liu.seSearch for publications in DiVA
Change search
Refine search result
3456789 251 - 300 of 474
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 251.
    Liljeroos, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Caring needs in patient-partner dyads affected by heart failure: An evaluation of the long-term effects of a dyadic psycho-educational intervention2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: As medical treatment has improved, patients with heart failure (HF) now live longer and care mostly takes place at home with partners providing the main assistance. Taking care of an ill or disabled individual imposes a well-documented burden on the partner’s healthrelated quality of life. The awareness of partners’ burdensome situation is increasing, but few interventions have targeted the needs of patientpartner dyads with HF. The results have been inconclusive and give no clear guidance on how interventional programmes should be designed to improve both patient and partner outcomes.

    Aim: The overall aim of this thesis was to evaluate the effects of a psychoeducational intervention delivered to patient-partner dyads with HF during long-term follow-up, and to explore the dyads’ perceived caring needs.

    Methods: The thesis is based on four papers that used both quantitative and qualitative data. Study I and II used a randomized controlled design with a follow-up assessment after 24 months including 155 patientpartner dyads. The control group received care as usual. The intervention group received care as usual, and in addition they participated in the nurse-led psycho-educational intervention. Data was collected using questionnaires before and 24 months after the intervention, in order to determine the long-term effects on patients and partners regarding health related quality of life, perceived control, symptoms of depression and partners’ caregiver burden (I, II). A conceptual health promotion model inspired the intervention. To describe how the model was applied, a qualitative approach analysing nurses’ documentation of the sessions with 71 dyads in the intervention group (III) was used. Study IV has an explorative design. To further explore the dyads’ perceived caring needs, focus groups interviews with 19 patient-partner dyads with heart failure (IV) were performed.

    Results: The intervention did not have any significant effect on physical or mental health- related quality of life, depressive symptoms, or perceived control over the heart failure among the dyads (I) or caregiver burden in the partners (II) after 24 months. Furthermore, time to first event did not differ significantly between the dyads in the intervention group and the control group (I, II). As for the partners, both the intervention and control group reported decreased physical health between the baseline assessment and the 24-month follow-up (I). The intervention was composed of three components; 1) cognitive 2) supportive, and 3) behavioural component. The analysis of the nurses’ documentation confirmed the coverage of all the components and the analysis revealed a vide range of caring needs among the dyads (III). The dyads described a need to learn about HF to be able to manage everyday life. Regular outpatient clinic visits and access to telephone support were vital and both the patient and the partner need to be present at the clinic visits. Meeting others who are in the same situation and sharing the burden in nurse-led group sessions was proposed as an opportunity to support each other and others (IV).

    Conclusions: Over the 24-month follow-up period, the intervention had a neutral effect on health- related quality of life, depressive symptoms and perceived control over the HF among the dyads, and on partners’ caregiver burden. Considering the fact that partners serve as a critical extension of the formal healthcare system, and that both patients and partners ask for more support, it will become crucial to find new ways to support dyads affected by heart failure. This thesis may be viewed as a first step in trying to understand dyads’ perceived caring needs, and it can serve as a guide in clinical work and when designing new dyadic interventions.

    List of papers
    1. Long Term Follow-Up after a Randomized Integrated Educational and Psychosocial Intervention in Patient-Partner Dyads Affected by Heart Failure
    Open this publication in new window or tab >>Long Term Follow-Up after a Randomized Integrated Educational and Psychosocial Intervention in Patient-Partner Dyads Affected by Heart Failure
    Show others...
    2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 9, p. e0138058-Article in journal (Refereed) Published
    Abstract [en]

    Background To date, contemporary heart failure care remains patient-focused, but awareness of the partners and families situation is increasing. Randomized studies have mainly evaluated the short-term effects of dyadic interventions. Therefore, the aim of this study was to determine the 24-month effects of an intervention with psych-educational support in dyads of heart failure patients and their partners. Methods This study used a randomized study design and 155 patient-partner dyads were enrolled. The intervention included a nurse-led program of three sessions addressing psychoeducational support. Results The intervention did not have any effect on health, depressive symptoms or perceived control among the patient-partner dyads after 24 months. Furthermore, time to first event did not differ significantly between the intervention group and the control patients. Conclusion This study may be regarded as a first step in trying to understand dyads need for supportive care. Individualized and more targeted interventions seem necessary to achieve a higher impact on dyad outcomes.

    Place, publisher, year, edition, pages
    PUBLIC LIBRARY SCIENCE, 2015
    National Category
    Clinical Medicine Sociology
    Identifiers
    urn:nbn:se:liu:diva-122211 (URN)10.1371/journal.pone.0138058 (DOI)000361800700030 ()26406475 (PubMedID)
    Note

    Funding Agencies|Centre for Clinical Research Sormland; Linkoping University; Swedish Research Council; Swedish Institute for Health Sciences

    Available from: 2015-10-26 Created: 2015-10-23 Last updated: 2019-06-27
    2. Long-term effects of a dyadic psycho-educational intervention on caregiver burden and morbidity in partners of patients with heart failure: a randomized controlled trial
    Open this publication in new window or tab >>Long-term effects of a dyadic psycho-educational intervention on caregiver burden and morbidity in partners of patients with heart failure: a randomized controlled trial
    Show others...
    2017 (English)In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 26, no 2, p. 367-379Article in journal (Refereed) Published
    Abstract [en]

    Background

    Partners of patients with heart failure provide both practical and emotional support. Many partners assume caregiving responsibilities without being aware of the burden related with this role.

    Objective

    Our work has established that a psycho-educational intervention has benefits at 3, but not at 12 months for patients with heart failure. Further we had not described the long-term effects in caregivers. This study aimed to determine the 24-months effects of a dyadic psycho-educational intervention on caregiver burden and morbidity in partners of patients with heart failure and study factors associated with a change in caregiver burden.

    Design

    A randomized controlled study design, with a follow-up assessment after 24 months.

    Setting and participants

    Partners to patients with heart failure were recruited from two hospitals in the southeast of Sweden.

    Intervention

    A three session nurse-led psycho-educational program was tested and included psychosocial support to maintain the partners’ physical and mental functions, and perceived control. Several instrument were used to measure caregiver burden, perceived control, physical and mental health, depression and morbidity.

