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  • 201.
    Kalkan, Almina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Hallert, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Bernfort, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Husberg, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Costs of rheumatoid arthritis during the period 1990–2010: a register-based cost-of-illness study in Sweden2014Ingår i: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, Vol. 53, nr 1, s. 153-160Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives. The objectives of this study were to analyse the total socio-economic impact of RA in Sweden during the period 1990–2010 and to analyse possible changes in costs during this period. The period was deliberately chosen to cover 10 years before and 10 years after the introduction of biologic drugs.

    Methods. A prevalence-based cost-of-illness study was conducted based on data from national and regional registries.

    Results. There was a decrease in the utilization of RA-related inpatient care as well as sick leave and disability pension during 1990–2010 in Sweden. Total costs for RA are presented in current prices as well as inflation-adjusted with the consumer price index (CPI) and a healthcare price index. The total fixed cost of RA was €454 million in 1990, adjusted to the price level of 2010 with the CPI. This cost increased to €600 million in 2010 and the increase was mainly due to the substantially increasing costs for pharmaceuticals. Of the total costs, drug costs increased from 3% to 33% between 1990 and 2010. Consequently the portion of total costs accounting for indirect costs for RA is lowered from 75% in 1990 to 58% in 2010.

    Conclusion. By inflation adjusting with the CPI, which is reasonable from a societal perspective, there was a 32% increase in the total fixed cost of RA between 1990 and 2010. This suggests that decreased hospitalization and indirect costs have not fallen enough to offset the increasing cost of drug treatment.

  • 202.
    Kalkan, Almina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Hallert, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Roback, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Sjöwall, Christopher
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Individual variations in treatment decisions by Swedish rheumatologists regarding biological drugs for rheumatoid arthritis2015Ingår i: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, nr 4, s. 265-270Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: In Sweden, reports indicate surprisingly large regional variation in prescription of biological drugs, despite a growing number of clinical studies describing their beneficial effects and guidelines by professional organizations and agencies. Our objective was to ascertain whether there is also variation between individual rheumatologists in prescribing biologics to patients with rheumatoid arthritis (RA) and to evaluate reasons for treatment choices.

    Methods: Ten hypothetical patient cases were constructed and presented to 26 rheumatologists in five regions in Sweden. The cases were based on actual cases and were thoroughly elaborated by a senior rheumatologist and pre-tested in a pilot study. The respondents were asked whether they would treat the patients with a biological agent (YES/NO) and to explain their decisions.

    Results: The response rate was 26/105; 25%. Treatment choices varied considerably between the rheumatologists, some prescribing biologics to 9/10 patients and others to 2/10. In five of the ten hypothetical cases, approximately half of the respondents would prescribe biologics. No regions with particularly high or low prescription were identified. Both the decision to prescribe biologics, as well as not to prescribe, were mainly motivated by medical reasons. Some rheumatologists also referred to lifestyle-related factors or social function of the patient.

    Conclusion: The choice of initiation of biologics varied substantially among rheumatologists presented with hypothetical patient cases, and there were also disparities between rheumatologists practising at the same clinic. Treatment choices were primarily motivated by medical reasons. This situation raises concerns about a lack of consensus in RA treatment strategies.

  • 203.
    Kalkan, Almina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Husberg, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Hallert, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Roback, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Thyberg, Ingrid
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Skogh, Thomas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Physician Preferences and Variations in Prescription of Biologic Drugs for Rheumatoid Arthritis: A Register-Based Study of 4,010 Patients in Sweden2015Ingår i: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 67, nr 12, s. 1679-1685Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. The prescription of biologic drugs for rheumatoid arthritis (RA) patients has varied considerably across different regions. Previous studies have shown physician preferences to be an important determinant in the decision to select biologic disease-modifying antirheumatic drugs (bDMARDs) rather than nonbiologic, synthetic DMARDs (sDMARDs) alone. The aim of this study was to test the hypothesis that physician preferences are an important determinant for prescribing bDMARDs for RA patients in Sweden. Methods. Using data from the Swedish Rheumatology Quality Register, we identified 4,010 RA patients who were not prescribed bDMARDs during the period 2008-2012, but who, on at least 1 occasion, had an sDMARD prescription and changed treatment for the first time to either a new sDMARD or a bDMARD. Physician preference for the use of bDMARDs was calculated using data on each physicians prescriptions during the study period. The relationship between prescription of a bDMARD and physician preference, controlling for patient characteristics, disease activity, and the physicians local context was evaluated using multivariate logistic regression. Results. When adjusting for patient characteristics, disease activity, and the physicians local context, physician preference was an important predictor for prescription of bDMARDs. Compared with patients of a physician in the lowest preference tertile, patients of physicians in the highest and middle tertiles had an odds ratio for receiving bDMARDs of 2.8 (95% confidence interval [95% CI] 2.13-3.68) and 1.28 (95% CI 1.05-1.57), respectively. Conclusion. Physician preference is an important determinant for prescribing bDMARDs.

  • 204.
    Kalkan, Almina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Roback, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Hallert, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Factors influencing rheumatologists prescription of biological treatment in rheumatoid arthritis: an interview study2014Ingår i: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 9, nr 153Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The introduction of biological drugs involved a fundamental change in the treatment of rheumatoid arthritis (RA). The extent to which biological drugs are prescribed to RA patients in different regions in Sweden varies greatly. Previous research has indicated that differences in health care practice at the regional level might obscure differences at the individual level. The objective of this study is to explore what influences individual rheumatologists decisions when prescribing biological drugs. Method: Semi-structured interviews, utilizing closed-and open-ended questions, were conducted with senior rheumatologists, selected through a mix of random and purposive sampling. The interview questions consisted of two parts, with a "parallel mixed method" approach. In the first and main part, open-ended exploratory questions were posed about factors influencing prescription. In the second part, the rheumatologists were asked to rate predefined factors that might influence their prescription decisions. The Consolidated Framework for Implementation Research (CFIR) was used as a conceptual framework for data collection and analysis. Results: Twenty-six rheumatologists were interviewed. A constellation of various factors and their interaction influenced rheumatologists prescribing decisions, including the individual rheumatologists experiences and perceptions of the evidence, the structure of the department including responsibility for costs, peer pressure, political and administrative influences, and participation in clinical trials. The patient as an actor emerged as an important factor. Hence, factors both at organizational and individual levels influenced the prescribing of biological drugs. The factors should not be seen as individual influences but were described as influencing prescription in an interactive, nonlinear way. Conclusions: Potential factors explaining differences in prescription practice are experience and perception of the evidence on the individual level and the structure of the department and participation in clinical trials on the organizational level. The influence of patient attitudes and preferences and interpretation of scientific evidence seemed to be somewhat contradictory in the qualitative responses as compared to the quantitative rating, and this needs further exploration. An implication of the present study is that in addition to scientific knowledge, attempts to influence prescription behavior need to be multifactorial and account for interactions of factors between different actors.

  • 205.
    Kalkan, Almina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Sandberg, Johanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Garpenby, Peter
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Management by Knowledge in Practice: Implementation of National Healthcare Guidelines in Sweden2015Ingår i: Social Policy & Administration, ISSN 0144-5596, E-ISSN 1467-9515, Vol. 49, nr 7, s. 911-927Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In the last ten years, the concept of management by knowledge has gained growing attention inSwedish healthcare, as well as internationally. In Sweden, the most prominent example ofmanagement by knowledge is the National Guidelines, aimed at influencing both clinical andpolitical decision-making in the health sector. The objective of this article is to explore the response among four Swedish county councils to the National Guidelines for Cardiac Care (NGCC). Empirical material was collected through 155 expert interviews with the target groups of the NGCC, politicians, administrators and clinical managers. Analysis of the responses to this multifaceted policy instrument was addressed by drawing on implementation theory (Matland 1995) and institutional theory (Oliver 1991). The NGCC are primarily based on the voluntary diffusion of norms. The county councils are a long way from having adapted all the means suggested by the National Board of Health and Welfare (NBHW): explicit prioritization, healthcare programmes and dialogue between the various actor groups. The high degree of ambiguity in the content of the NGCC, the inherent conflict and the multiplicity and uncertainty in the context of the county councils, have often resulted in avoidance and compromise. The strategic responses we observe can be viewed as an attempt to balance multiple constituents and achieve the various internal organizational goals. The ambiguity and conflict inherent in the policy of the NGCC influence the strategic responses made by the organization. The question remains how far management by knowledge can be applied in a political context.

  • 206.
    Kastenbom, Lisa
    et al.
    Umea Univ, Sweden.
    Falsen, Alexandra
    Umea Univ, Sweden.
    Larsson, Pernilla
    Region Östergötland, Folktandvården. Malmo Univ, Sweden;.
    Sunnegardh-Gronberg, Karin
    Umea Univ, Sweden.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Costs and health-related quality of life in relation to caries2019Ingår i: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 19, nr 1, artikel-id 187Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Dental caries remains a common and expensive disease for both society and affected individuals. Furthermore, caries often affect individuals health-related quality of life (HRQoL). Health economic evaluations are needed to understand how to efficiently distribute dental care resources. This study aims to evaluate treatment costs and QALY weights for caries active and inactive adult individuals, and to test whether the generic instrument EQ-5D-5 L can distinguish differences in this population. Methods A total of 1200 randomly selected individuals from dental clinics in Vasterbotten County, Sweden, were invited to participate. Of these, 79 caries active and 179 caries inactive patients agreed to participate (response rate of 21.7%). Inclusion criteria were participants between 20 and 65 years old and same caries risk group categorization in two consecutive check-ups between 2014 and 2017. Results Treatment costs showed to be twice as high in the caries active group compared to the caries inactive group and were three times higher in the caries active age group 20-29 compared to the caries inactive age group 20-29. Differences between the groups was found for number of intact teeth according to age groups. In the EQ-5D-5 L instrument, more problems relating to the dimension anxiety/depression was seen in the caries active group. QALY weights showed tendencies (non-significant) to be lower in the caries active group. Conclusions These findings highlight the need for efficient treatments and prevention strategies as well as adequate money allocation within dentistry. However, further research is needed to assess appropriate instruments for health economic evaluations.

  • 207.
    Kileng, H.
    et al.
    UiT Arctic University of Norway, Norway; University Hospital North Norway, Norway.
    Bernfort, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Gutteberg, T.
    UiT Arctic University of Norway, Norway; University Hospital North Norway, Norway.
    Moen, O. S.
    UiT Arctic University of Norway, Norway.
    Kristiansen, M. G.
    Nordland Hospital, Norway.
    Paulssen, E. J.
    UiT Arctic University of Norway, Norway; University Hospital North Norway, Norway.
    Berg, L. K.
    Helgeland Hospital, Norway.
    Florholmen, J.
    UiT Arctic University of Norway, Norway; University Hospital North Norway, Norway.
    Goll, R.
    UiT Arctic University of Norway, Norway; University Hospital North Norway, Norway.
    Future complications of chronic hepatitis C in a low-risk area: projections from the hepatitis c study in Northern Norway2017Ingår i: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 17, artikel-id 624Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Hepatitis C (HCV) infection causes an asymptomatic chronic hepatitis in most affected individuals, which often remains undetected until cirrhosis and cirrhosis-related complications occur. Screening of high-risk subjects in Northern Norway has revealed a relatively low prevalence in the general population (0.24%). Despite this, late complications of HCV infection are increasing. Our object was to estimate the future prevalence and complications of chronic HCV infection in the period 2013-2050 in a low-risk area. Methods: We have entered available data into a prognostic Markov model to project future complications to HCV infection. Results: The model extrapolates the prevalence in the present cohort of HCV-infected individuals, and assumes a stable low incidence in the projection period. We predict an almost three-fold increase in the incidence of cirrhosis (68 per 100,000), of decompensated cirrhosis (21 per 100,000) and of hepatocellular carcinoma (4 per 100,000) by 2050, as well as a six-fold increase in the cumulated number of deaths from HCV-related liver disease (170 per 100,000 inhabitants). All estimates are made assuming an unchanged treatment coverage of approximately 15%. The estimated numbers can be reduced by approximately 50% for cirrhosis, and by approximately one third for the other endpoints if treatment coverage is raised to 50%. Conclusion: These projections from a low-prevalence area indicate a substantial rise in HCV-related morbidity and mortality in the coming years. The global HCV epidemic is of great concern and increased treatment coverage is necessary to reduce the burden of the disease.

