to most effectively organise primary care are far too few. There is an extensive need for future research in this area, a suitable task for collaborative research between the Nordic countries.

  • 5.
    Faresjö (Olsen), Åshild
    et al.
    Linköping University, Department of Medicine and Health Sciences, Primary Care . Linköping University, Faculty of Health Sciences.
    Grodzinsky, Ewa
    Linköping University, Department of Medicine and Health Sciences, Primary Care . Linköping University, Faculty of Health Sciences.
    Johansson, S.
    Cardiovascular Institute, University of Gothenburg, Gothenburg .
    Foldevi, Mats
    Linköping University, Department of Medicine and Health Sciences, Primary Care . Linköping University, Faculty of Health Sciences.
    Wallander, Mari-Ann
    Department of Public Health and Caring Science, Uppsala University, Uppsala.
    Patients with irritable bowel syndrome in primary care appear not to be heavy health care utilisers2006In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 23, no 6, p. 807-814Article in journal (Refereed)
    Abstract [en]

    Background

    Irritable bowel syndrome is a frequently diagnosed gastrointestinal condition in general practice. Managing this chronic condition requires a co-ordinated effort between patient and doctor.

    Aim

    To explore the patterns of treatment and healthcare utilization of irritable bowel syndrome cases in a Swedish primary care setting.

    Methods

    All cases with a registered diagnosis of irritable bowel syndrome were identified retrospectively for a 5-year period through computerized medical records at three primary healthcare centres in Sweden. Documentation of diagnosis, healthcare visits, treatments, investigations, medications, referrals, laboratory tests, mental and demographic data were retrieved from the records.

    Results

    Of all 723 irritable bowel syndrome patients identified, only 37% had a follow-up appointment to their General Practitioner during the study period. For 80%, the General Practitioner initiated some treatment during the initial consultation and 75% were prescribed medication. Fibre and bulking laxatives and acid-suppressive drugs were the most common medication. Almost a quarter was referred for complementary investigations at hospital, only 8.9% of the irritable bowel syndrome patients were referred to a specialist investigation. Laboratory investigations varied and were ordered more frequently (P = 0.05) for men.

    Conclusions

    Irritable bowel syndrome patients appear not to be heavy utilizers of primary care and, of those who attend, the majority are managed by their General Practitioner.

  • 6.
    Faresjö (Olsen), Åshild
    et al.
    Linköping University, Department of Medicine and Health Sciences, Primary Care . Linköping University, Faculty of Health Sciences.
    Grodzinsky, Ewa
    Linköping University, Department of Medicine and Health Sciences, Primary Care . Linköping University, Faculty of Health Sciences.
    Johansson, Saga
    Cardiovascular Institute, University of Gothenburg, Gothenburg, Sweden.
    Wallander, Mari-Ann
    Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden.
    Foldevi, Mats
    Linköping University, Department of Medicine and Health Sciences, Primary Care . Linköping University, Faculty of Health Sciences.
    Patients with irritable bowel syndrome in Swedish primary care2006In: European Journal of General Practice, ISSN 1381-4788, Vol. 12, no 2, p. 88-90Article in journal (Refereed)
  • 7.
    Foldevi, Mats
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Implementation and evaluation of problem-based learning in general practice.1995Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The Faculty of Health Sciences, Linköping, Sweden, started the reformedmedical curriculum in 1986. Problem-based Learning as an educational method was introduced into the entire curriculum. It was a response to requests for community-orientation by increasing the involvement of general practice. A new extensive communication skills training - the 'Strand', a new form of examination- 'phase examination', and recurrent clerkships in general practice in the clinical phase were also introduced. The medical cuniculum, with its focus on general practice, together with these innovations are presented in a case report of its implementation and development.

    The similarities between quality assurance and problem-based learning, as processes and methods, are also identified, described and discussed.

    Two of the innovations where general practice is a main contributor, namely, the clerkships in general practice and the phase examination 1 and 2 have been evaluated. Of the 115 students, in semester six to nine in the autumn of 1992, 74% filled in the clerkship evaluation questionnaire. The overall rating was very positive. Regression analysis of the rated variables showed that the quality of the tutoring was the strongest determinator of the overall rating. No decline in the students' ratings in the latter semesters was found.