    Results

    One hundred fifty-five partners were included. There were no significant differences in any index of caregiver burden or morbidity among the partners in the intervention and control groups after 24 months. Overall, the mean total caregiver burden was found to be significantly increased compared to baseline (36 ± 12 vs 38 ± 14, p < 0.05). A younger partner, less comorbidity, higher levels of perceived control, better physical health and less symptoms of depression in patients, and better mental health in the partners were factors associated with absence of increased caregiver burden over time.

    Discussion and conclusion

    Our intervention did not significantly decrease caregiver burden or morbidity. Over time, several aspects of burden increased in both groups. To improve outcomes, individualized and targeted interventions might be beneficial.

    Place, publisher, year, edition, pages
    Dordrecht: Springer Netherlands, 2017
    Keywords
    Heart failure, Partner, Intervention, Caregiver, Caregiver burden, Perceived control
    National Category
    Nursing Physiotherapy General Practice Psychiatry Geriatrics
    Identifiers
    urn:nbn:se:liu:diva-133178 (URN)10.1007/s11136-016-1400-9 (DOI)000394145600013 ()27631892 (PubMedID)2-s2.0-84986309447 (Scopus ID)
    Note

    Funding agencies: Swedish Institute for Health Sciences

    Available from: 2016-12-13 Created: 2016-12-13 Last updated: 2019-06-27Bibliographically approved
    3. Perceived caring needs in patient-partner dyads affected by heart failure: A qualitative study.
    Open this publication in new window or tab >>Perceived caring needs in patient-partner dyads affected by heart failure: A qualitative study.
    2014 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 19-20, p. 2928-2938Article in journal (Refereed) Published
    Abstract [en]

    AIMS AND OBJECTIVES: To explore the perceived caring needs in patient-partner dyads affected by heart failure to develop an understanding of potential areas of support.

    BACKGROUND: Being affected by heart failure has a great impact on both the patient and the partner but until now contemporary care has remained patient focused.

    DESIGN: A qualitative study design was used.

    METHODS: Eight focus group interviews were performed, which included nineteen patients diagnosed with heart failure and their cohabiting partner. Patients were aged between 55-89 years and partners' ages ranged from 48-87 years. Data were analysed using qualitative content analyses.

    RESULTS: The dyads perceived that caring needs could be summarised in two themes 'Dyads perceive a need for continuous guidance through the different phases of the illness trajectory' and 'Dyads perceive a need to share burden and support with each other and others'. The dyads described a need to learn more about heart failure to be able to manage everyday life. Regular outpatient clinic visits and access to telephone support were vital, and having someone who cared about the well-being of the partners was perceived as comforting. Both the patient and the partner need to be present at the clinic visits. Receiving the same information and being able to ask questions reduce insecurity. Meeting others in the same situation and sharing the burden in group sessions were proposed as an opportunity to support each other and others.

    CONCLUSIONS: There is a need to improve education and support for patient-partner dyads affected by heart failure.

    RELEVANCE TO CLINICAL PRACTICE: The result shows the importance to provide continuous healthcare contacts throughout the illness trajectory. Furthermore, partners should be included at follow-up, and support groups should be organised so that dyads can meet and support each other.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2014
    Keywords
    heart failure, family, partner, focus groups, qualitative study, psychosocial nursing
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-107727 (URN)10.1111/jocn.12588 (DOI)000343857700023 ()24698101 (PubMedID)
    Available from: 2014-06-19 Created: 2014-06-19 Last updated: 2019-06-27
  • 252.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering. SICS East Swedish ICT, Linköping, Sweden.
    Carlgren, Gunnar
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Advanced Home Care in Linköping.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Old-and With Severe Heart Failure: Telemonitoring by Using Digital Pen Technology in Specialized Homecare: System Description, Implementation, and Early Results2016In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 34, no 8, p. 360-368Article in journal (Refereed)
    Abstract [en]

    Telehealth programs for heart failure have been studied using a variety of techniques. Because currently a majority of the elderly are nonusers of computers and Internet, we developed a home telehealth system based on digital pen technology. Fourteen patients (mean age, 84 years [median, 83 years]) with severe heart failure participated in a 13-month pilot study in specialized homecare. Participants communicated patient-reported outcome measures daily using the digital pen and health diary forms, submitting a total of 3 520 reports. The reports generated a total of 632 notifications when reports indicated worsening health. Healthcare professionals reviewed reports frequently, more than 4700 times throughout the study, and acted on the information provided. Patients answered questionnaires and were observed in their home environment when using the system. Results showed that the technology was accepted by participants: patients experienced an improved contact with clinicians; they felt more compliant with healthcare professionals advice, and they felt more secure and more involved in their own care. Via the system, the healthcare professionals detected heart failure-related deteriorations at an earlier stage, and as a consequence, none of the patients were admitted into hospital care during the study.

  • 253.
    Lindblad, Marlene
    et al.
    Royal Inst Technol, Sweden.
    Schildmeijer, Kristina
    Linnaeus Univ, Sweden.
    Nilsson, Lena
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Ekstedt, Mirjam
    Karolinska Inst, Sweden.
    Unbeck, Maria
    Karolinska Inst, Sweden.
    Development of a trigger tool to identify adverse events and no-harm incidents that affect patients admitted to home healthcare2018In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 27, no 7, p. 502-511Article in journal (Refereed)
    Abstract [en]

    Background Adverse events (AEs) and no-harm incidents are common and of great concern in healthcare. A common method for identification of AEs is retrospective record review (RRR) using predefined triggers. This method has been used frequently in inpatient care, but AEs in home healthcare have not been explored to the same extent. The aim of this study was to develop a trigger tool (TT) for the identification of both AEs and no-harm incidents affecting adult patients admitted to home healthcare in Sweden, and to describe the methodology used for this development. Methods The TT was developed and validated in a stepwise manner, in collaboration with experts with different skills, using (1) literature review and interviews, (2) a five-round modified Delphi process, and (3) two-stage RRRs. Ten trained teams from different sites in Sweden reviewed 600 randomly selected records. Results In all, triggers were found 4031 times in 518 (86.3%) records, with a mean of 6.7 (median 4, range 1-54) triggers per record with triggers. The positive predictive values (PPVs) for AEs and no-harm incidents were 25.4% and 16.3%, respectively, resulting in a PPV of 41.7% (range 0.0%-96.1% per trigger) for the total TT when using 38 triggers. The most common triggers were unplanned contact with physician and/or registered nurse, moderate/severe pain, moderate/severe worry, anxiety, suffering, existential pain and/or psychological pain. AEs were identified in 37.7% of the patients and no-harm incidents in 29.5%. Conclusion This study shows that adapted triggers with definitions and decision support, developed to identify AEs and no-harm incidents that affect patients admitted to home healthcare, may be a valid method for safety and quality improvement work in home healthcare.