  • 208.
    Kip, Michelle M. A.
    et al.
    Univ Twente, Netherlands.
    IJzerman, Maarten J.
    Univ Twente, Netherlands.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Merlin, Tracy
    Univ Adelaide, Australia.
    Weinstein, Milton C.
    Harvard TH Chan Sch Publ Hlth, MA USA.
    Phelps, Charles E.
    Univ Rochester, NY USA.
    Kusters, Ron
    Univ Twente, Netherlands; Jeroen Bosch Ziekenhuis, Netherlands.
    Koffijberg, Hendrik
    Univ Twente, Netherlands.
    Toward Alignment in the Reporting of Economic Evaluations of Diagnostic Tests and Biomarkers: The AGREEDT Checklist2018Ingår i: Medical decision making, ISSN 0272-989X, E-ISSN 1552-681X, Vol. 38, nr 7, s. 778-788Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives. General frameworks for conducting and reporting health economic evaluations are available but not specific enough to cover the intricacies of the evaluation of diagnostic tests and biomarkers. Such evaluations are typically complex and model-based because tests primarily affect health outcomes indirectly and real-world data on health outcomes are often lacking. Moreover, not all aspects relevant to the evaluation of a diagnostic test may be known and explicitly considered for inclusion in the evaluation, leading to a loss of transparency and replicability. To address this challenge, this study aims to develop a comprehensive reporting checklist. Methods. This study consisted of 3 main steps: 1) the development of an initial checklist based on a scoping review, 2) review and critical appraisal of the initial checklist by 4 independent experts, and 3) development of a final checklist. Each item from the checklist is illustrated using an example from previous research. Results. The scoping review followed by critical review by the 4 experts resulted in a checklist containing 44 items, which ideally should be considered for inclusion in a model-based health economic evaluation. The extent to which these items were included or discussed in the studies identified in the scoping review varied substantially, with 14 items not being mentioned in 47 (75%) of the included studies. Conclusions. The reporting checklist developed in this study may contribute to improved transparency and completeness of model-based health economic evaluations of diagnostic tests and biomarkers. Use of this checklist is therefore encouraged to enhance the interpretation, comparability, andindirectlythe validity of the results of such evaluations.

  • 209.
    Klompstra, Leonie
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Ekdahl, Anne W.
    Lund Univ, Sweden.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Milberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i östra Östergötland, LAH i Norrköping.
    Eckerblad, Jeanette
    Karolinska Inst, Sweden.
    Factors related to health-related quality of life in older people with multimorbidity and high health care consumption over a two-year period2019Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, artikel-id 187Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundThe prevalence of multimorbidity is increasing worldwide, and older people with multimorbidity are frequent users of health care services. Since multimorbidity has a significant negative impact on Health-related Quality of Life (HrQoL) and is more common in older age it would be expected that factors related to HrQoL in this group might have been thoroughly researched, but this is not the case. Furthermore, it is important to look at old people living at home, considering the shift from residential to home-based care. Therefore, we aim to investigate factors that are related to HrQoL in older people with multimorbidity and high health care consumption, living at home.MethodsThis is a secondary analysis of a RCT study conducted in a municipality in south-eastern Sweden. The study had a longitudinal design with a two-year follow-up period assessing HrQoL, symptom burden, activities of daily living, physical activity and depression.ResultsIn total, 238 older people with multimorbidity and high health care consumption, living at home were included (mean age 82, 52% female). A multiple linear regression model including symptom burden, activities of daily living and depression as independent variables explained 64% of the HrQoL. Higher symptom burden, lower ability in activities of daily living and a higher degree of depression were negatively related to HrQoL. Depression at baseline and a change in symptom burden over a two-year period explained 28% of the change in HrQoL over a two-year period variability. A higher degree of depression at baseline and negative change in higher symptom burden were related to a decrease in HrQoL over a two-year period.ConclusionIn order to facilitate better delivery of appropriate health care to older people with high health care consumption living at home it is important to assess HrQoL, and HrQoL over time. Symptom burden, activities of daily living, depression and change in symptom burden over time are important indicators for HrQoL.Trial registrationClinicaltrials.gov identifier: NCT01446757, the trial was registered prospectively with the date of trial registration October 5(th), 2011.

  • 210.
    Koppel, Lina
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Centrum för social och affektiv neurovetenskap. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Nationalekonomi. Linköpings universitet, Filosofiska fakulteten.
    Andersson, David
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Nationalekonomi. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Centrum för social och affektiv neurovetenskap. Linköpings universitet, Medicinska fakulteten.
    Morrison, India
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Centrum för social och affektiv neurovetenskap. Linköpings universitet, Medicinska fakulteten.
    Västfjäll, Daniel
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Centrum för social och affektiv neurovetenskap. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Nationalekonomi. Decis Research, OR USA.
    Tinghög, Gustav
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Nationalekonomi. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Centrum för social och affektiv neurovetenskap. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    The (Null) Effect of Affective Touch on Betrayal Aversion, Altruism, and Risk Taking2017Ingår i: Frontiers in Behavioral Neuroscience, ISSN 1662-5153, E-ISSN 1662-5153, Vol. 11, artikel-id 251Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Pleasant touch is thought to increase the release of oxytocin. Oxytocin, in turn, has been extensively studied with regards to its effects on trust and prosocial behavior, but results remain inconsistent. The purpose of this study was to investigate the effect of touch on economic decision making. Participants (n = 120) were stroked on their left arm using a soft brush (touch condition) or not at all (control condition; varied within subjects), while they performed a series of decision tasks assessing betrayal aversion (the Betrayal Aversion Elicitation Task), altruism (donating money to a charitable organization), and risk taking (the Balloon Analog Risk Task). We found no significant effect of touch on any of the outcome measures, neither within nor between subjects. Furthermore, effects were not moderated by gender or attachment. However, attachment avoidance had a significant effect on altruism in that those who were high in avoidance donated less money. Our findings contribute to the understanding of affective touch-and, by extension, oxytocin-in social behavior, and decision making by showing that touch does not directly influence performance in tasks involving risk and prosocial decisions. Specifically, our work casts further doubt on the validity of oxytocin research in humans.

  • 211.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Patienter, hälso- och sjukvårdens främsta angelägenhet: Från objekt till aktör2016Ingår i: Perspektiv på utvärdering, prioritering, implementering och hälsoekonomi: En hyllningsskrift till Per Carlsson / [ed] Martin Henriksson, Linköping: Linköping University Electronic Press, 2016, s. 55-61Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 212.
    Krevers, Barbro
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Broqvist, Mari
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Bäckman, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Frågor till medborgare om öppenhet, prioriteringsprocess och beslutsfattare avseende prioritering och ransonering: En artikelöversikt2015Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Vårt syfte med denna rapport är att öka kunskapen om vad medborgare tillfrågats om i forskningsstudier avseende prioritering och ransonering inom hälso- och sjukvård. Avsikten är också att belysa studiernas syfte och tillvägagångssätt för att genom det få information om i vilken grad det finns tillförlitlig, överförbar och generaliserbar kunskap om vad medborgare tänker, anser och vill i dessa frågor. En sådan översikt kan visa på eventuella kunskapsluckor och därigenom belysa behov av framtida studier.

    Vi utgick från en metod för översiktsstudier och utvecklade sökord, granskningsstruktur och inklusions- och exklusionskriterier. I sökningen användes en kombination av sökord i tre databaser för internationella vetenskapliga tidskrifter. I granskning av artiklarna kategoriserades de utifrån vad medborgare hade blivit tillfrågad om, åtta frågeområden kunde identifieras.

    Denna rapport bygger på ett delresultat och omfattar artiklar inom tre frågeområden: öppenhet, prioriteringsprocesser och beslutsfattare. Av dem handlar fyra studier om öppenhet, tre om prioriteringsprocessen och nitton om beslutsfattare. De kommer från nio olika länder, varav de flesta från Europa, och är publicerade från 1993 till 2013. Studierna baseras på både kvalitativ och kvantitativa metoder av olika slag.

    Sammantaget gav vår artikelöversikt relativt få artiklar inom de tre frågeområden som ingår i rapporten och det finns även en del metodbrister i dessa studier t.ex. i urval och frågornas precisering. Det råder därmed osäkerhet om vad medborgare tänker, anser och vill när det gäller öppenhet, prioriteringsprocesser och beslutsfattare. Några exempel på kunskapsbrister som vår artikelöversikt pekar på är att kunskapen om svenska medborgares syn på dessa tre frågeområden är bristfällig och kunskap om hur medborgarnas åsikter förändras över tid saknas. Det råder även brist på kunskap om det finns skillnader mellan medborgare från olika länder inklusive Sverige, och deras syn på dessa tre frågeområden om prioritering och ransonering samt om deras syn skiljer sig åt i relation till välfärdssystem, demokratiska system, auktoritetskultur, grad av tillit, trygghet, etc.

    Andra kunskapsbrister gäller vilka faktorer som kan ha betydelse för medborgares syn när det gäller dessa tre frågeområden samt vad sådana faktorer i så fall skulle få för konsekvenser t.ex. för hur frågor ska ställas till medborgare, hur beslut beskrivs, hur beslutsprocesser ska gå till och öppenheten kring beslut.

    Det saknas även kunskap om involvering av medborgare verkligen leder till det som ofta framhålls som motiv för att involvera dem t.ex. bättre beslut, ökad legitimitet i beslut och större acceptans och tillit hos medborgare och/eller att de uppskattar detta som en demokratisk handling. Det saknas också kunskap om och problematisering av hur medborgares åsikter ska vägas mot andra gruppers synpunkter t.ex. i relation till politiker som är utsedda genom demokratiska val.

    Dessa kunskapsbrister kan vara utgångspunkter för framtida intressanta och viktiga studier där medborgare tillfrågas om hur de ser på öppenhet,prioriteringsprocesser och beslutsfattare. Det kan ge betydelsefull kunskap om vilken roll medborgare och andra aktörer kan och bör ha i relation till prioritering och ransonering, vilka aktiviteter som bör genomföras och vilka konsekvenser det kan ge.