    A qualitative study was made on all free comments made by the same study group in the same questionnaires. This study identified an area not covered in the quantitative evaluation, the important elements of the student-tutor relationship.

    The 'phase examinations' have been found to be a valid assessment ofcommunication skills, integrative knowledge and the search for scientificinformation. The use of general practitioners as assessors has strengthened the role of general practice in the curriculum.

  • 8.
    Foldevi, Mats
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland.
    Gunnarsson, K
    Viktigt att ta medicinen rätt2003In: Hälsotecken, p. 12-15Article in journal (Other (popular science, discussion, etc.))
  • 9.
    Hansson, Anders
    et al.
    University of Gothenburg.
    Foldevi, Mats
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.
    Mattsson, Bengt
    University of Gothenburg.
    Medical students attitudes toward collaboration between doctors and nurses - a comparison between two Swedish universities2010In: JOURNAL OF INTERPROFESSIONAL CARE, ISSN 1356-1820, Vol. 24, no 3, p. 242-250Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate differences in attitudes towards collaboration between doctors and nurses among medical students in two medical schools Gothenburg University (GU), which did not offer interprofessional education, and Linkoping University (LiU), with a curriculum containing an interprofessional education programme; between male and female students; and between those with previous working experience in medical care and those without. A questionnaire, the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration, was distributed to 314 first year and final year students at GU and LiU 261 (82%) answers were received. There was no significant difference in attitudes toward collaboration, between first students at GU and LiU, between final year students at the two universities; and between those who had or did not have earlier experience of working in health care. There was a significant difference between male and female students (p = 0.0017) implying a more positive attitude among female students. Females were in majority among final year students (females 80 and males 46) final year, yet, students at both universities did not show a more positive attitude towards collaboration, than did first year students. It was concluded that students who had an interprofessional thread within their medical curriculum did not show different attitudes towards collaboration. The impact of the interprofessional teaching and training programme is discussed and further, especially longitudinal, studies are advocated.andlt;/.

  • 10.
    Johansson, Kajsa
    et al.
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Adolfsson, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Foldevi, Mats
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.
    Attitudes toward management of patients with subacromial pain in Swedish primary care1999In: Family Practice, ISSN 0263-2136, Vol. 16, no 3, p. 233-237Article in journal (Refereed)
    Abstract [en]

    Objective. We aimed to describe the attitudes among GPs and physiotherapists toward the diagnostic approach and management of patients with a common shoulder disorder.

    Method. A questionnaire was sent out to 188 GPs and 71 physiotherapists. The total response rate was 71.8%. The questions were based on a written case simulation with cues about history and symptoms.

    Results. The results showed a unanimous opinion of the diagnosis. Rotator cuff tendinitis was marked as the most probable. The two groups showed similarities in the way that they would examine the patient. The GPs referred the patients to the physiotherapists significantly more often than the other way around. The most probable choice of treatment made by the GPs was non-steroidal anti-inflammatory drugs (NSAIDs) and by the physiotherapists, movement exercises together with ergonomics. Most treatment alternatives had at least 20% of the responders marking a neutral attitude, and few treatments were disregarded.

    Conclusions. We conclude that in Swedish primary care GPs and physiotherapists have a uniform diagnostic approach towards patients with subacromial pain, but their choice of treatment reflects an uncertainty about the effectiveness of conservative treatments. The questioned pathogenesis of the suggested diagnosis and lack of research regarding the efficacy of conservative treatments could explain this uncertainty.

  • 11.
    Johansson, Kajsa
    et al.
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Adolfsson, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences.
    Foldevi, Mats
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Effects of acupuncture versus ultrasound for patients with impingement syndrome: Randomized clinical trial2005In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 85, no 6, p. 490-501Article in journal (Refereed)
    Abstract [en]

    Background and Purpose. There is no definitive evidence for the efficacy of the physical therapy interventions used for patients with impingement syndrome. The purpose of this study was to compare manual acupuncture and continuous ultrasound, both applied in addition to home exercises, for patients diagnosed with impingement syndrome.