  • 254.
    Lindenfalk, Bertil
    et al.
    Jonkoping Univ, Sweden.
    Vimarlund, Vivian
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering. Jonkoping Univ, Sweden.
    Guidance Through Use: Value as a Pathfinder in e-Health Services Implementation2017In: MEDINFO 2017: PRECISION HEALTHCARE THROUGH INFORMATICS, IOS PRESS , 2017, Vol. 245, p. 151-155Conference paper (Refereed)
    Abstract [en]

    The lack of awareness and confidence in eHealth solutions among certain stakeholders creates a barrier for the implementation of e-Health services. The aim of this paper is to explore issues that promote the development and implementation of patient-centered care services for the elderly. An exploratory case study approach is applied to a e-Health monitoring service that was developed and piloted in 38 homes for the elderly in Sweden and the Netherlands. The unit of analysis, concept of value-in-use, was used in order to determine how pilot participants felt about a service of this kind benefiting them the most. The findings were then translated into actionable considerations for implementing organizations. The results indicate a need for active participation, technical support infrastructure, mobility demands, and an extension of the concept of trust in e-Health services. The knowledge presented in the study is important for decisions makers, public organization strategists, and policy writers.

  • 255.
    Lindh Falk, Annika
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Interprofessional Collaboration in Health Care: Education and Practice2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Interprofessional collaboration is of global interest for addressing to the complex health care needs and improving patient safety in health care. Professionals have to develop collaborative skills and the ability to share knowledge. Interprofessional education describes learning activities where students learn with, from and about each other to improve collaboration. The dimension of interprofessional collaboration is complex and includes different collaborative competencies to bring about the best for the patients. To  become a  professional, often understood as someone exerting expertise within a specific field of practice, involves a learning process that challenges the boundaries of the professions. Boundaries are not only barriers, but also places that increase learning. There is a complexity to studying the phenomenon of interprofessional collaboration and learning regarding how it occurs in education and health care practice. By using a sociomaterial perspective on practice, it is possible to more robustly explore the collaborative context.

    Aim: The overarching aim of the thesis has been to explore interprofessional collaboration and learning in health care education and in interprofessional health care practice. More specifically, the research questions in the thesis were answered in two studies regarding how professional knowledge is developed and shared in interprofessional undergraduate health care education and in interprofessional health care practice.

    Methods: A questionnaire was distributed to students from a medicine, nursing, physiotherapy and occupational therapy programme who participated in a two-week period of practice at an Interprofessional Training Ward in Linköping. The data was analysed quantitatively to explore how female and male students experienced their professional identity formation. The open-ended responses were analysed using a sociomaterial perspective on practice.

    An ethnographic study was conducted in a hospital setting during a period of one year, during which two interprofessional teams were observed. A theory-driven analysis was made using a sociomaterial perspective on practice, and this provided a lens through which the nature of interprofessional collaboration and knowledge sharing could be observed.

    Findings: The main findings from the questionnaire showed that the practice architectures of the Interprofessional Training Ward, prefigured practices where different professional responsibilities were enacted in ways that were reproducing expected and unexpected roles in a traditional health care practice. That disrupted the students´ practical and general understandings of professional responsibilities and the nature of professional work including their professional identity formation.

    The findings from the ethnographic study showed different patterns of how knowledge was shared among professionals in their daily work practice as it unfolded, like chains of actions. The patterns arose through activities where collaboration between professionals was planned beforehand, and at other times it arose in more spontaneous or responsive ways. Due to the way the activities were arranged, the nursing assistants were totally or partially excluded from the collaborative practices.

    Conclusions: The way that educational and health care practices were arranged had an influence on the patterns of interactions between the students as well as the professionals. The arrangement at the Interprofessional Training Ward enabled and constrained the possibilities for students to learn professional and interprofessional competencies. Professional practices in health care hung together through chains of actions that influenced interprofessional collaboration and learning. The relations between human actors, material objects and artifacts are of importance for understanding interprofessional practices.

    List of papers
    1. One site fits all? A student ward as a learning practice for interprofessional development
    Open this publication in new window or tab >>One site fits all? A student ward as a learning practice for interprofessional development
    Show others...
    2013 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 27, no 6, p. 476-481Article in journal (Refereed) Published
    Abstract [en]

    Interprofessional training wards (IPTWs), aiming to enhance interprofessional collaboration, have been implemented in medical education and evaluated over the last decade. The Faculty of Health Sciences, Linkoping University has, in collaboration with the local health provider, arranged such training wards since 1996, involving students from the medical, nursing, physiotherapy, and occupational therapy programs. Working together across professional boundaries is seen as a necessity in the future to achieve sustainable and safe healthcare. Therefore, educators need to arrange learning contexts which enhance students interprofessional learning. This article shows aspects of how the arrangement of an IPTW can influence the students collaboration and learning. Data from open-ended questions from a questionnaire survey, during autumn term 2010 and spring term 2011 at an IPTW, was analyzed qualitatively using a theoretical framework of practice theory. The theoretical lens gave a picture of how architectures of the IPTW create a clash between the "expected" professional responsibilities and the "unexpected" responsibilities of caring work. Also revealed was how the proximity between students opens up contexts for negotiations and boundary work. The value of using a theoretical framework of professional learning in practice within the frames of healthcare education is discussed.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2013
    Keywords
    Collaboration, interprofessional education, interprofessional training ward, practice theory, professional boundaries, qualitative method
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-102721 (URN)10.3109/13561820.2013.807224 (DOI)000327284700006 ()
    Available from: 2013-12-19 Created: 2013-12-19 Last updated: 2017-12-06
    2. Does gender matter?: Differences between students at an interprofessional training ward
    Open this publication in new window or tab >>Does gender matter?: Differences between students at an interprofessional training ward
    2015 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 29, no 6, p. 616-621Article in journal (Refereed) Published
    Abstract [en]

    Studies on graduates’ transitions from education into clinical work highlight inequalities concerning how women and men experience their professional learning and development. This study explores how female and male students from different programs within the health care education system, i.e. medicine, nursing, occupational therapy and physiotherapy programmes, experience an IPTW as a part of their professional identity formation.