  • 213.
    Krevers, Barbro
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Bäckman, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Development of systematic prioritizations between different welfare sectors - and get it running2016Konferensbidrag (Övrigt vetenskapligt)
  • 214.
    Krevers, Barbro
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Milberg, Anna
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, LAH Öst. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Palliativt kompetenscentrum.
    The instrument Sense of Security in Care - Patients Evaluation: its development and presentation2014Ingår i: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 23, nr 8, s. 914-920Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    ObjectiveThe aim of this paper is to report the development, construction, and psychometric properties of the new instrument Sense of Security in Care - Patients Evaluation (SEC-P) in palliative home care. MethodsThe preliminary instrument was based on a review of the literature and an analysis of qualitative interviews with patients about their sense of security. To test the instrument, 161 patients (58% women) in palliative home care were recruited and participated in a structured interview based on a comprehensive questionnaire (response rate 73%). We used principal component analysis to identify subscales and tested the construction in correlation with other scales and questions representing concepts that we expected to be related to sense of security in care. ResultsThe principal component analysis resulted in three subscales: Care Interaction, Identity, and Mastery, built on a total of 15 items. The component solution had an explained variance of 55%. Internal consistency of the subscales ranged from 0.84 to 0.69. Inter-scale correlations varied between 0.40 and 0.59. The scales were associated to varying degrees with the quality of the care process, perceived health, quality of life, stress, and general sense of security. ConclusionsThe developed SEC-P provides a three-component assessment of palliative home care settings using valid and reliable scales. The scales were associated with other concepts in ways that were expected. The SEC-P is a manageable means of assessment that can be used to improve quality of care and in research focusing on patients sense of security in care.

  • 215.
    Krevers, Barbro
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Milberg, Anna
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Region Östergötland, Närsjukvården i östra Östergötland, Palliativt kompetenscentrum. Region Östergötland, Närsjukvården i östra Östergötland, LAH Öst.
    The sense of security in care-relatives' evaluation instrument: its development and presentation.2015Ingår i: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 49, nr 3, s. 586-94Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    CONTEXT: Relatives' sense of security in their family members' palliative home care is important, and a valid and reliable instrument is needed to measure this.

    OBJECTIVES: The aim of this article is to report the development, structure, and psychometric properties of a new instrument, the Sense of Security in Care-Relatives' Evaluation (SEC-R), in palliative home care.

    METHODS: Instrument development was based on a previous study and review of the literature; 213 relatives (55% women) of patients in palliative home care were recruited (response rate 73%) and participated in a structured interview based on a questionnaire. Principal component analysis (PCA) was used to identify subscales. The construction was tested in correlation with other scales and questions representing concepts expected to be related to sense of security in care.

    RESULTS: The PCA resulted in three subscales, namely care interaction, mastery and patient situation, which had an explained variance of 53%. Internal consistency of the subscales ranged from 0.76 to 0.78. The final instrument comprises 17 items. The scales were associated with the quality-of-care process and the relatives' situation, perceived health, quality of life, stress, general sense of security, and general sense of security in care.

    CONCLUSION: The SEC-R provides a three-component assessment of palliative home care settings using valid and reliable scales associated with other concepts. The SEC-R is a manageable means of assessment that may contribute to quality-of-care measures and to further research on relatives' sense of security in care.

  • 216.
    Kvarven, Amanda
    et al.
    University of Bergen.
    Strömland, Eirik
    Bergen University.
    Wollbrant, Conny
    Stirling University.
    David, Andersson
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Nationalekonomi.
    Magnus, Johannesson
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Nationalekonomi. Stockholm School of economics .
    Tinghög, Gustav
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Nationalekonomi. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys.
    Västfjäll, Daniel
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Nationalekonomi. Decision Research .
    Myrseth, Kristian
    Trinity College Dublin .
    The Intuitive Cooperation Hypothesis Revisited: A Meta-analytic Examination of Effect-size and Between-study HeterogeneityManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    The hypothesis that intuition promotes cooperation has attracted considerable attention. We address the question with a meta-analysis of 82 cooperation experiments, spanning four different types of intuition manipulations—time pressure, cognitive load, depletion, and induction—including 29,087 participants in total. To our knowledge, this is the largest and most comprehensive data set to date. We obtain a positive overall effect of intuition on cooperation, though substantially weaker than that reported in prior meta-analyses, and between studies the effect exhibits a substantial degree of systematic variation. We find that this overall effect depends exclusively on the inclusion of six experiments featuring emotion-induction manipulations, which prompt participants to rely on emotion over reason when making allocation decisions. Upon excluding from the total data set experiments featuring this class of manipulations, between-study variation in the meta-analysis is reduced substantially—and we observed no statistically discernable effect of intuition on cooperation.

  • 217.
    Landén Ludvigsson, Maria
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Rehab Väst.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Peterson, Gunnel
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Uppsala University, Sweden.
    Dedering, Åsa
    Karolinska University Hospital, Sweden; Karolinska Institute, Sweden.
    Johansson, Gun
    Karolinska Institute, Sweden.
    Bernfort, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Cost-effectiveness of neck-specific exercise with or without a behavioral approach versus physical activity prescription in the treatment of chronic whiplash-associated disorders Analyses of a randomized clinical trial2017Ingår i: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, nr 25, artikel-id e7274Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Fifty percent of people injured by whiplash still report neck pain after 1 year and costs associated with whiplash associated disorders (WAD) are mostly attributed to health service and sick-leave costs in chronic conditions. With increasing health care expenditures the economic impact of interventions needs to be considered. Objective: To analyze the cost-effectiveness of physiotherapist-led neck-specific exercise without (NSE) or with a behavioral approach (NSEB), or prescription of physical activity (PPA) in chronic WAD, grade 2 to 3. Methods: This is a secondary cost-effectiveness analysis of a multicenter randomized clinical trial of 216 participants with chronic WAD grade 2 to 3. The interventions were physiotherapist-led neck-specific exercise without or with a behavioral approach, or prescription of physical activity for 12 weeks. Incremental cost-effectiveness ratios (ICERs) were determined after 1 year and bootstrapped cost-effectiveness planes and sensitivity analyses of physiotherapy visits were performed. Health care and production loss costs were included and quality-adjusted life years (QALYs) were estimated, using the Euroqol-5D questionnaire. Comparisons with the Short Form-6D, and neck disability index (NDI) were also made. Results: The 1-year follow-up was completed by 170 participants (79%). Both physiotherapist-led groups improved in health related quality of life. The intervention cost alone, per quality-adjusted life year (QALY) gain in the NSE group was US$12,067. A trend for higher QALY gains were observed in the NSEB group but the costs were also higher. The ICERs varied depending on questionnaire used, but the addition of a behavioral approach to neck-specific exercise alone was not cost-effective from a societal perspective (ICER primary outcome $127,800 [95% confidence interval [CI], 37,816-711,302]). The sensitivity analyses confirmed the results. The prescription of physical activity did not result in any QALY gain and the societal costs were not lower. Conclusion: Neck-specific exercise was cost-effective from a societal perspective in the treatment of chronic WAD compared with the other exercise interventions. ICERS varied depending on health-related quality of life questionnaires used, but the addition of a behavioral approach was not cost-effective from a societal perspective. The prescription of physical activity did not result in any QALY gain and was thus not considered a relevant option.

  • 218.
    Larsson, Britt
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Gerdle, Björn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Bernfort, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Dragioti, Elena
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Distinctive subgroups derived by cluster analysis based on pain and psychological symptoms in Swedish older adults with chronic pain - a population study (PainS65+)2017Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, artikel-id 200Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Improved knowledge based on clinical features of chronic pain in older adults would be valuable in terms of patient-orientated approaches and would provide support for health care systems in optimizing health care resources. This study identifies subgroups based on pain and psychological symptoms among Swedish older adults in the general population and compares derived subgroups with respect to socio-demographics, health aspects, and health care costs. Methods: This cross-sectional study uses data collected from four registers and one survey. The total sample comprised 2415 individuals amp;gt;= 65 years old. A two-step cluster analysis was performed. Data on pain intensity, number of pain sites, anxiety, depression, and pain catastrophizing were used as classification variables. Differences in socio-demographics, quality of life, general health, insomnia, and health care costs among the clusters were investigated. Association of the clusters with the above parameters was further evaluated using multinomial logistic regression. Results: Four major clusters were identified: Subgroup 1 (n = 325; 15%) - moderate pain and high psychological symptoms; Subgroup 2 (n = 516; 22%) - high pain and moderate psychological symptoms; Subgroup 3 (n = 686; 30%) - low pain and moderate psychological symptoms; and Subgroup 4 (n = 767; 33%) - low pain and low psychological symptoms. Significant differences were found between the four clusters with regard to age, sex, educational level, family status, quality of life, general health, insomnia, and health care costs. The multinomial logistic regression analysis revealed that Subgroups 1 and 2, compared to Subgroup 4, were significantly associated with decreased quality of life, decreased general health, and increased insomnia. Subgroup 3, compared to Subgroup 4, was associated with decreased general health and increased insomnia. In addition, compared to Subgroup 4, Subgroups 1 and 2 were significantly associated with higher health care costs. Conclusions: Two high risk clusters of older adults suffering from chronic pain; one mainly based on psychological symptoms and one mainly on pain intensity and pain spread, associated with decreased quality of life and health and increased health care costs were identified. Our findings indicate that subgroup-specific treatment will improve pain management and reduce health care costs.

  • 219.
    Lee, Dawn
    et al.
    BresMed, England.
    Kildegaard Nielsen, Sandy
    BresMed, England.
    van Keep, Marjolijn
    BresMed, Netherlands.
    Andersson, Fredrik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet. Ferring Int PharmaScience Centre, Denmark.
    Greene, Damien
    Sunderland Royal Hospital, England.
    Quality of Life Improvement in Patients Treated with Degarelix versus Leuprorelin for Advanced Prostate Cancer2015Ingår i: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 193, nr 3, s. 839-846Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: We used responses to questionnaires included in the CS21 degarelix trial and published mapping algorithms to address the paucity of evidence for health related quality of life in patients with advanced hormone dependent prostate cancer treated with degarelix. Materials and Methods: We measured health related quality of life in 610 patients enrolled in the CS21 trial using SF-12 (R) and EORTC QLQ-C30. Based on responses to these questionnaires we estimated patient utility using 4 published mapping algorithms. Utility was tested for relationships with aspects of the symptom and side effect burden that may be affected by degarelix treatment, that is prostate specific antigen progression and adverse events. Results: Average utility in patients without prostate specific antigen progression or an adverse event was 0.742, similar to previously published utilities for nonprogressed prostate cancer states. Prostate specific antigen progression was associated with a utility decrement of between 0.062 and 0.134 depending on the mapping algorithm used. Of adverse events considered in our analysis musculoskeletal events were associated with the greatest effects on patient utility with a decrement of between 0.029 and 0.086. The 4 mapping algorithms generated similar utility estimates, although values derived from SF-12 were consistently lower than those derived from EORTC QLQ-C30. Conclusions: Prostate specific antigen progression status and the incidence of treatment and disease related adverse events result in significant decrements to patient health related quality of life. By slowing prostate specific antigen progression degarelix may improve patient utility and the health related quality of life burden.

  • 220.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Vad är det som gör hälsoekonomiska utvärderingar av diagnostiska metoder så utmanande men samtidigt så spännande?2016Ingår i: Perspektiv på utvärdering, prioritering, implementering och hälsoekonomi: En hyllningsskrift till Per Carlsson / [ed] Martin Henriksson, Linköping: Linköping University Electronic Press, 2016, s. 62-67Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 221.
    Levin, Lars-Åke
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Husberg, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Sobocinski, Piotr Doliwa
    Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
    Kull, Viveka Frykman
    Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
    Friberg, Leif
    Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
    Rosenqvist, Mårten
    Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke.2015Ingår i: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, nr 2, s. 207-14Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: The purpose of this study was to estimate the cost-effectiveness of two screening methods for detection of silent AF, intermittent electrocardiogram (ECG) recordings using a handheld recording device, at regular time intervals for 30 days, and short-term 24 h continuous Holter ECG, in comparison with a no-screening alternative in 75-year-old patients with a recent ischaemic stroke.