    Subjects and Methods. Eighty-five patients with clinical signs of impingement syndrome were randomly assigned to either a group that received acupuncture (n=44) or a group that received ultrasound (n=41). Both interventions were given by physical therapists twice a week for 5 weeks in addition to a home exercise program. Scores from 3 shoulder disability measures, combined in the analysis, measured change during a period of 12 months.

    Results. Both groups improved, but the acupuncture group had a larger improvement in the combined score.

    Discussion and Conclusion. The results suggest that acupuncture is more efficacious than ultrasound when applied in addition to home exercises.

  • 12.
    Johansson, Kajsa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland.
    Adolfsson, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Foldevi, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland.
    "Effects of Acupuncture Versus Ultrasound in Patients With Impingement Syndrome: A Randomized Clinical Trial" comment and author reply2006In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 86, p. 143-145Article in journal (Other academic)
  • 13.
    Johansson, Kajsa
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Bergström, Anna
    Östergötlands Läns Landsting.
    Schröder, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Physiotherapy. Östergötlands Läns Landsting.
    Foldevi, Mats
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Primary Health Care Centres.
    Subacromial corticosteroid injection or acupuncture with home exercises when treating patients with subacromial impingement in primary care-a randomized clinical trial2011In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 28, no 4, p. 355-365Article in journal (Refereed)
    Abstract [en]

    bjective. To compare the efficacy of subacromial corticosteroids injected by a GP with physiotherapy combining acupuncture and home exercises as treatments for SIS. less thanbrgreater than less thanbrgreater thanMethods. A randomized clinical trial was performed in primary health care. Patients diagnosed with SIS were randomized to either subacromial corticosteroid injection (s) or 10 acupuncture treatments combined with home- exercises. The main outcomes were pain and shoulder function (Adolfsson-Lysholm shoulder assessment score). Secondary outcomes were health-related quality of life (HRQL) (EuroQol-five dimension self-report questionnaire) and the patients global assessment of change. All patients were assessed at baseline and after 6 weeks and 3, 6 and 12 months. less thanbrgreater than less thanbrgreater thanResults. One hundred and seventeen patients with SIS were included, of which 91 complied with the study protocol. There were no significant differences between treatments with regard to pain, shoulder function and HRQL in change over time. However, both treatment groups improved significantly from baseline over time. less thanbrgreater than less thanbrgreater thanConclusions. Both subacromial corticosteroid injection and a series of acupuncture treatments combined with home exercises significantly decreased pain and improved shoulder function in patients with SIS, but neither treatment was significantly superior to the other.

  • 14.
    Johansson, Kajsa
    et al.
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Adolfsson, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Foldevi, Mats
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.
    A combination of systematic review and clinicians’ beliefs in interventions for subacromial pain2002In: British Journal of General Practice, ISSN 0960-1643, Vol. 52, no 475, p. 145-152Article in journal (Refereed)
    Abstract [en]

    The aim of the study is to determine which treatments for patients with subacromial pain are trusted by general practitioners (GPs) and physiotherapists, and to compare trusted treatments with evidence from a systematic critical review of the scientific literature. A two-step process was used: a questionnaire (written case simulation) and a systematic critical review. The questionnaire was mailed to 18 GPs and 71 physiotherapists in Sweden. The total response rate was 72% (186/259). The following treatments were trusted: ergonomics/adjustments at work, corticosteroids, non-steroidal anti-inflamatory drugs, movement exercises, acupuncture, ultrasound therapy, strengthening exercises, stretching, transcutaneous electric nerve stimulation, and superficial heat or ice therapy. The review, including efficacy studies for the treatments found to be trusted, was conducted using the CINAHL, EMBASE and MEDLINE databases. Evidence for efficacy was recorded in relation to methodological quality and to diagnostic criteria that labelled participants as having subacromial pain or a non-specific shoulder disorder. Forty studies were included. The methodological quality varied and only one treatment had definitive evidence for efficacy for non-specific patients, namely injection of corticosteroids. The trust in corticosteroids, injected in the subacromial bursa, was supported by definitive evidence for short-term efficacy. Acupuncture had tentative evidence for short-term efficacy in patients with subacromial pain. Ultrasound therapy was ineffective for subacromial pain. This is supported by tentative evidence and, together with earlier reviews, this questions both the trust in the treatment and its use. The clinicians' trust in treatments had a weak association with available scientific evidence.