    Students from the medicine, nursing, physiotherapy, and occupational therapy programmes collaborate in teams during two weeks at one of three IPTWs at the medical school, Linköping University. They together take the responsibility for diagnosis, treatment and rehabilitation of the patients, albeit with professional supervisors as support. During 2010 to 2011 454 (93%) of the 488 students who practiced at the IPTWs answered a questionnaire on their experiences of the IPTW. The students stated that the IPTW had positively influenced their professional development. The female and male medical students were significantly less positive than other female and male students, respectively, concerning the value of IPTW. The male students from all programmes were slightly, but significantly, less positive than all the female students. These findings show that students “do gender” as an integral part of the educational practice. It is important to scrutinize the IPTW as an educational practice, influencing students’ preparation for future work. Gender should be discussed during the IPTW rotation but also in general during the curriculum for all healthcare programmes.

     

    Place, publisher, year, edition, pages
    Taylor & Francis, 2015
    Keywords
    IPTW, professional development, gender, questionnaire
    National Category
    Pedagogical Work
    Identifiers
    urn:nbn:se:liu:diva-121056 (URN)10.3109/13561820.2015.1047491 (DOI)000366450200017 ()
    Available from: 2015-09-04 Created: 2015-09-04 Last updated: 2017-12-04
  • 256.
    Lindh Falk, Annika
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences.
    Hult, Håkan
    Karolinska Inst, Sweden.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Hopwood, Nick
    Univ Technol Sydney, Australia; Univ Stellenbosch, South Africa.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nursing assistants mattersAn ethnographic study of knowledge sharing in interprofessional practice2018In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 25, no 2, article id e12216Article in journal (Refereed)
    Abstract [en]

    Interprofessional collaboration involves some kind of knowledge sharing, which is essential and will be important in the future in regard to the opportunities and challenges in practices for delivering safe and effective health care. Nursing assistants are seldom mentioned as a group of health care workers that contribute to interprofessional collaboration in health care practice. The aim of this ethnographic study was to explore how the nursing assistants knowledge can be shared in a team on a spinal cord injury rehabilitation ward. Using a sociomaterial perspective on practice, we captured different aspects of interprofessional collaboration in health care. The findings reveal how knowledge was shared between professionals, depending on different kinds of practice architecture. These specific cultural-discursive, material-economic, and social-political arrangements enabled possibilities through which nursing assistants knowledge informed other practices, and others knowledge informed the practice of nursing assistants. By studying what health care professionals actually do and say in practice, we found that the nursing assistants could make a valuable contribution of knowledge to the team.

  • 257.
    Lindstrom Egholm, Cecilie
    et al.
    Holbaek Univ Hosp, Denmark; Odense Univ Hosp, Denmark; Univ Southern Denmark, Denmark.
    Knold Rossau, Henriette
    Odense Univ Hosp, Denmark; Univ Southern Denmark, Denmark.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Bunkenborg, Gitte
    Holbaek Univ Hosp, Denmark.
    Rod, Morten Hulvej
    Univ Southern Denmark, Denmark.
    Doherty, Patrick
    Univ York, England.
    Bartels, Paul
    Danish Clin Registries, Denmark.
    Helmark, Lotte
    Zealand Univ Hosp, Denmark.
    Zwisler, Ann-Dorthe
    Odense Univ Hosp, Denmark; Univ Southern Denmark, Denmark.
    Implementation of a politically initiated national clinical guideline for cardiac rehabilitation in hospitals and municipalities in Denmark2018In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 122, no 9, p. 1043-1051Article in journal (Refereed)
    Abstract [en]

    A politically initiated national clinical guideline was launched in Denmark in 2013 to improve quality and equality of cardiac rehabilitation (CR) services. The guideline is to be implemented in both hospital and community (municipality) settings due to shared responsibility for provision of CR services. Little is known about implementation outcomes of a guideline in these two settings. We aimed to study this by determining the extent to which Danish CR services in hospitals and municipalities adhered to national recommendations following the launch of the guideline. The study employed an observational, longitudinal design. Data were gathered by a questionnaire survey to compare CR services at baseline, measured in 2013 immediately before the guideline was launched, with CR services at a two-year follow up in 2015. All Danish hospital departments offering CR services (N = 36) and all municipalities (N = 98) were included. Data were analysed using inferential statistics. Hospitals reported improvement of both content and quality of CR services. Municipalities reported no change in content of services, and lower level of fulfilment of one quality aspect. The results suggest that the guideline had different impact in hospitals and municipalities and that the differences in content and quality of services between the two settings increased in the study period, thus contradicting the guidelines aim of uniform, evidence-based content of CR services across settings. (C) 2018 Elsevier B.V. All rights reserved.

  • 258.
    Lindström Egholm, Cecilie
    et al.
    Univ Southern Denmark, Denmark; Region Southern Denmark, Denmark; Holbaek Univ Hosp, Denmark.
    Helmark, Charlotte
    Zealand Univ Hosp, Denmark.
    Christensen, Jan
    Copenhagen Univ Hosp, Denmark.
    Eldh, Ann Catrine
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Winblad, Ulrika
    Uppsala Univ, Sweden.
    Bunkenborg, Gitte
    Holbaek Univ Hosp, Denmark.
    Zwisler, Ann-Dorthe
    Univ Southern Denmark, Denmark.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Facilitators for using data from a quality registry in local quality improvement work: a cross-sectional survey of the Danish Cardiac Rehabilitation Database2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 6, article id e028291Article in journal (Refereed)
    Abstract [en]