    METHODS AND RESULTS: The long-term (20-year) costs and effects of all alternatives were estimated with a decision analytic model combining the result of a clinical study and epidemiological data from Sweden. The structure of a cost-effectiveness analysis was used in this study. The short-term decision tree model analysed the screening procedure until the onset of anticoagulant treatment. The second part of the decision model followed a Markov design, simulating the patients' health states for 20 years. Continuous 24 h ECG recording was inferior to intermittent ECG in terms of cost-effectiveness, due to both lower sensitivity and higher costs. The base-case analysis compared intermittent ECG screening with no screening of patients with recent stroke. The implementation of the screening programme on 1000 patients resulted over a 20-year period in 11 avoided strokes and the gain of 29 life-years, or 23 quality-adjusted life years, and cost savings of €55 400.

    CONCLUSION: Screening of silent AF by intermittent ECG recordings in patients with a recent ischaemic stroke is a cost-effective use of health care resources saving costs and lives and improving the quality of life.

  • 222.
    Levin, Lars-Åke
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Wallentin, Lars
    Uppsala University, Sweden .
    Bernfort, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Andersson, David
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet.
    Storey, Robert F.
    University of Sheffield, England .
    Bergstrom, Gina
    AstraZeneca RandD, Sweden .
    Lamm, Carl-Johan
    AstraZeneca RandD, Sweden .
    Janzon, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Kaul, Padma
    University of Alberta, Canada .
    Health-Related Quality of Life of Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes-Results from the PLATO Trial2013Ingår i: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 16, nr 4, s. 574-580Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The purpose of this study was to compare the effects of ticagrelor versus clopidogrel on health-related quality of life in the PLATelet inhibition and patient Outcomes (PLATO) trial. Background: The PLATO trial showed that ticagrelor was superior to clopidogrel for the prevention of cardiovascular death, myocardial infarction, or stroke in a broad population of patients with acute coronary syndromes. Methods: HRQOL in the PLATO study was measured at hospital discharge, 6-month visit, and end of treatment (anticipated at 12 months) by using the EuroQol five-dimensional (EQ-5D) questionnaire. All patients who had an EQ-5D questionnaire assessment at discharge from the index hospitalization (n = 15,212) were included in the study. Patients who died prior to the end-of-treatment visit were assigned an EQ-5D questionnaire value of 0. Results: The EQ-5D questionnaire value at discharge among 7631 patients assigned to ticagrelor was 0.847 and among 7581 patients assigned to clopidogrel was 0.846 (P = 0.71). At 12 months, the mean EQ-5D questionnaire value was 0.840 for ticagrelor and 0.832 for clopidogrel (P = 0.046). Excluding patients who died resulted in mean EQ-5D questionnaire values of 0.864 among ticagrelor patients and 0.863 among clopidogrel patients (P = 0.69). Conclusions: In patients hospitalized with acute coronary syndromes with or without ST-segment elevation, treatment with ticagrelor was associated with a lower mortality but otherwise no difference in quality of life relative to treatment with clopidogrel. The improved survival and reduction in cardiovascular events with ticagrelor are therefore obtained with no loss in quality of life.

  • 223.
    Lind, Leili
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten. RISE SICS East.
    Wiréhn, Ann-Britt
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland. Region Östergötland.
    Carlgren, Gunnar
    Region Östergötland, Närsjukvården i centrala Östergötland, LAH Linköping.
    Mudra, Jacqueline
    Region Östergötland, Närsjukvården i centrala Östergötland, LAH Linköping.
    Synnergren, Henrik
    Region Östergötland, Närsjukvården i centrala Östergötland, LAH Linköping.
    Hilding, Niclas
    Region Östergötland, Närsjukvården i centrala Östergötland, LAH Linköping.
    Lyth, Johan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland. Region Östergötland.
    Karlsson, Daniel
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Persson, Hans Lennart
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Lungmedicinska kliniken US.
    Re-organising care of elderly, multi-morbid COPD and heartfailure patients with low digital literacy: —a 4 year Swedishtelehealth intervention study2016Ingår i: Health—exploring complexity: an interdisciplinary systems approach HEC2016 / [ed] Grill, E., Müller, M. & Mansmann, U., Munich, Germany, 2016, Vol. 31, s. 118-118Konferensbidrag (Refereegranskat)
  • 224.
    Lind, Therese
    et al.
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Nationalekonomi. Linköpings universitet, Filosofiska fakulteten.
    Erlandsson, Arvid
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Västfjäll, Daniel
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Decision Research, Eugene, OR, USA.
    Tinghög, Gustav
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Nationalekonomi. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Medicinska fakulteten.
    Motivated reasoning when assessing the effects of refugee intake2018Ingår i: Behavioural Public Policy, ISSN 2398-063XArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    Do differences in worldview ideology hinder people from objectively interpreting the effect of immigration? In an experiment with Swedish adults (n = 1015), we investigate whether people display motivated reasoning when interpreting numerical information about the effects of refugee intake on crime rate. Our results show clear evidence of motivated reasoning along the lines of worldview ideology (i.e., whether people identify themselves primarily as nationally oriented or globally oriented). In scenarios where refugee intake was associated with higher crime rate, nationally oriented people were 18 percentage points more likely to make the correct assessment compared to globally oriented people. Likewise, in scenarios where refugee intake was associated with lower crime rate, nationally oriented people were 20 percentage points less likely to make the correct assessment compared to globally oriented people. Individuals with higher numeric ability were less likely to engage in motivated reasoning, suggesting that motivated reasoning more commonly is driven by feelings and emotional cues rather than deliberate analytical processes.

  • 225.
    Lindh Åstrand, Lotta
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Hoffmann, Mikael
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Fredrikson, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Hammar, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Spetz Holm, Anna-Clara
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Use of hormone therapy (HT) among Swedish women with contraindications - A pharmacoepidemiological cohort study2019Ingår i: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 123, s. 55-60Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To assess how women in Sweden with breast cancer (BC), endometrial cancer (EC), and/or pulmonary embolism (PE) were dispensed menopausal hormone therapy (HT). Study design: A retrospective study of Swedish women aged 40 years or more on 31 December 2005 (n = 2,863,643), followed through to December 2011. The study analysed three mandatory national healthcare registries: the Swedish Prescribed Drug Register, the National Inpatient Register and the Cancer Register. New users were defined as having a first dispensation after at least a 9-month break, and thus were possible to identify from April 2006. New users with at least one of the diagnoses BC, EC or PE before the first dispensation were classified as having a relative or absolute contraindication for HT. Main outcome measures: The relative risks of having HT dispensed after being diagnosed with BC, EC and/or PE. Results: In total, 171,714 women had at least one of the diagnoses BC, EC or PE. The relative risk of having hormone therapy dispensed (current and new users) after being diagnosed with any of the diagnoses was significantly lower (PE, IRR 0.11, 95% CI 0.10-0.12;/ BC, IRR 0.12, 95% CI 0.11-0.13; EC, IRR 0.43, CI 0.40-0.46) than for women without these diagnoses. Conclusions: One in about 250 women started treatment with HT after being diagnosed with BC, PE or EC. Swedish prescribers seem to be well aware of the recommendations for HT use in women with contraindications. A few women, however, are prescribed HT despite having BC, EC or PE, possibly after careful evaluation of the risks and benefits and giving informed consent. Women with a history of PE were prescribed transdermal HT to a larger extent than women in general, in line with results from observational studies.

    Publikationen är tillgänglig i fulltext från 2020-02-23 16:02
  • 226.
    Lindholm, Daniel
    et al.
    AstraZeneca RandD, Sweden.
    Sarno, Giovanna
    Uppsala Univ, Sweden.
    Erlinge, David
    Lund Univ, Sweden.
    Svennblad, Bodil
    Uppsala Univ, Sweden.
    Hasvold, Lars Pal
    AstraZeneca, Sweden.
    Janzon, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Jernberg, Tomas
    Karolinska Inst, Sweden.
    James, Stefan K.
    Uppsala Univ, Sweden.
    Combined association of key risk factors on ischaemic outcomes and bleeding in patients with myocardial infarction2019Ingår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 105, nr 15, s. 1175-1181Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective In patients with myocardial infarction (MI), risk factors for bleeding and ischaemic events tend to overlap, but the combined effects of these factors have scarcely been studied in contemporary real-world settings. We aimed to assess the combined associations of established risk factors using nationwide registries. Methods Using the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry, patients with invasively managed MI in 2006-2014 were included. Six factors were assessed in relation to cardiovascular death (CVD)/MI/stroke, and major bleeding: age amp;gt;= 65, chronic kidney disease, diabetes, multivessel disease, prior bleeding and prior MI. Results We studied 100 879 patients, of whom 20 831 (20.6%) experienced CVD/MI/stroke and 5939 (5.9%) major bleeding, during 3.6 years median follow-up. In adjusted Cox models, all factors were associated with CVD/MI/stroke, and all but prior MI were associated with major bleeding. The majority (53.5%) had amp;gt;= 2 risk factors. With each added risk factor, there was a marked but gradual increase in incidence of the CVD/MI/stroke. This was seen also for major bleeding, but to a lesser extent, largely driven by prior bleeding as the strongest risk factor. Conclusions The majority of patients with MI had two or more established risk factors. Increasing number of risk factors was associated with higher rate of ischaemic events. When excluding patients with prior major bleeding, bleeding incidence rate increased only minimally with increasing number of risk factors. The high ischaemic risk in those with multiple risk factors highlights an unmet need for additional preventive measures.

  • 227.
    Lindholm, Lars
    et al.
    Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    Broqvist, Mari
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Waldau, Susanne
    Västerbottens läns landsting. Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    Att mäta hälsobehov, vårdbehov och patientnytta2013Ingår i: Att välja rättvist: om prioriteringar i hälso- och sjukvården / [ed] Per Carlsson och Susanne Waldau, Lund: Studentlitteratur, 2013, 1, s. 65-76Kapitel i bok, del av antologi (Övrigt vetenskapligt)
    Abstract [sv]

    Hälso- och sjukvårdens resurser räcker inte till alla behov och önskemål från patienter och medborgare, vilket gör att personal och beslutsfattare hamnar i svåra situationer. Hur ska vi veta att det är rätt patienter som tvingas stå tillbaka? Att välja rättvist tar upp centrala begrepp och etiska principer kring prioriteringar. Boken beskriver även metoder för att göra prioriteringar på ett systematiskt sätt och erfarenheter av såväl nationella som internationella prioriteringar.

    Prioriteringsbeslut fattas på alla nivåer och kan gälla fördelning av resurser till olika verksamheter, behandlingsbeslut av enskilda patienter eller investeringar i nya medicinska metoder. Boken ger förslag på hur beslutsunderlagen kan förbättras. Här ges anvisningar om hur man mäter behov och nytta hos patientgrupper och i befolkningen, hur kostnadseffektivitet beräknas och hur man skapar ett kunskapsunderlag. På så sätt får läsaren inte bara ta del av prioriteringarnas teori utan även av deras praktik, inte minst genom konkreta exempel på hur öppna prioriteringar i dag tillämpas i svensk hälso- och sjukvård.