  • 15.
    Kohli, Sunil
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Sahlén, K.
    Linköping University, Faculty of Health Sciences.
    Löfman, Owe
    Linköping University, Faculty of Health Sciences.
    Sivertun, Åke
    Linköping University, Faculty of Health Sciences.
    Foldevi, Mats
    Linköping University, Department of Department of Health and Society, General Practice. 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.
    Wigertz, Ove
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Individuals living in areas with high background radon: a GIS method to identify populations at risk1997In: Computer Methods and Programs in Biomedicine, ISSN 0169-2607, E-ISSN 1872-7565, Vol. 53, no 2, p. 105-112Article in journal (Refereed)
    Abstract [en]

    Objective: to identify and link populations and individuals that live within high risk areas. Design: census registers and disease registers which contain data on individuals can only give aggregate statistics relating to postal code districts, town, county or state boundaries. However environmental risk factors rarely, if ever, respect these man-made boundaries. What is needed is a method to rapidly identify individuals who may live within a described area or region and to further identify the disease(s) occurring among these individuals and/or in these areas. Method: this paper describes a method for linking the standard registers available in Sweden, notably the residence-property addresses they contain and the geographical coordinate setting of these, to map the population as a point coverage. Using standard GIS methods this coverage could be linked, merged or intersected with any other map to create new subsets of population. Representation of populations down to the individual level by automatised spatialisation of available census data is in its simplicity a new informatics method which in the designated GIS medium adds a new power of resolution. Results: we demonstrate this using the radon maps provided by the local communes. The Swedish annual population registration records of 1991 for the county ofÖstergötland and the property register available at the Central Statistical Bureau of Sweden formed the main data sources. By coupling the address in the population register to the property register each individual was mapped to the centroid of a property. By intersecting the population coverage with the radon maps, the population living in high, normal or low risk areas was identified and then analysed and stratified by commune, sex and age. The resulting tables can be linked to other databases, e.g. disease registers, to visualise and analyse geographical and related patterns. The methodology can be adapted for use with any other environmental map or small area. It can also be expanded to the fourth dimension by linking likewise available migration information to generate immediately coordinate-set, accumulated exposition and similar data.

  • 16.
    Kristinasson, I
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics.
    Ardel, B
    Steinar, J
    Sigurdsson, J A
    Foldevi, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Björkstén, B
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics.
    Health needs assessment in general practice: the Cretan approach.1999In: European Journal of General Practice, ISSN 1381-4788, E-ISSN 1751-1402, Vol. 5, p. 75-77Article in journal (Refereed)
  • 17. Kristjansson, I
    et al.
    Ardal, B
    onsson, JS
    Sigurdsson, JA
    Foldevi, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Björkstén, B
    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.
    Adverse reactions to food and food allergy in young children in Iceland and Sweden.  1999In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 17, p. 30-34Article in journal (Refereed)
  • 18.
    Lagerström, Folke
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Bader, M
    Varberga VC .
    Fredlund, H
    Örebro .
    Nordin-Olsson, I
    Varberga VC .
    Holmberg, H
    Örebro .
    Foldevi, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Microbiological etiology in clinically diagnosed community-acquired pneumonia in primary care in ╓rebro Sweden2003In: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 9, no 7, p. 645-652Article in journal (Refereed)
    Abstract [en]