    Objectives To investigate use of data from a clinical quality registry for cardiac rehabilitation in Denmark, considering the extent to which data are used for local quality improvement and what facilitates the use of these data, with a particular focus on whether there are differences between frontline staff and managers. Design Cross-sectional nationwide survey study. Setting, methods and participants A previously validated, Swedish questionnaire regarding use of data from clinical quality registries was translated and emailed to frontline staff, mid-level managers and heads of departments (n=175) in all 30 hospital departments participating in the Danish Cardiac Rehabilitation Database. Data were analysed descriptively and through multiple linear regression. Results Survey response rate was 58% (101/175). Reports of registry use at department level (measured through an index comprising seven items; score min 0, max 7, where a low score indicates less use of data) varied significantly between groups of respondents: frontline staff mean score 1.3 (SD=2.0), mid-level management mean 2.4 (SD=2.3) and heads of departments mean 3.0 (SD=2.5), p=0.006. Overall, department level use of data was positively associated with higher perceived data quality and usefulness (regression coefficient=0.22, p=0.019), management request for data (regression coefficient=0.40, p=0.008) and personal motivation of the respondent (regression coefficient=1.63, pamp;lt;0.001). Among managers, use of registry data was associated with data quality and usefulness (regression coefficient=0.43, p=0.027), and among frontline staff, reported data use was associated with management involvement in quality improvement work (regression coefficient=0.90, p=0.017) and personal motivation (regression coefficient=1.66, pamp;lt;0.001). Conclusions The findings suggest relatively sparse use of data in local quality improvement work. A complex interplay of factors seem to be associated with data use with varying aspects being of importance for frontline staff and managers.

  • 259.
    Lindström Egholm, Cecilie
    et al.
    Univ Southern Denmark, Denmark; Odense Univ Hosp, Denmark; Holbaek Univ Hosp, Denmark.
    Helmark, Charlotte
    Zealand Univ Hosp, Denmark.
    Doherty, Patrick
    Univ York, England.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Zwisler, Ann-Dorthe
    Univ Southern Denmark, Denmark; Odense Univ Hosp, Denmark.
    Bunkenborg, Gitte
    Holbaek Univ Hosp, Denmark.
    Struggling with practices2019In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, article id 102Article in journal (Refereed)
    Abstract [en]

    BackgroundThe use of clinical quality registries as means for data driven improvement in healthcare seem promising. However, their use has been shown to be challenged by a number of aspects, and we suggest some may be related to poor implementation. There is a paucity of literature regarding barriers and facilitators for registry implementation, in particular aspects related to data collection and entry. We aimed to illuminate this by exploring how staff perceive the implementation process related to the registries within the field of cardiac rehabilitation in England and Denmark.MethodsA qualitative, interview-based study with staff involved in collecting and/or entering data into the two case registries (England N=12, Denmark N=12). Interviews were analysed using content analysis. The Consolidated Framework for Implementation Research was used to guide interviews and the interpretation of results.ResultsThe analysis identified both similarities and differences within and between the studied registries, and resulted in clarification of staffs experiences in an overarching theme: Struggling with practices and five categories; the data entry process, registry quality, resources and management support, quality improvement and the wider healthcare context. Overall, implementation received little focused attention. There was a lack of active support from management, and staff may experience a struggle of fitting use of a registry into a busy and complex everyday practice.Conclusion The study highlights factors that may be important to consider when planning and implementing a new clinical quality registry within the field of cardiac rehabilitation, and is possibly transferrable to other fields. The results may thus be useful for policy makers, administrators and managers within the field and beyond. Targeting barriers and utilizing knowledge of facilitating factors is vital in order to improve the process of registry implementation, hence helping to achieve the intended improvement of care processes and outcomes.

  • 260.
    Lindström, Pål
    et al.
    Susano Rehab AB, Malmö, Sweden.
    Lemming, Dag
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Lantz Lenander, Eva
    Susano Rehab AB, Malmö, Sweden.
    Jönsson, Rolf
    Apport Rehab, Kristianstad, Sweden.
    Sverige behöver riktlinjer för oberoende medicinska utredningar [Sweden needs guidelines for independent medical evaluations]2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, article id DHRZArticle in journal (Other academic)
    Abstract [sv]

    En oberoende medicinsk utredning kräver ett tydligt etiskt ställningstagande från utövaren, anser Pål Lindström och medförfattare. De föreslår tydliga etiska riktlinjer baserade på internationell standard, anpassade för svenska förhållanden.

  • 261.
    Lionis, Christos
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Univ Crete, Greece.
    Symvoulakis, Emmanouil K.
    Univ Crete, Greece.
    Markaki, Adelais
    Univ Crete, Greece; Univ Alabama Birmingham, AL USA.
    Petelos, Elena
    Univ Crete, Greece; Univ Maastricht, Netherlands.
    Papadakis, Sophia
    Univ Crete, Greece; Univ Ottawa, Canada; Univ Ottawa, Canada.
    Sifaki-Pistolla, Dimitra
    Univ Crete, Greece.
    Papadakakis, Maria
    Univ Crete, Greece; Technol Educ Inst Crete, Greece.
    Souliotis, Kyriakos
    Univ Peloponnese, Greece.
    Tziraki, Chariklia
    Melabey and Hebrew Univ, Israel.
    Integrated people-centred primary health care in Greece: unravelling Ariadnes thread2019In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 20, article id PII S1463423619000446Article in journal (Refereed)
    Abstract [en]

    The 40th anniversary of the World Health Organization Alma-Ata Declaration in Astana offered the impetus to discuss the extent to which integrated primary health care (PHC) has been successfully implemented and its impact on research and practice. This paper focuses on the experiences from Greece in implementing primary health care reform and lessons learned from the conduct of evidence-based research. It critically examines what appears to be impeding the effective implementation of integrated PHC in a country affected by the financial and refugee crisis. The key challenges for establishing integrated people-centred primary care include availability of family physicians, information and communication technology, the prevention and management of chronic disease and migrant and refugees health. Policy recommendations are formulated to guide the primary health care reform in Greece, while attempting to inform efforts in other countries with similar conditions.