    Att välja rättvist : prioriteringar i hälso- och sjukvården

  • 228.
    Lindh-Åstrand, Lotta
    et al.
    Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Hoffmann, Mikael
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. The NEPI foundation.
    Hammar, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping. Linköpings universitet, Medicinska fakulteten.
    Spetz, Anna-Clara
    Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Hot flushes, hormone therapy and alternative treatments: 30 years of experience from Sweden2015Ingår i: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 18, nr 1, s. 53-62Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives The use of hormone therapy (HT) for hot flushes has changed dramatically over the past five decades. In this cross-sectional questionnaire study, the aim was to describe the use of HT and alternative treatments and to study the frequency of hot flushes. A further aim was to compare data from the present questionnaire with data from previous studies made in the same geographic area. Method A questionnaire was sent to a random sample of 2000 women aged 47-56 years living in Ostergotland County, Sweden. The results were compared with findings from previous studies regarding use of HT, alternative treatment and hot flushes, and the number of HT prescriptions dispensed during the corresponding time using data derived from the Swedish Prescribed Drug Registry. Results The response rate was 66%. Six percent used HT, in line with prevalence data from the Swedish Prescribed Drug Registry. Alternative treatments were used by 10%. About 70% of postmenopausal women reported flushes and almost one-third of those with flushes stated that they would be positive to HT if therapy could be shown to be harmless, a view more often stated by women with severe complaints of hot flushes (67%). Conclusion The use of HT and alternative treatments is low and many women suffer from flushes that could be treated. Women considered their knowledge of the climacteric period and treatment options as insufficient. Individualized information should be given and women with significant climacteric complaints, without contraindications, should be given the opportunity to try HT.

  • 229.
    Lindh-Åstrand, Lotta
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Hoffmann, Mikael
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Järvstråt, Lotta
    Fredrikson, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Hälsouniversitetet.
    Hammar, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Spetz, Anna-Clara
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Hormone therapy might be underutilized in women with early menopause.2015Ingår i: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 30, nr 4, s. 848-852Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY QUESTION Are Swedish women age 40–44 years with assumed early menopause ‘undertreated’ by hormone therapy (HT)?

    SUMMARY ANSWER Many women with probable early menopause discontinue their HT after a short period of time. Thus, they fail to complete the recommended replacement up to age 51–52 years, the average age of menopause.

    WHAT IS KNOWN ALREADY Spontaneous early menopause occurs in ∼5% of women age 40–45 years. Regardless of the cause, women who experience hormonal menopause due to bilateral oophorectomy before the median age of spontaneous menopause are at increased risk of cardiovascular disease, neurological disease, osteoporosis, psychiatric illness and even death.

    STUDY DESIGN, SIZE, DURATION The study is descriptive, and epidemiological and was based on the use of national registers of dispensed drug prescriptions (HT) linking registers from the National Board of Health and Welfare and Statistics Sweden from 1 July 2005 until 31 December 2011.

    PARTICIPANTS/MATERIALS, SETTING, METHODS The study population consisted of 310 404 women, 40–44 years old on 31 December 2005 who were followed from 1 July 2005 until 31 December 2011.

    MAIN RESULTS AND THE ROLE OF CHANCE Only 0.9% of women 40–44 years old started HT during the study period. A majority of these women used HT <1 year.

    LIMITATIONS, REASONS FOR CAUTION We do not know the indications that led to the prescription of HT but assume that early onset of menopause was the main reason. Because of the study design—making a retrospective study of registers—we can only speculate on the reasons for most of the women in this group discontinuing HT. Another limitation of this study is that we have a rather short observation time. However, we have up to now only been able to collect and combine the data since July 2005.

    WIDER IMPLICATIONS OF THE FINDINGS As the occurrence of spontaneous early menopause in women age 40–45 is reported to be ∼5%, the fact that <1% of Swedish women age 40–44 are prescribed HT, and can be shown also to have had the medication dispensed at a pharmacy suggests an unexpectedly low treatment rate. Some women with early menopause may have used combined contraceptives as supplementation therapy, but in Sweden HT is the recommended treatment for early menopause so any such women are not following this recommendation. Women who experience early menopause are at increased risk for overall morbidity and mortality, and can expect to benefit from HT until they have reached at least the median age of spontaneous menopause. It is therefore important to individualize the information given these women and to convey new knowledge in this area to gynaecologists and physicians in general as well as the recommendation that women in this group continue HT at least until the average age for spontaneous menopause is reached.

  • 230.
    Lindroth, Katrin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Resolving health care's difficult choices: survey of priority setting in Sweden and an analysis of principles and guidelines on priorities in health care2008Rapport (Övrigt vetenskapligt)
    Abstract [en]

    This project report is the product of an extensive survey and analysis by Sweden’s National Centre for Priority Setting in Health Care. The project was commissioned by the National Board of Health and Welfare, which shall report to the Swedish Government on the priority setting activities of local governments (eg, county councils and municipalities) and assess how well they comply with the intent of Sweden’s Health and Medical Services Act and the Riksdag’s (Swedish parliament) resolutions on priority setting. We were also assigned to analyse problems in applying the guidelines on priority setting and to propose changes and clarification.

    The National Centre for Priority Setting in Health Care has been engaged in the complexities of prioritisation issues for many years. We welcomed the Government’s initiative and gladly accepted this assignment. Our ambition has been to describe the situation throughout Sweden from multiple perspectives. We reviewed the literature on studies and follow-ups related to the Riksdag’s guidelines. In studying the experiences of local governments in establishing healthcare priorities we focused on county council leaders, but complemented the study by interviewing representatives of major personnel categories. We also interviewed a smaller sample representing Swedish municipalities. Based on over 150 interviews, we describe current activities, plans for priority setting, and perceptions towards the current guidelines. Karin Bäckman served as coordinator for this part of the project. Other contributors from the National Centre for Priority Setting in Health Care included: Mari Broqvist, Per Carlsson, Peter Garpenby, Catrine Jacobsson, Per Johansson, Erling Karlsson, Sven Larsson, Karin Lund, Per-Erik Liss, and Ann-Charlotte Nedlund.

    In addition to the interview study, and under the leadership of Per-Erik Liss of the National Centre for Priority Setting in Health Care, we conducted an ethical analysis of principles and guidelines in priority setting. Anders Melin reviewed international ethical guidelines and principles in priority setting. A separate chapter presents a summary of this work. The ethical analysis also includes proposals for improvement, eg, reinterpretation and description of the ethical principles in the current platform, the addition of another ethical principle, and suggestions concerning the role of health services. Preliminary versions of the analysis were discussed at seminars with ethicists and individuals experienced in transparent priority setting and representing the National Board of Health and Welfare, the Pharmaceutical Benefits Board, the Swedish Association of Health Professionals, the Swedish Association of Registered Physiotherapists, the Swedish Federation of Occupational Therapists, and the Swedish Medical Association.

    Katrin Lindroth conducted literature reviews and edited the report. Elisabeth Furberg, Gustav Tinghög, Niklas Ekerstad, and Peter Wahlberg from the National Centre for Priority Setting in Health Care also contributed valuable perspectives. Appendix 3 presents the staff of the National Centre for Priority Setting in Health Care.

    Preliminary versions were discussed with the Board of Directors of the National Centre for Priority Setting in Health Care, who offered many constructive viewpoints.

    I would like to express my sincere appreciation to all who contributed valuable input and perspectives throughout the process. It is my hope that our collective effort will lead to improvement in regulations and work methods and will generate greater understanding for the importance of transparent priority setting in health care.

    Linköping, Sweden

    March 2007

    Professor Per Carlsson

    Director of the National Centre for Priority Setting in Health Care

  • 231.
    Ludvigsson, Mikael
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Medicinska och geriatriska akutkliniken.
    Bernfort, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Marcusson, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Medicinska och geriatriska akutkliniken.
    Wressle, Ewa
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Medicinska och geriatriska akutkliniken.
    Milberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i östra Östergötland, LAH i Norrköping.
    Direct Costs of Very Old Persons with Subsyndromal Depression: A 5-Year Prospective Study2018Ingår i: The American journal of geriatric psychiatry, ISSN 1064-7481, E-ISSN 1545-7214, Vol. 26, nr 7, s. 741-751Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives

    This study aimed to compare, over a 5-year period, the prospective direct healthcare costs and service utilization of persons with subsyndromal depression (SSD) and non-depressive persons (ND), in a population of very old persons. A second aim was to develop a model that predicts direct healthcare costs in very old persons with SSD.

    Design and Setting

    A prospective population-based study was undertaken on 85-year-old persons in Sweden.

    Measurements

    Depressiveness was screened with the Geriatric Depression Scale at baseline and at 1-year follow-up, and the results were classified into ND, SSD, and syndromal depression. Data on individual healthcare costs and service use from a 5-year period were derived from national database registers. Direct costs were compared between categories using Mann-Whitney U tests, and a prediction model was identified with linear regression.

    Results

    For persons with SSD, the direct healthcare costs per month of survival exceeded those of persons with ND by a ratio 1.45 (€634 versus €436), a difference that was significant even after controlling for somatic multimorbidity. The final regression model consisted of five independent variables predicting direct healthcare costs: male sex, activities of daily living functions, loneliness, presence of SSD, and somatic multimorbidity.

    Conclusions

    SSD among very old persons is associated with increased direct healthcare costs independently of somatic multimorbidity. The associations between SSD, somatic multimorbidity, and healthcare costs in the very old need to be analyzed further in order to better guide allocation of resources in health policy.

  • 232.
    Luedecke, Daniel
    et al.
    Univ Med Ctr Hamburg Eppendorf, Germany.
    Bien, Barbara
    Med Univ Bialystok, Poland.
    McKee, Kevin
    Dalarna Univ, Sweden.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Mestheneos, Elizabeth
    50 Hellas, Greece.
    Di Rose, Mirko
    Natl Inst Hlth and Sci Aging, Italy.
    von dem Knesebeckl, Olaf
    Univ Med Ctr Hamburg Eppendorf, Germany.
    Kofahl, Christopher
    Univ Med Ctr Hamburg Eppendorf, Germany.
    For better or worse: Factors predicting outcomes of family care of older people over a one-year period. A six-country European study2018Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, nr 4, artikel-id e0195294Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives Demographic change has led to an increase of older people in need of long-term care in nearly all European countries. Informal carers primarily provide the care and support needed by dependent people. The supply and willingness of individuals to act as carers are critical to sustain informal care resources as part of the home health care provision. This paper describes a longitudinal study of informal care in six European countries and reports analyses that determine those factors predicting the outcomes of family care over a one-year period. Methods Analyses are based on data from the EUROFAMCARE project, a longitudinal survey study of family carers of older people with baseline data collection in 2004 and follow-up data collection a year later in six European countries (Germany, Greece, Italy, Poland, Sweden, and the United Kingdom), N = 3,348. Descriptive statistics of the sample characteristics are reported. Binary logistic random-intercept regressions were computed, predicting the outcome of change of the care dyads status at follow-up. Results Where care is provided by a more distant family member or by a friend or neighbour, the care-recipient is significantly more likely to be cared for by someone else (OR 1.62) or to be in residential care (OR 3.37) after one year. The same holds true if the care-recipient has memory problems with a dementia diagnosis (OR 1.79/OR 1.84). Higher dependency (OR 1.22) and behavioural problems (OR 1.76) in the care-recipient also lead to a change of care dyad status. Country of residence explained a relatively small amount of variance (8%) in whether a care-recipient was cared for by someone else after one year, but explained a substantial amount of variance (52%) in whether a care-recipient was in residential care. Particularly in Sweden, care-recipients are much more likely to be cared for by another family or professional carer or to be in residential care, whereas in Greece the status of the care dyad is much less likely to change. Discussion The majority of family carers continued to provide care to their respective older relatives over a one-year period, despite often high levels of functional, cognitive and behavioural problems in the care-recipient. Those family carers could benefit most from appropriate support. The carer/care-recipient relationship plays an important role in whether or not a family care dyad remains intact over a one-year period. The support of health and social care services should be particularly targeted toward those care dyads where there is no partner or spouse acting as carer, or no extended family network that might absorb the caring role when required. Distant relatives, friends or acquaintances who are acting as carers might need substantial intervention if their caregiving role is to be maintained.