    Objective. To study the etiology of clinically diagnosed community-acquired pneumonia (CAP) in antibiotically naive patients attending a primary care center and treated at their homes. Methods. A three-year prospective study was carried out, and 177 patients presenting with clinical signs of CAP were included. All patients had chest X-rays after inclusion, and 82 (46%) showed infiltrates. Nasopharyngeal swab culture was performed on all patients, and 51% produced a representative sputum sample. Paired sera were obtained from 176 patients. Results. Among the 82 patients with radiographically proven CAP, Streptococcus pneumoniae was detected in 26 patients (32%), Haemophilus influenzae in 23 (28%), Mycoplasma pneumoniae in 15 (18%), and Chlamydia pneumoniae in four (5%). Serologic evidence of a viral infection was found in 13 patients (16%). Among the 95 patients without infiltrates, S. pneumoniae was found in 21 (22%), H. influenzae in 14 (15%), M. pneumoniae in two (2%), and C. pneumoniae in five (5%). Viral infection was detected in 19 (20%) of these 95 patients. Conclusion. In primary care in Sweden, the initial antibiotic treatment in any patient with pneumonia should be effective against S. pneumonia and H. influenzae. In addition, M. pneumoniae should be targeted during recurrent epidemics. C. pneumoniae, and especially Legionella, seem to be uncommon in primary care.

  • 19.
    Lööf-Johansson, Margareta
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Foldevi, Mats
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care in Central County.
    Rudebeck, Carl-Edvard
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Breastfeeding as a Specific Value in Womens Lives: The Experiences and Decisions of Breastfeeding Women2013In: Breastfeeding Medicine, ISSN 1556-8253, E-ISSN 1556-8342, Vol. 8, no 1, p. 38-44Article in journal (Refereed)
    Abstract [en]

    Background: Worldwide, breastfeeding is recommended for every woman who gives birth to a child. The propensity to breastfeed varies. There is considerable knowledge about the experiences and circumstances that affect the decision to breastfeed, but knowledge about what actually generates the decision's force still needs to be increased. The aim of this study was to gain knowledge of how the decision to breastfeed is initiated and upheld.

    Subjects and Methods: Eighteen women from three generations were interviewed, and the data were analyzed by qualitative content analysis.

    Results: Six categories were revealed: “Task,” “Instinct,” “Silent Impact,” “Conflicts,” “Job,” and “Joy.” The women took on the Task of breastfeeding during pregnancy. The will to breastfeed was also recognized as an Instinct. The older women remained more in the background, exerting a Silent Impact. Parents' agreement that mothers remain at home and breastfeed for the first 6 months could be considered disturbing from a gender equality perspective. Competition arose between spouses, which could lead to Conflicts at weaning. The mothers in the study chose to stay home to do the Job and experience the Joy of breastfeeding.

    Conclusions: A summarizing theme was the specific life value of breastfeeding, encompassing feelings of coherence, pleasure, and pride, regardless of generation affiliation. As the favorable interplay of biological, sensual, relational, and social elements this value upheld the decision to breastfeed. It compensated for the effort and negative experiences, and as a finding, it appears to be transferable among breastfeeding mothers in other developed countries.

  • 20.
    Waller, John
    et al.
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Eriksson, Olle
    Linköping University, Department of Mathematics. Linköping University, The Institute of Technology.
    Foldevi, Mats
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Grahn Kronhed, Ann-Charlotte
    Linköping University, Department of health and environment. Linköping University, Faculty of Health Sciences.
    Larsson, Lasse
    Linköping University, Department of Biomedicine and Surgery. Linköping University, Faculty of Health Sciences.
    Löfman, Owe
    Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences. Linköping University, Faculty of Health Sciences.
    Toss, Göran
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Möller, Margareta
    Linköping University, Department of Neuroscience and Locomotion. Linköping University, Faculty of Health Sciences.
    Knowledge of osteoporosis in a Swedish municipality: a prospective study2002In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 34, no 4, p. 485-491Article in journal (Refereed)
    Abstract [en]

    Background. As a part of the Vadstena Osteoporosis Prevention Project, the knowledge of osteoporosis was examined before the intervention program started, after 5 and 10 years.

    Methods. At baseline (in 1989) 15% of the population in two Swedish municipalities was randomly invited to the study. The participants in the study group were invited for examination by forearm bone densitometry and a questionnaire concerning lifestyle and risk factors for osteoporosis and also knowledge of osteoporosis, while the subjects in the control group were examined only by questionnaire. Follow-ups were made in 1994 and in 1999. Meanwhile education about osteoporosis was given to the study group, to the public, and to various professionals in the study community.