  • 262.
    Liss, Per-Erik
    Linköping University, Department of Thematic Studies, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Fördelning, prioritering och ransonering av hälso- och sjukvård: en begreppsanalys2002Report (Other academic)
    Abstract [sv]

    I diskussioner om prioriteringar förekommer andra begrepp närbesläktade med begreppet prioritering såsom fördelning och ransonering. Likaså förekommer begreppet prioritering i ett flertal olika innebörder. Detta är otillfredsställande både ur handlings- och kommunikationssynpunkt. Enligt prioriteringsutredningen, och senare riksdagen, skall prioriteringsbesluten vägledas av vissa riktlinjer. Frågan blir då vilka beslut det är som skall räknas som prioriteringsbeslut. Syftet med denna skrift är att redovisa resultatet av en analys av begreppen fördelning, prioritering och ransonering.

    Begreppet fördelning. Med termen “fördelning” kan vi endera syfta på en process eller ett tillstånd. Processen kan innehålla en sammanhängande yttersta avsikt – ett resultat (resultatorienterad). Processen kan också vara av annan karaktär. Den kan vara slumpartad eller sakna sammanhängande avsikt (tillståndsorienterad). För att processen skall räknas som en fördelningsprocess där något fördelats mellan olika mottagare måste de tänkta mottagarna ingå i reflektionen över hur fördelningen skall ske. Detta ger oss följande formella definitioner av begreppet fördelning:

    • Processen P innebär en fördelning av X i den utsträckning P utförs i syfte att dela upp eller dela ut X mellan två eller flera mottagare.

    Förutom att syfta på en process kan vi syfta på ett tillstånd när vi använder termen “fördelning”. Vi betraktar då ett visst tillstånd ur fördelningssynpunkt.

    • Tillståndet T innebär en fördelning av X i den utsträckning delar av X tillfallit två eller flera, alternativt att X endast tillfallit en mottagare men delar av X kunde ha tillfallit ytterligare minst en mottagare.

    Begreppet prioritering. Kärnan i begreppet prioritering torde fångas av Nationalencyklopedins formulering ”ge företräde åt”. Beslutet att ge företräde åt något innebär ett val och kan ske genom att endera ”sätta före” eller ”säga nej”. Alla val utgör dock inte prioritering.

    För att ett val mellan olika alternativ skall räknas som en prioritering måste följande villkor vara uppfyllda:

    • alternativen måste alla vara övervägda,
    • valet innebär skapandet av en ordning mellan alternativen, och
    • ordningen måste skapas utifrån enhetligt prioriteringsobjekt.

    Det första villkoret innebär att endast medvetna val skall räknas som prioritering. Det andra villkoret berör beslutet att ”sätta före” eller ”säga nej”. Det sista villkoret innebär att ett val mellan t.ex. två patienter utgör prioritering endast om valet baseras på samma prioriteringsobjekt (vårdbehov, kostnadseffektivitet, etc.). Vart och ett av de tre villkoren är nödvändiga för att ett beslut skall räknas som en prioritering. Tillsammans utgör de tre villkoren en tillräcklig betingelse för att ett beslut skall räknas som en prioritering.

    Begreppet öppen prioritering. Analysen har utmynnat i följande förslag till definition av begreppet öppen prioritering.

    • En prioritering är öppen i den utsträckning prioriteringsbesluten, grunderna och resonemangen (inklusive förväntade konsekvenser) är tillgängliga för alla som önskar ta del av dem.

    Begreppet ransonering. Vi kan med termen ransonering syfta på både ett beslut och ett tillstånd.

    • Beslut B innebär en ransonering av vård i den utsträckning B fattas med insikten att vårdbehovet inte blir optimalt åtgärdat.
    • Tillstånd T utgör en ransonering i den utsträckning T innebär att vårdbehoven inte är optimalt åtgärdade.
    • Begränsning av vårdbehovets tillfredsställande utgör kärnan i ransoneringsbegreppet. Begränsningen kan ske på flera olika sätt. Vi kan därför tala om olika typer av ransonering.
    • Målransonering – en begränsning av behovsmålet, d.v.s. optimal hälsa kommer ej att uppnås.
    • Tidsransonering – t.ex. ökade väntetider för patienten, vilket betyder en begränsning av hur snabbt patientens vårdbehov blir åtgärdat.
    • Utspädning – glesare återbesök, sämre protestyper, personal med lägre utbildning, billigare läkemedel med sämre effekt eller med flera biverkningar än ett dyrare alternativ. Det handlar här om en begränsning av kvaliteten på åtgärderna.

    Besparing och satsning i relation till prioritering och ransonering. Besparing eller minskning av vårdutbud kan vara en vanlig form för ransonering. Men alla besparingar eller minskningar av vårdutbud innebär inte ransonering. Det kan t ex ibland handla om att anpassa utbudet till ett förändrat vårdbehovspanorama. En satsning på ett visst område kan ha förgåtts av ett prioriteringsbeslut. Men enbart beslutet att satsa resurser på ett område kan inte räknas som en prioritering.

  • 263.
    Liss, Per-Erik
    Linköping University, Department of Thematic Studies, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Fördelning, prioritering och ransonering av hälso- och sjukvård: en begreppsanalys2004Report (Other academic)
    Abstract [sv]

    I diskussioner om resursfördelning förekommer andra begrepp närbesläktade med begreppet prioritering som t ex ransonering, besparing eller utbudsminskning. Det händer ibland att termen prioritering används för att benämna samtliga aktiviteter som är aktuella vid fördelning av begränsade resurser. Begreppet prioritering förekommer dessutom i ett flertal olika innebörder. Denna oklara och mångtydiga användning av begreppet prioritering är otillfredsställande både ur handlings- och kommunikationssynpunkt. Enligt prioriteringsutredningen, och senare riksdagen, skall prioriteringsbesluten vägledas av de tre etiska riktlinjerna Människovärdesprincipen, Behovs- eller solidaritetsprincipen och Kostnadseffektivitetsprincipen. Frågan blir då vilka beslut det är som skall räknas som prioriteringsbeslut och därmed vägledas av riktlinjerna. Ur kommunikationssynpunkt är det viktigt med en enhetlig terminologi. När ett begrepp omedvetet används i olika betydelser blir följden ofta missförstånd, ofruktbara diskussioner och i slutändan minskad rationalitet i olika processer. Syftet med denna skrift är att redovisa resultatet av en analys av begreppen “fördelning”, “prioritering” och “ransonering”.