  • 233.
    Lund, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Prioriteringar i samverkan mellan kommun och landsting: erfarenheter av Socialstyrelsens arbete med nationella riktlinjer för vård och omsorg vid demenssjukdom2010Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Socialstyrelsens nationella riktlinjer för vård och omsorg vid demenssjukdom 2009 finns sedan augusti 2009 i en preliminär version. De är ett pionjärarbete på så sätt att de innehåller stöd för styrning och ledning både för hälso- och sjukvårdsåtgärder och sociala omsorgsinsatser. Metoden som Socialstyrelsen har använt för sitt arbete bygger på den arbetsmodell för öppna vertikala prioriteringar som Socialstyrelsen och PrioriteringsCentrum har tagit initiativ

    till. Modellen utgår från de grunder och principer för prioriteringar som finns i Hälso- och sjukvårdslagen. I riktlinjearbetet för vård och omsorg vid demenssjukdom har vissa modifieringar gjorts som ansetts vara nödvändiga med hänsyn till Socialtjänstlagens grundprinciper.

    Socialstyrelsen och PrioriteringsCentrum har beslutat att studera processen och resultatet genom deltagande i de två arbetsgrupper som gjort rangordningen av insatser för demenssjuka och genom intervjuer med dem som deltagit i arbetsgrupperna. Den ena arbetsgruppen prövade och rangordnade de medicinska åtgärder som ingår i vården av demenssjuka och som landstingen huvudsakligen har ansvar för. Den andra arbetsgruppen ansvarade på motsvarande sätt för de sociala omvårdnadsinsatser som ingår i kommunernas ansvar.

    Syftet med studien har varit att få svar på ett antal frågor:

    • Fungerar den nationella modellen för vertikala prioriteringar som utarbetats för hälso- och sjukvården tillfredsställande även för den kommunala omvårdnaden som ges till demenssjuka?

    • Är socialtjänstlagen ett hinder för öppna prioriteringar?

    • Finns det skillnader i att resonera kring rangordning av insatser/åtgärder mellan huvudsakligen medicinskt och huvudsakligen socialt skolade företrädare?

    • Hur kan en samordnad prioritering mellan medicinska åtgärder och sociala insatser se ut?

    Rapporten är i princip indelad i två avsnitt. Det första som utgörs av kapitel 1 till 3 är en bakgrund som beskriver landstingens och kommunernas arbete med prioriteringar inom vård och omsorg hittills, och redogör för den lagstiftning som styr hälso- och sjukvårdens och socialtjänstens arbete att göra prioriteringar. Det andra avsnittet som utgörs av kapitel 4 till 6 beskriver och analyserar den modell och det arbete som bedrivits av Socialstyrelsen för att ta fram de nationella riktlinjerna för vård och omsorg vid demenssjukdom. Utgångspunkt har varit den intervjuundersökning och de observationer som gjorts under arbetets gång.

  • 234.
    Lundberg, Kristina
    et al.
    Jonkoping Univ, Sweden; Univ Boras, Sweden.
    Kjellstrom, Sofia
    Jonkoping Univ, Sweden.
    Sandman, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Univ Boras, Sweden.
    Dual loyalties: Everyday ethical problems of registered nurses and physicians in combat zones2019Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 26, nr 2, s. 480-495Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: When healthcare personnel take part in military operations in combat zones, they experience ethical problems related to dual loyalties, that is, when they find themselves torn between expectations of doing caring and military tasks, respectively. Aim: This article aims to describe how Swedish healthcare personnel reason concerning everyday ethical problems related to dual loyalties between care and military tasks when undertaking healthcare in combat zones. Design: Abductive qualitative design. Participants and research context: Individual interviews with 15 registered nurses and physicians assigned for a military operation in Mali. Ethical considerations: The participants signed up voluntarily, and requirements for informed consent and confidentiality were met. The research was approved by the Regional Ethics Review Board in Gothenburg (D no. 816-14; 24 November 2014). Findings: Three main categories emerged: reasons for not undertaking combat duties, reasons for undertaking combat duties and restricted loyalty to military duties, and 14 subcategories. Reasons for not undertaking combat duties were that it was not in their role, not according to ethical codes or humanitarian law or a breach towards patients. Reasons for undertaking combat duties were that humanitarian law does not apply or has to be treated pragmatically or that it is a case of force protection. Shortage of resources and competence were reasons for both doing and not doing military tasks. Under some circumstances, they could imagine undertaking military tasks: when under threat, if unseen or if not needed for healthcare duties. Discussion/conclusion: These discrepant views suggest a lack of a common view on what is ethically acceptable or not, and therefore we suggest further normative discussion on how these everyday ethical problems should be interpreted in the light of humanitarian law and ethical codes of healthcare personnel and following this, further training in ethical reflection before going on military operations.

  • 235.
    Lundqvist, Martina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Alwin, Jenny
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Husberg, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Ekdahl, Anne W.
    Karolinska Inst, Sweden; Lund Univ, Sweden.
    Cost-effectiveness of comprehensive geriatric assessment at an ambulatory geriatric unit based on the AGe-FIT trial2018Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 18, artikel-id 32Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Older people with multi-morbidity are increasingly challenging for todays healthcare, and novel, cost-effective healthcare solutions are needed. The aim of this study was to assess the cost-effectiveness of comprehensive geriatric assessment (CGA) at an ambulatory geriatric unit for people amp;gt;= 75 years with multi-morbidity. Method: The primary outcome was the incremental cost-effectiveness ratio (ICER) comparing costs and quality-adjusted life years (QALYs) of a CGA strategy with usual care in a Swedish setting. Outcomes were estimated over a lifelong time horizon using decision-analytic modelling based on data from the randomized AGe-FIT trial. The analysis employed a public health care sector perspective. Costs and QALYs were discounted by 3% per annum and are reported in 2016 euros. Results: Compared with usual care CGA was associated with a per patient mean incremental cost of approximately 25,000 EUR and a gain of 0.54 QALYs resulting in an ICER of 46,000 EUR. The incremental costs were primarily caused by intervention costs and costs associated with increased survival, whereas the gain in QALYs was primarily a consequence of the fact that patients in the CGA group lived longer. Conclusion: CGA in an ambulatory setting for older people with multi-morbidity results in a cost per QALY of 46,000 EUR compared with usual care, a figure generally considered reasonable in a Swedish healthcare context. A rather simple reorganisation of care for older people with multi-morbidity may therefore cost effectively contribute to meet the needs of this complex patient population.

  • 236.
    Lundqvist, Martina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Sjödahl, Rune
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Theodorsson, Elvar
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk kemi.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Patient benefit of dog-assisted interventions in health care: a systematic review2017Ingår i: BMC Complementary and Alternative Medicine, ISSN 1472-6882, E-ISSN 1472-6882, Vol. 17, artikel-id 358Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Dogs are the most common companion animal, and therefore not surprisingly a popular choice for animal-assisted interventions. Dog-assisted interventions are increasingly used in healthcare. The aim of the review was to conduct a systematic literature review of quantitative studies on dog-assisted interventions in healthcare, with the intention of assessing the effects and cost-effectiveness of the interventions for different categories of patients. Methods: A systematic review of the scientific literature reporting results of studies in healthcare, nursing home or home care settings, was conducted. The inclusion criteria applied for this review were: quantitative studies, inclusion of at least 20 study subjects, existence of a control and performed in healthcare settings including nursing homes and home care. The electronic databases PubMed, AMED, CINAHL and Scopus were searched from their inception date through January 2017, for published articles from peer-reviewed journals with full text in English. Results: Eighteen studies that fulfilled the inclusion criteria, and were judged to be of at least moderate quality, were included in the analysis. Three of them showed no effect. Fifteen showed at least one significant positive effect but in most studied outcome measures there was no significant treatment effect. Dog-assisted therapy had the greatest potential in treatment of psychiatric disorders among both young and adult patients. Dog-assisted activities had some positive effects on health, wellbeing, depression and quality of life for patients with severe cognitive disorders. Dog-assisted support had positive effects on stress and mood. Conclusions: The overall assessment of the included studies indicates minor to moderate effects of dog-assisted therapy in psychiatric conditions, as well as for dog-assisted activities in cognitive disorders and for dog-assisted support in different types of medical interventions. However, the majority of studied outcome measures showed no significant effect.

  • 237.
    Lundqvist, Martina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Hälsoekonomisk analys av hemtandvård jämfört med tandvård på stationära kliniker för äldre vid särskilda boenden2013Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Förbättrade livsbetingelser, såsom social välfärd och folkhälsa, har medfört en ökad medellivslängd i Sverige. Äldre har med tiden kommit att utgöra en allt större andel av befolkningen. Stora satsningar på tandhälsovård har medfört att fler äldre har de flesta egna tänder i behåll i hög ålder. Tidigare utförda rehabiliterande tandvårdsåtgärder, som till exempel kronor, broar och implantat, kan komplicera munvården och därigenom påverka allmänhälsan, om förmågan till egenvård sviktar. Åldrandet innebär för många ökad sjuklighet och behov av ett flertal läkemedel. Såväl hälso- och sjukvårdskostnaderna, som  tandvårdskostnaderna förväntas öka kraftigt de närmaste 15-25 åren.

    Nuvarande ersättningssystem för tandvården medför att kostnadsökningen för de allra äldsta främst belastar landstingen. Landstingen ska enligt tandvårdslagen se till att uppsökande verksamhet och nödvändig tandvård erbjuds vissa äldre och funktionshindrade med omfattande omvårdnadsbehov. Dessa grupper ska erbjudas avgiftsfri munhälsobedömning och nödvändig tandvård enligt samma avgiftssystem som inom den öppna hälso- och sjukvården. Munhälsobedömning upphandlas av landstingets tandvårdsenhet. Nödvändig tandvård erbjuds utifrån behov och vårdtagaren har själv rätt att välja vårdgivare.

    Syftet med studien var att analysera och diskutera samhällsekonomiska konsekvenser av hemtandvård jämfört med tandvård på stationär klinik, vid nödvändig tandvård för äldre personer på särskilda boenden.

    Intervjuer har genomförts med personal på särskilda boenden, beställare av nödvändig tandvård samt sakkunniga forskare. För att belysa de ekonomiska aspekterna av de olika vårdformerna har kostnadsanalyser och kostnadseffektivitetsanalyser genomförts. Dessutom har ett flertal viktiga aspekter identifierats för att kartlägga marknaden för nödvändig tandvård utifrån ett bredare perspektiv. Marknaden för nödvändig tandvård har också analyserats med hänsyn till den asymmetriska information som råder mellan de olika aktörerna och respektive aktörs incitament att nyttomaximera.