    Results. There was a difference in the level of knowledge between the groups prior to the intervention. The rate of increment did not differ significantly between the groups for the study period. Previous participants had 0.58 higher score than new participants in the study group in 1994 (P = 0.031) and 0.76 higher score in 1999 (P < 0.001) regarding the total number of correct answers. The women in the study group had 0.63 higher score than the men in 1994 (P = 0.016) and 1.03 higher score in 1999 (P < 0.001) regarding the total number of correct answers.

    Conclusion. There was no significant effect of a general intervention program concerning the knowledge of osteoporosis in participants in the intervention area compared to the control area.

  • 21.
    Wilhelmsson, Susan
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Foldevi, Mats
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Åkerlind, Ingemar
    Linköping University, Department of health and environment. Linköping University, Faculty of Health Sciences.
    The personal doctor reform in Sweden: perceived changes in working conditions1998In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 15, no 3, p. 192-197Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In primary care in Sweden, several organizational changes have been implemented during the last decades in order to facilitate a shift from a high proportion of hospital care to a more primary-health-based care. The personal doctor reform has been one of the most important during recent years, for both personnel and patients.

    OBJECTIVES: We aimed to compare perceived changes in psychosocial working conditions for GP and district nurses in regions with traditional primary care and regions that have implemented a personal doctor system.

    METHODS: A questionnaire was mailed to 566 GPs and 554 district nurses in four selected county councils, two with traditional primary care and two with a personal doctor system. The overall response rate was 83%. A factor analysis of data concerning the experience of the organizational change revealed the following factors: fellowship at work, demands on the individual, influence and control, competence development and stimulation at work.

    RESULTS AND CONCLUSIONS: In the group as a whole, there was a general experience of deterioration of working conditions in all aspects except stimulation at work. This tendency was mostly marked in the regions with a personal doctor system. In these regions, GPs and district nurses reported significantly more impairments concerning demands on the individual and competence development. In addition, the district nurses also found themselves less able to exercise influence and control. These changes are neither desirable nor necessary consequences of an organizational development. It is important to follow continuously the personnel's experience in a changing primary health care system.

  • 22.
    Wilhelmsson, Susan
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Foldevi, Mats
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Exploring views on Swedish district nurses' prescribing: a focus group study in primary health care2003In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 12, no 5, p. 643-650Article in journal (Refereed)
    Abstract [en]

    • Since 1994 district nurses (DNs) in Sweden have been permitted to prescribe drugs from a limited list. This reform has met severe resistance from doctors and the opinions of general practitioners (GPs) and DNs have differed in many aspects.

    •  The aim of this study was to gain deeper understanding of the different opinions about DNs' prescribing and to explore the impact of the reform on primary care.

    • Six focus group interviews were conducted, four with DNs and two with GPs.

    •  Data analysis revealed six categories, which were condensed into two dimensions. The dimensions were individual prerequisites, with the categories responsibility and knowledge, and organizational prerequisites, with the categories distribution of work, climate of co-operation, resistance and economic considerations.

    •  District nurses were very positive towards prescribing and had gained new knowledge through the compulsory training course and via discussions with pharmacists. Because of the responsibility required for prescribing, some nurses had introduced systems for self-monitoring. Prescribing was seen as a natural part of the nursing process. All interviewees could describe periods of resistance against the reform, and the head of the health centre was a key person for attitudes at the workplace.

    • The DNs found the nurse prescribing reform very positive. They experienced a strengthening of professionalism and also thought that the reform was a natural development. Negative attitudes and opinions offset the positive feelings. The resistance that had appeared in the beginning had now turned into silent acceptance.