    Begreppet fördelning

    Resultatet av analysen av begreppet “fördelning” kan sammanfattas i några påståenden som finns förklarade i kapitlet om fördelning.

    • Med termen “fördelning” kan vi endera syfta på en process där något fördelas, eller på ett tillstånd som är resultatet av en process.
    • Det som fördelas kallas fördelningsobjekt.
    • Standardformen av fördelning som process innebär att det som utgör fördelningsobjekt delas upp och delas ut till olika mottagare som t ex sjukhus, vårdcentraler, kliniker eller patienter.
    • Avgörande kriterier för om beslut skall räknas som fördelning är att de är medvetna och mottagarna kända.
    • Processer kan vara av två slag – planerade eller oplanerade. Den planerade processen kännetecknas av att deltagarna i processen har en gemensam målsättning att komma fram till ett resultat. Den oplanerade processen kan innehålla moment av slump eller sakna sammanhängande målsättning.

    Med termen “fördelning” kan vi även syfta på ett tillstånd. Vi betraktar då ett visst tillstånd ur fördelningssynpunkt – hur det som utgör fördelningsobjektet är fördelat mellan olika mottagare. Vid denna användning av termen “fördelning” finns inga krav på att processen som leder fram till tillståndet innehåller medvetna val.

    Begreppet prioritering

    Kärnan i begreppet “prioritering” fångas av Nationalencyklopedins formulering “ge företräde åt”. Beslutet att ge företräde åt något eller någon innebär ett val baserat på en rangordning.

    Att prioritera innebär att rangordna eller välja ut.

    Rangordning är en central komponent i begreppet “prioritering”. Prioritering innebär också att utifrån rangordningen välja ut de alternativ som skall sättas före och åtgärdas framför de alternativ som skall senareläggas eller inte åtgärdas alls. Vi måste dock ställa vissa krav på rangordning respektive val för att de skall kunna räknas som prioritering. Resonemangen har lett fram till att följande villkor måste vara uppfyllda:

    • alternativen måste vara övervägda,
    • de måste vara relevanta.

    Det sista villkoret innebär att en rangordning mellan två alternativ utgör prioritering endast om bägge alternativen skulle ha kunnat komma ifråga. Bägge villkoren är nödvändiga för att ett beslut skall räknas som en prioritering. Tillsammans utgör villkoren en tillräcklig betingelse för att en rangordning skall räknas som en prioritering.

    Det som vi rangordnar eller prioriterar mellan, t ex olika sjukdomstillstånd, behandlingar, etc kommer att benämnas prioriteringsobjekt.

    Prioriteringskriterium är det som vägleder rangordningen. Det är vad vi prioriterar med avseende på och anges av de etiska riktlinjerna.

    Horisontella prioriteringar innebär val mellan t ex verksamhetsområden, kliniker eller sjukdomsgrupper. Vertikala prioriteringar innebär val mellan t ex sjukdomar inom en sjukdomsgrupp eller mellan olika behandlingsformer för en enskild patient.

    Öppen prioritering innebär att prioriteringsbesluten, grunderna och resonemangen är tillgängliga för alla som önskar ta del av dem.

    Begreppet ransonering

    Vi kan med termen “ransonering” syfta på både ett beslut och ett tillstånd.

    • Beslut B innebär en ransonering i den utsträckning B fattas med insikten att behovet inte blir optimalt åtgärdat.
    • Tillstånd T utgör en ransonering i den utsträckning T innebär att behoven inte är optimalt åtgärdade. Begränsning av behovets tillfredsställande utgör kärnan i ransoneringsbegreppet. Begränsningen kan ske på flera olika sätt. Vi kan därför tala om olika typer av ransonering.
    • Målransonering – en begränsning av behovsmålet, d v s optimal hälsa eller livskvalitet kommer ej att uppnås.
    • Bortval – vissa besvär, sjukdomar eller tillstånd av nedsatt livskvalitet blir inte alls att åtgärdade.
    • Tidsransonering – t ex ökade väntetider för patienten, vilket betyder en begränsning av hur snabbt patientens behov blir tillfredsställt.
    • Utspädning – glesare återbesök, sämre protestyper, personal med lägre utbildning, billigare läkemedel med sämre effekt eller med flera biverkningar än ett dyrare alternativ.
    • Indikationsförändringar – ökad försämring innan behovet åtgärdas.

    Besparing och satsning i relation till prioritering och ransonering

    Besparing eller minskning av vårdutbud kan vara en vanlig form för ransonering. Men alla besparingar eller minskningar av vårdutbud innebär inte ransonering. Det kan t ex ibland handla om att anpassa utbudet till förändrade behov hos befolkningen. En satsning på ett visst område kan ha förgåtts av ett prioriteringsbeslut. Men enbart beslutet att satsa resurser på ett område kan inte räknas som en prioritering.

  • 264.
    Liss, Per-Erik
    Linköping University, Department of Thematic Studies, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Målformuleringar och dess betydelse för prioriteringar i kommunal vård och omsorg: en pilotstudie2001Report (Other academic)
    Abstract [sv]

    Prioriteringar är nödvändiga även inom den kommunala hälso- och sjukvården. Enligt hälso- och sjukvårdslagen, som också omfattar den kommunala hälso- och sjukvården, skall prioriteringarna inom området utgå ifrån de tre etiska principerna människovärdesprincipen, behovs- och solidaritetsprincipen samt kostnadseffektivitetsprincipen. Tillämpningen av de båda senare principerna innebär en bedömning av vårdbehov respektive en värdering av åtgärdernas effekter. I bägge dessa tillämpningar har målet med verksamheten en avgörande betydelse. Både behovsbedömning och värdering av åtgärdernas utfall bör ske i relation till verksamhetens mål.

    Syftet med denna studie är att studera målformuleringar rörande kommunal vård och omsorg. Detta innebär att följande frågor kommer att besvaras: (1) Vilken karaktär har målformuleringarna, och (2) vilken begreppsapparat behövs för att analysera målen?