    Analyserna visar att kostnaden för hemtandvård i medeltal är lägre än för tandvård vid stationär klinik vid utförande av nödvändig tandvård. Hemtandvård förväntas i genomsnitt vara positivt för de äldres livskvalitet, och är därmed kostnadseffektivt för den genomsnittlige patienten. Eftersom de äldres förutsättningar för tandvård varierar är det viktigt att olika vårdformer kan erbjudas. Kostnaden skiljer sig åt för de olika aktörerna, och det krävs ett samhällsekonomiskt perspektiv för att undvika suboptimering av resurser. Det krävs en bred och öppen samverkan mellan alla involverade aktörer för att få till en effektiv och ekonomiskt försvarbar tandvård av god kvalitet.

  • 238.
    Lundqvist, Martina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Ordell, Sven
    Region Östergötland, Folktandvården.
    Sjöstrom, O.
    Oral Care AB, Sweden.
    Zimmerman, M.
    Oral Care AB, Sweden.
    Sjogren, P.
    Oral Care AB, Sweden.
    Health economic analyses of domiciliary dental care and care at fixed clinics for elderly nursing home residents in Sweden2015Ingår i: Community Dental Health, ISSN 0265-539X, Vol. 32, nr 1, s. 39-43Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Dental care for elderly nursing home residents is traditionally provided at fixed dental clinics, but domiciliary dental care is an emerging alternative. Longer life expectancy accompanied with increased morbidity, and hospitalisation or dependence on the care of others will contribute to a risk for rapid deterioration of oral health so alternative methods for delivering oral health care to vulnerable individuals for whom access to fixed dental clinics is an obstacle should be considered. The aim was to analyse health economic consequences of domiciliary dental care for elderly nursing home residents in Sweden, compared to dentistry at a fixed clinic. Methods: A review of relevant literature was undertaken complemented by interviews with nursing home staff, officials at county councils, and academic experts in geriatric dentistry. Domiciliary dental care and fixed clinic care were compared in cost analyses and cost-effectiveness analyses. Results: The mean societal cost of domiciliary dental care for elderly nursing home residents was lower than dental care at a fixed clinic, and it was also considered cost-effective. Lower cost of dental care at a fixed dental clinic was only achieved in a scenario where dental care could not be completed in a domiciliary setting. Conclusions: Domiciliary dental care for elderly nursing home residents has a lower societal cost and is cost-effective compared to dental care at fixed clinics. To meet current and predicted need for oral health care in the ageing population alternative methods to deliver dental care should be available.

  • 239.
    Lundqvist, Martina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Ennab Vogel, Nicklas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Effects of eating breakfast and school breakfast programmes on children and adolescents: a systematic review2018Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Bakgrund: Frukost beskrivs ofta som dagens viktigaste måltid och flera studier har visat att kostintag har en positiv effekt på barn och ungdomars såväl fysiska som mentala utveckling. Ett sätt att öka barn och ungdomars frukostintag är att servera frukost på skoltid. Idag finns flera publicerade översiktsatiklar som har granskat effekterna av att äta frukost såväl som effekterna av skolfrukostprogram. För att kunna fatta ett beslut om huruvida man ska lägga resurser på att främja frukostätand eller servera frukost på skoltid krävs dock ytterligare information.

    Syftet med rapporten är att systematiskt granska de vetenskapliga publikationer som studerar effekter av att äta frukost eller effekter av implementering av skolfrukostprogram potentiellt relevanta att inkludera i en ekonomisk utvärdering.

    Metod: En systematisk litteratursökning genomfördes. Studierna identifierades genom att söka de elektroniska databaserna PubMed, CINAHL, Web of Science och PsycINFO från januari 2000 till oktober 2017. De inklusionskriterier som tillämpades var: artiklar på engelska publicerade i granskade tidskrifter, artiklar som presenterar primärdata, kvantitativa studier, studier jämförbara med Sverige gällande näringsintag, ekonomiska och sociala förhållanden samt publikationer som studerar minst ett av ämnena; akademisk prestation, livskvalitet och välbefinnande, riskfaktorer/morbiditet eller kognitiv prestanda.

    Resultat: Tjugosex artiklar som studerade effekter av att äta frukost samt elva studier som studerade effekter av skolfrukostprogram uppfyllde de uppsatta inklusionskriterierna och bedömdes vara av minst måttlig kvalitet inkluderades i analysen. Studierna som studerade effekter av att äta frukost var samstämmiga. De visade att frukostätande hade positiva effekter på kognitiv prestanda, akademisk prestation, livskvalitet och välbefinnande samt på morbida riskfaktorer. Artiklar som studerade effekter av skolfrukostprogram visade på varierande resultat. Ett fåtal studier fann att skolfrukostprogram hade positiva effekter på kognitiv prestanda och akademisk prestation men majoriteten av studierna kunde inte påvisa några effekter. Flertalet av studierna var dock behäftade med metodologiska svagheter.

    Slutsats: Äta frukost har överlag positiva effekter på de studerade utfallsmåtten. Skolfrukostprogram har små till måttliga effekter på de studerade utfallsmåtten. Majoriteten av studierna som undersökte skolfrukostprogram visade dock inga effekter och alla studier var behäftade med metodologiska svagheter. För att kunna bedöma kostnadseffektiviteten av att äta frukost och skolfrukostprogram, behöver vi mer kunskap om hur de identifierade effekterna påverkar samhällets kostnader och en individs livskvalitet och levnadsår, på såväl kort som lång sikt.

  • 240.
    Lundqvist, Martina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Ennab Vogel, Nicklas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Effects of eating breakfast on children and adolescents: A systematic review of potentially relevant outcomes in economic evaluations2019Ingår i: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 63, artikel-id 1618Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Breakfast is often described as the most important meal of the day. Several studies have focused on examining if breakfast habits have any short-term effects on school attendance, academic achievement, and general health in children and adolescents. Informed decisions of whether to promote eating breakfast or not require a more long-term perspective. Objective: The aim of this study was to conduct a systematic review of scientific publications studying the effects identified as potentially relevant for the economic evaluation of eating breakfast in children and adolescents. Design: A systematic literature review was conducted. Studies were identified by searching the electronic databases PubMed, CINAHL, Web of Science, and PsycINFO between January 2000 and October 2017. The inclusion criteria applied were published articles from peer-reviewed journals with full text in English, quantitative studies collecting primary data with school-aged children, and adolescents aged from 6 to 18 years as participants, performed entirely or partly in countries with advanced economies, except Japan and Taiwan. Results: Twenty-six studies fulfilled the inclusion criteria, and studies that were judged to be of at least moderate quality were included in the analysis. The results of the review of eating breakfast studies showed positive and conclusive effects on cognitive performance, academic achievement, quality of life, well-being and on morbidity risk factors. Conclusions: The overall assessment of the studies indicated positive effects of eating breakfast. How the identified effects influence societal costs and an individuals quality-adjusted life years require further research.

  • 241.
    Lundqvist, Martina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Roback, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Alwin, Jenny
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    The impact of service and hearing dogs on health-related quality of life and activity level: a Swedish longitudinal intervention study2018Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, artikel-id 497Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Individuals with severe disability often require personal assistance and help from informal caregivers, in addition to conventional health care. The utilization of assistance dogs may decrease the need for health and social care and increase the independence of these individuals. Service and hearing dogs are trained to assist specific individuals and can be specialized to meet individual needs. The aim of this study was to describe and explore potential consequences for health-related quality of life, well-being and activity level, of having a certified service or hearing dog. Methods: A longitudinal interventional study with a pre-post design was conducted. At inclusion, all participants in the study had a regular (untrained) companion dog. Data were collected before training of the dog started and three months after certification of the dog. Health-related quality of life was assessed with EQ-5D-3L, EQ-VAS and RAND-36. Well-being was measured with WHO-5 and self-esteem with the Rosenberg Self-Esteem Scale. In addition, questions were asked about physical activity and time spent away from home and on social activities. Subgroups were analyzed for physical service and diabetes alert dogs. Results: Fifty-five owner-and-dog pairs completed the study (30 physical service dogs, 20 diabetes alert dogs, 2 epilepsy alert dogs, and 3 hearing dogs). Initially, study participants reported low health-related quality of life compared with the general population. At follow-up, health-related quality of life measured with the EQ-VAS, well-being and level of physical activity had improved significantly. In the subgroup analysis, physical service dog owners had lower health-related quality of life than diabetes alert dog owners. The improvement from baseline to follow-up measured with EQ-5D statistically differed between the subgroups. Conclusions: The target population for service and hearing dogs has an overall low health-related quality of life. Our study indicates that having a certified service or hearing dog may have positive impact on health-related quality of life, well-being and activity level. Service and hearing dogs are a potentially important "wagging tail aid" for this vulnerable population, able to alleviate strain, increase independence, and decrease the risk of social isolation.

  • 242.
    Lyth, Johan
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Regionalt cancercentrum. Linköpings universitet, Medicinska fakulteten.
    Carstensen, John
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Synnerstad, Ingrid
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för inflammationsmedicin. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Hudkliniken i Östergötland. Linköpings universitet, Medicinska fakulteten.
    Lindholm, Christer
    Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Regionalt cancercentrum.
    Stage-specific direct healthcare costs in patients with cutaneous malignant melanoma2016Ingår i: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 30, nr 5, s. 789-793Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Clinical stage at diagnosis is a strong prognostic factor for death in cutaneous malignant melanoma (CMM), with worse prognosis at higher stages. However, few studies have investigated how direct healthcare cost per patient varies with clinical stage.

    Objective The aim of this study was to determine the stage-specific direct healthcare costs for CMM patients compared to the healthcare costs in the general population in the County of Östergötland, Sweden.

    Methods CMM patients in the County of Östergötland diagnosed 2005-2012 were identified from the Swedish cancer registry. Information on clinical stage was collected from the Swedish Melanoma Register (SMR) and cost data from the Cost per Patient database (CPP) for 1 075 CMM patients in Östergötland. CPP contains costs associated with all healthcare contacts per patient including inpatient, outpatient, and primary care. The CMM-related costs were defined as the difference in mean healthcare costs between CMM patients and general population.

    Results The first year after CMM diagnosis, the average healthcare costs for CMM patients was 2.8 times higher than in the general population. The healthcare cost ratio varied from 2.0 (stage I) to 10.1 (stage IV) and the CMM-related costs per patient-year varied from €2 670 (stage I) to €29 291 (stage IV). The mean healthcare costs decreased over time but remained significantly higher than in the general population for all clinical stages. During the first year after diagnosis, patients in clinical stage III-IV (7% of CMM patients) accounted for 27% of the total CMM-related healthcare costs.

    Conclusions The direct healthcare costs for CMM patients were significantly higher than in the general population independent of clinical stage. CMM patients diagnosed in clinical stage III-IV were associated with particularly high costs and the healthcare system may save resources by finding CMM patients in earlier stages.

  • 243.
    Lyth, Johan
    et al.
    Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Regionalt cancercentrum. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Eriksson, H.
    Department of Oncology-Pathology, Karolinska Institute, Stockholm.
    Hansson, J.
    Department of Oncology-Pathology, Karolinska Institute, Stockholm.
    Ingvar, C.
    Department of Surgery, Lund University Hospital, Lund.
    Jansson, M.
    Department of Surgery, Umeå University, Umeå.
    Lapins, J.
    Department of Dermatology, Karolinska University Hospital, Stockholm.
    Månsson-Brahme, E.
    Department of Oncology-Pathology, Karolinska Institute, Stockholm.
    Naredi, P.
    Department of Surgery, University of Gothenburg, Sahlgrenska University Hospital, Göteborg.
    Stierner, U.
    Department of Oncology, Sahlgrenska University Hospital, Göteborg.
    Ullenhag, G.
    Department of Radiology, Oncology and Radiation Science, Section of Oncology, Uppsala University, Uppsala.
    Carstensen, John
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Lindholm, C.
    Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Regionalt cancercentrum.
    Trends in cutaneous malignant melanoma in Sweden 1997-2011: Thinner tumours and improved survival among men2015Ingår i: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 172, nr 3, s. 700-706Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Both patient survival and the proportion of patients diagnosed with thin cutaneous malignant melanoma (CMM) have been steadily rising in Sweden as in most western countries, though the rate of improvement in survival appears to have declined in Sweden at the end of last millennium.