  • 23.
    Wilhelmsson, Susan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Foldevi, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Åkerlind, Ingemar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, National Centre for Work and Rehabilitation.
    Faresjö, T
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV), Science in Nursing.
    Unfavourable working conditions for female GPs. A comparison between Swedish general practitiners and district nurses2002In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 20, p. 74-78Article in journal (Refereed)
  • 24.
    Wilhelmsson, Susan
    et al.
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Foldevi, Mats
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Åkerlind, Ingemar
    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.
    Faresjö, Tomas
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Unfavourable Working Conditions for Female GPs: A Comparison between Swedish General Practitioners and District NursesManuscript (preprint) (Other academic)
    Abstract [en]

    Objective: The aim of this study was to investigate gender and occupational differences in the psychosocial work environment among general practitioners (GPs) and district nurses (DNs) in Sweden.

    Design: A stratified random sample of general practitioners (n = 566) and district nurses (n= 554) from four county councils in Sweden was selected. The overall participation rate was 83%. A mailed questionnaire including ten items of demographic and work sites characteristics, and 36 items of psychosocial working conditions was used. The questionnaire had been tested concerning validity and reliability. A factor analysis gave five factors: strains and symptoms, professional content, social support at work, workload, and job control.

    Results: In total, professional content was the most positively experienced aspect whereas workload was the most negatively. The GPs perceived a higher workload and fewer opportunities to social support at work compared with the DNs. The female GPs scored significantly more unfavourable than both male GPs and female DNs did in four out of the five factors. The female GPs reported a high workload, low job control and fewer opportunities to social support at work. The female DNs also reported a high workload, relatively low job control but a rather strong social support at work.

    Conclusion: Female GPs perceive more unfavourable psychosocial working conditions compared with both male GPs and female DNs in the same organisational setting.

  • 25.
    Ólafsdóttir, María
    et al.
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Foldevi, Mats
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Marcusson, Jan
    Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Linköping University, Faculty of Health Sciences.
    Dementia in Primary Care: Why the Low Detection Rate?2001In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 19, no 3, p. 194-198Article in journal (Refereed)
    Abstract [en]

    Objective - The aim of the present study was to find reasons for the low detection rate of dementia in primary care. Another aim was to investigate the attitudes and knowledge on dementia among Swedish general practitioners (GPs).

    Design - Two-hundred-and-twenty-eight postal questionnaires were distributed to GPs in the county of Östergötland. Setting - Primary care in Sweden.

    Main outcome measures - The opinions of GPs on dementia management in primary care.

    Results - The response rate was 67%. GPs showed a good knowledge of dementia diseases but underestimated the occurrence of dementia. They presented a positive attitude towards managing patients with dementia and considered that existing drug therapy justified an active search for patients with dementia in primary care, but they believed the efficacy of the drugs to be limited. Assessing the social environment of patients and organising social support were regarded as the most difficult tasks in the management of demented patients.

    Conclusion - The study indicates that the main obstacles are a lack of resources and a sceptical attitude to the benefits of drug treatment. Co-operation between the community services, specialist clinics and the primary care team should be improved.

  • 26.
    Ólafsdóttir, María
    et al.
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Ragnardóttir, Bertha
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Marcusson, Jan
    Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Linköping University, Faculty of Health Sciences.
    Foldevi, Mats
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Skoog, Ingemar
    Institute of Clinical Neuroscience, Department of Psychiatry, Sahlgrenska University Hospital, Göteborg University.
    Mini-Mental State Examination: A Tool for Detecting Dementia in Primary Care?Manuscript (preprint) (Other academic)
    Abstract [en]

    The Mini-mental State Examination (MMSE) is the most widely used test for cognitive function, but its usefulness as a screening tool for dementia has been debated. We investigated the ciiterion validity of the MMSE in patients, aged 70 years and above, attending a piimary care centre (PPC). The MMSE was administered (N=1225) and compared with further diagnosing of dementia according to DSM-III-R in a subgroup (N=350). The major finding was that the use of the traditional cut-off score of 23/24 points on MMSE, left more than 70% of mild cases and 30% of moderate cases undetected. When using a cut-off score of 26/27 a good criterion validity was found and an excellent agreement between the testing by the social worker at the PCC and the general practitioner in the patient's home. As the major problem in the dementia management has been under-detection, we recommend MMSE as an opportunistic screening test in PCC population.

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