    Objectives: To analyse the most recent trends in the distribution of tumour thickness (T-category) as well as CMM-specific survival in Swedish patients diagnosed 1997-2011.

    Methods: This nationwide population-based study included 30 590 patients registered in the Swedish Melanoma Register (SMR) and diagnosed with a first primary invasive CMM 1997-2011. The patients were followed through 2012 in the national Cause-of-Death Register.

    Results: Logistic and Cox regression analyses adjusting for age at diagnosis, tumour site, and health care region were carried out. The odds ratio for being diagnosed with thicker tumours was significantly reduced (P = 0·0008) and the CMM-specific survival significantly improved in men diagnosed 2007-2011 compared to men diagnosed 1997-2001 (hazard ratio=0·81; 95% CI 0·72-0·91, P = 0·0009) while the corresponding differences for women were not significant. Women were diagnosed with significantly thicker tumours during 2002-2006 and a tendency towards decreased survival was observed compared to those diagnosed earlier 1997-2001 and later 2007-2011.

    Conclusion: In Sweden, the CMMs of men are detected earlier over time and this seems to be followed by an improved CMM-specific survival for men. Women are still diagnosed with considerably thinner tumours and they experience a better survival than men.

  • 244.
    Lyth, Johan
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionstyrelsen, Enheten för forskningsstöd Ledningsstaben.
    Lind, Leili
    Linköpings universitet, Institutionen för medicinsk teknik, Avdelningen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Persson, Hans L.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Lungmedicinska kliniken US.
    Wiréhn, Ann-Britt
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionstyrelsen, Enheten för forskningsstöd Ledningsstaben.
    Can a telemonitoring system lead to decreased hospitalization in elderly patients?2019Ingår i: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, artikel-id UNSP 1357633X19858178Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction Growing populations of elderly patients with chronic obstructive pulmonary disease (COPD) or heart failure (HF) require more healthcare. A four-year telehealth intervention - the Health Diary system based on digital pen technology - was implemented. We hypothesized that study patients with advanced COPD or HF would have lower rates of hospitalization when using the Health Diary. The aim was to investigate the effects of the intervention on healthcare costs and the number of hospitalizations, as well as other care required in COPD and HF patients. Methods Patients were introduced to the telemonitoring system which was supervised by a specialized hospital-based home care (HBHC) unit. Staff associated with this unit were responsible for the healthcare provided. The study included patients with COPD or HF, aged amp;gt;= 65 years who were frequently hospitalized due to exacerbations - at least two inpatient episodes within the last 12 months. Observed number of hospitalizations and total healthcare costs were compared with the expected values, which were calculated using the generalized estimating equations (GEE) method. Results A total of 36 COPD and 58 HF patients with advanced stages of disease were included. The number of hospitalizations was significantly reduced for both HF and COPD patients participating in telemonitoring. Accordingly, hospitalization costs were significantly reduced for both groups, but the total healthcare cost was not significantly different from the expected costs. Conclusion A telemonitoring system, the Health Diary, combined with a specialized HBHC unit significantly decreases the need for hospital care in elderly patients with advanced HF or COPD without increasing total healthcare costs.

  • 245.
    Lyttkens, Carl
    et al.
    Lunduniversity.
    Gerdtham, Ulf
    Lund University.
    Tinghög, Gustav
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Nationalekonomi. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys.
    Do We Know What We Are Doing? An Exploratory Study on Swedish Health Economists and the EQ-5DManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    The UK tariff for quality of life associated with the health states in the EQ-5D is probably not consistent with the preferences of Swedish health economists. This is worrying in view of the widespread use of the tariff values and the fact that health economists likely are better able than ordinary citizens to report their preferences for health states in a valid and reliable manner. We suggest this result is taken into account when the EQ-5D instrument is used, and that researchers should be cautious in using the UK (or any other) value sets. Our results also indicate that the variation across citizens in preferences for health may be a more complex issue than previously observed and deserves further study. An intriguing question for the future is to what extent health economists use methods and instruments that they themselves do not believe in.

  • 246.
    Lärfars, Gerd
    et al.
    NT-rådet.
    Sandman, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. University of Boras, Sweden.
    Därför måste vi ibland säga nej till dyra läkemedel2017Ingår i: Göteborgs PostenArtikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 247.
    Malmqvist, Erik
    et al.
    Linköpings universitet, Institutionen för kultur och kommunikation, Avdelningen för kultur och estetik. Linköpings universitet, Filosofiska fakulteten.
    Furberg, Elisabeth
    Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala Sweden.
    Sandman, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. University of Boras, Sweden.
    Ethical aspects of medical age assessment in the asylum process: a Swedish perspective.2018Ingår i: International journal of legal medicine (Print), ISSN 0937-9827, E-ISSN 1437-1596, Vol. 132, nr 3, s. 815-823Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    According to European regulations and the legislations of individual member states, children who seek asylum have a different set of rights than adults in a similar position. To protect these rights and ensure rule of law, migration authorities are commonly required to assess the age of asylum seekers who lack reliable documentation, including through various medical methods. However, many healthcare professionals and other commentators consider medical age assessment to be ethically problematic. This paper presents a simplified and amended account of the main findings of a recent ethical analysis of medical age assessment in the asylum process commissioned by the Swedish National Board of Health and Welfare. A number of ethical challenges related to conflicting goals, equality and fairness, autonomy and informed consent, privacy and integrity, and professional values and roles are identified and analysed. It is concluded that most of these challenges can be met, but that this requires a system where the assessment is sufficiently accurate and where adequate safeguards are in place. Two important ethical questions are found to warrant further analysis. The first is whether asylum seekers' consent to the procedure can be considered genuinely voluntary. The second is whether and how medical age assessments could affect negative public attitudes towards asylum seekers or discriminatory societal views more generally.

  • 248.
    Marcusson, Jan
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Medicinska och geriatriska akutkliniken.
    Nord, Magnus
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Johansson, Maria
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Rörelse och Hälsa.
    Alwin, Jenny
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Dannapfel, Petra
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Thomas, Kristin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Poksinska, Bozena
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Logistik- och kvalitetsutveckling. Linköpings universitet, Tekniska fakulteten.
    Sverker, Annette M.
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Region Östergötland, Närsjukvården i centrala Östergötland, Rörelse och Hälsa.
    Olaison, Anna
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Socialt arbete. Linköpings universitet, Filosofiska fakulteten.
    Cedersund, Elisabet
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen Åldrande och social förändring. Linköpings universitet, Filosofiska fakulteten.
    Kelfve, Susanne
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen Åldrande och social förändring. Linköpings universitet, Filosofiska fakulteten.
    Motel-Klingebiel, Andreas
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen Åldrande och social förändring. Linköpings universitet, Filosofiska fakulteten.
    Hellstrom, Ingrid
    Norrkoping Univ, Sweden.
    Kullberg, Agneta
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Socialt arbete. Linköpings universitet, Filosofiska fakulteten.
    Böttiger, Ylva
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk farmakologi.
    Dong, Huan-Ji
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Wass, Malin
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och didaktik. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV).
    Lyth, Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Ledningsstab Region Östergötland, Enheten för forskningsstöd.
    Andersson, Agneta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Ledningsstab Region Östergötland, Enheten för forskningsstöd.
    Proactive healthcare for frail elderly persons: study protocol for a prospective controlled primary care intervention in Sweden2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 5, artikel-id e027847Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction.

    Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire.

    Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.

  • 249.
    Matinrad, Niki
    et al.
    Linköpings universitet, Institutionen för teknik och naturvetenskap, Kommunikations- och transportsystem. Linköpings universitet, Tekniska fakulteten.
    Andersson Granberg, Tobias
    Linköpings universitet, Institutionen för teknik och naturvetenskap, Kommunikations- och transportsystem. Linköpings universitet, Tekniska fakulteten.
    Ennab Vogel, Nicklas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Angelakis, Vangelis
    Linköpings universitet, Institutionen för teknik och naturvetenskap, Kommunikations- och transportsystem. Linköpings universitet, Tekniska fakulteten.
    Optimal Dispatch of Volunteers to Out-of-hospital Cardiac Arrest Patients2019Ingår i: Proceedings of the 52nd Hawaii InternationalConference on System Sciences (HICSS), Hawaii, USA, 8th-11th January 2019, University of Hawai'i at Manoa , 2019, s. 4088-4097Konferensbidrag (Refereegranskat)
    Abstract [en]

    Initiatives with mobile phone dispatched volunteers to out-of-hospital cardiac arrest (OHCA) cases, can be found today in some countries, e.g. Sweden, the Netherlands, Switzerland and Italy. When an OHCA case is reported, an alarm is sent to the registered volunteers’ phones. However, the allocation of which volunteers to send to the automatic external defibrillator (AED) and who to send directly to the patient, is today based on simple rules of thumb. In this paper, we propose a model to optimally select how many and which volunteers to send directly to the patient, and who should pick up and deliver an AED. The results show that the model can help increase the survivability of the patients, compared to simple decision rules.

  • 250.
    Mazya, A. L.
    et al.
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Geriatriska kliniken ViN. Danderyd Hospital, Sweden .
    Eckerblad, Jeanette
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Hellström, Ingrid
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Milberg, Anna
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, LAH Linköping. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Palliativt kompetenscentrum. Vrinnevi Hospital, Sweden .
    Unosson, Mitra
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Westöö, A.
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Geriatriska kliniken ViN.
    Ekdahl, Anne
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Geriatriska kliniken ViN.
    The Ambulatory Geriatric Assessment - a Frailty Intervention Trial (AGe-FIT) - A randomised controlled trial aimed to prevent hospital readmissions and functional deterioration in high risk older adults: A study protocol2013Ingår i: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 4, nr 4, s. 242-247Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Care of old people with multimorbidity living at home is often fragmented with lack of coordination and information exchange between health care professionals, the elderly and their relatives. This paper describes the protocol of a randomised, controlled study, which aims to compare the efficacy of caring for older people with multimorbidity and three or more hospital admissions in the previous year at a geriatric ambulatory department based on Comprehensive Geriatric Assessment (CGA) versus usual care.

    Participants and methods

    A total of 400 community-dwelling old people with multimorbidity who are living in the city of Norrköping (Sweden) and one of their relatives are recruited for this trial and randomized to an intervention and a control group. Participants in the intervention group receive interdisciplinary care after a CGA at an Ambulatory Geriatric Unit with easy accessibility during working hours in addition to usual care. The control group receives usual care provided by the primary care or hospital.

    Outcomes

    The primary outcome is number of hospitalisation, the secondary outcomes are health-related outcomes including measures of frailty, cognition, symptom burden, feeling of security, quality of life of participants and relatives and as well as costs for health and social care. Participants will be followed for 2 years.

    Discussion

    This study will contribute to evidence of the effect of two different care models. The study has the potential to change care for older people with multimorbidity.

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