    Målformuleringar har studerats i följande dokument: Hälso- och sjukvårdslagen (HSL), Lag om stöd och service till vissa funktionshindrade (LSS), Socialtjänstlagen (SoL), Prioriteringsutredningens slutbetänkande, Nationella folkhälsokommitténs slutbetänkande, allmänna inriktningsmål för Norrköpings kommun, äldreomsorgsplaner i 5 kommuner i Östergötland samt plan för kommunsjukvården i Linköping.

    Målformuleringarna har analyserats med hjälp av en preliminär begreppsapparat, vilket ledda fram till följande slutsatser.

    • Hälsa och livskvalitet föreslås i en del sammanhang som mål för hälso- och sjukvården. Det förekommer ingen explicit definition av begreppen, men vi finner motstridiga antydningar hos några dokument. HSL anger ett vitt hälsobegrepp medan Prioriteringsutredningen använder ett smalt begrepp. Många målformuleringar i kommunala dokument betonar det allmänna eller det vanliga. Målet för verksamheten är t.ex. att ge individen möjlighet att leva som andra. Att kunna bo kvar i eget boende är ett annat viktigt mål för kommunal vård och omsorg.
    • Målformuleringarna anger i första hand den kvalitativa dimensionen. De svarar på frågan vad det är som skall uppnås. Men det förekommer även inslag av den kvantitativa dimension i termer av t.ex. god, skälig, ökad, minskad, främja eller stärka. Dock förekommer ingen precisering av dessa termer. Intressanta målformulering är dessutom de som sker i termer av ”största möjliga” eller ”så långt som möjligt”. Några av dem innehåller även en restriktion. Det heter t.ex. att verksamheten skall så långt möjligt anpassa insatserna till den enskildes önskemål. Det framgår dock inte av dokumentet exakt vad som utgör restriktionen eller dess omfattning. I något fall utgörs restriktionen av tillgängliga resurser. Den temporala dimensionen, d.v.s. inom vilken tidsram målet bör realiseras, är överhuvudtaget inte är nämnd i dokumenten.
    • Målen är genomgående vagt formulerade. Detta medför att de ger liten vägledning. Även om de är avsedda som inriktningsmål krävs en viss grad av precisering. Ett inriktningsmål som t.ex. ”ett gott liv för alla boende i kommunen” ger praktiskt taget ingen vägledning för val och beslut.
    • Vagheten hos målformuleringar ger intrycket att målen i första hand är avsedda att fylla en symbolisk eller motiverande funktion. I något fall är detta klart uttryckt i dokumentet.
    • Det förekommer både finala och instrumentella mål. I en del fall förekommer en mer eller mindre utvecklad målhierarki i andra fall endast ett finalt mål. Exempel på det senare utgör de båda lagarna HSL och LSS. Målet är där ”en god hälsa” respektive ”möjlighet att leva som andra”. Ett tydligt exempel på målhierarki förekommer hos Nationella folkhälsokommittén. Det finala målet är enligt kommittén ”lika möjligheter att fritt forma sitt liv”. Detta mål skall realiseras genom det instrumentella målet ”minskad ohälsa” vilken i sin tur skall realiseras genom förverkligandet av 18 instrumentella mål som kommittén kallar för ”nationella mål för folkhälsan”. De flesta av de kommuner som ingår i studien formulerar mål som hierarkier bestående av inriktningsmål samt delmål. I något fall anges även en viss arbetsfördelning mellan kommunens instanser. Fullmäktige antar inriktningsmål medan nämnderna formulerar och antar delmål.
    • Vården och omsorgen om vissa grupper av individer omfattas av ett flertal olika målformuleringar. Lagarna HSL, LSS, SoL innehåller alla formuleringar som berör målet för den kommunala hälso- och sjukvården mer eller mindre direkt. Dessutom har varje kommun utformat egna mål oftast framställda som hierarkier. Det är dock oklart hur relationen mellan dessa olika mål ser ut. Är målen förenliga eller är de i konflikt? Det tycks t.ex. finnas en spänning mellan det individuella och unika å ena sidan och det mer allmänna och vanliga å andra sidan.
    • Vagheten hos målformuleringarna och dess begränsning till kvalitativ och kvantitativ dimension gör dem mindre lämpliga som grund för precisering av behovsbegreppet och därmed som underlag för behovsbedömning. Det gör dem också mindre lämpade att utgöra grund för val av utfallsmått vid bedömning eller värdering av olika åtgärders effekter.
    • Pilotstudien har givit värdefulla erfarenheter för fortsatta och mera omfattande studier inom området. Studiet av målformuleringarna i centrala och kommunala dokument gav ytterligare stöd för kravet på en väl utarbetad begreppsapparat för att studera och analysera målsättningar. Fortsatta studier bör därför inkludera en teoretisk analys av målbegreppet och relaterade begrepp. Det innebär att utarbeta och föreslå en struktur för målanalys som också kan bli användbar i ett framtida empiriskt arbete.
  • 265.
    Liss, Per-Erik
    et al.
    Linköping University, Department of Department of Health and Society, Tema Health and Society. Linköping University, Faculty of Arts and Sciences.
    Nordin, Ingemar
    Linköping University, Department of Department of Health and Society, Tema Health and Society. Linköping University, Faculty of Arts and Sciences.
    Svensson, Tommy
    Linköping University, Department of Behavioural Sciences, Sociology. Linköping University, Faculty of Arts and Sciences.
    Målsättningar och verklighet – vård och omsorg i kommunal regi: Del I Mål och prioriteringar2006Report (Other academic)
    Abstract [sv]

    Hur bra är vården och omsorgen i kommunal regi? Det är en vidsträckt fråga där svaren åtminstone delvis måste vara av rent subjektiv karaktär. ”Bra” respektive ”dålig” är inga objektiva egenskaper som saker bara har, utan de är något som vi människor tillskriver dem genom att relatera till våra personliga värderingar. Det blir lite mer lätthanterligt ur vetenskaplig synvinkel om vi istället frågar oss hur vården och omsorgen lever upp till de målsättningar som verksamheten själv ställt upp.

    Att diskutera och utvärdera vården inom landstingen är ju något vi vant oss vid under de senare decennierna. Men idag sker det faktiskt en hel del vård i kommunernas regi. Inom kommunerna har man bland annat ett uppdrag att sköta äldrevården. Hur ser det ut där? Hur bra lever man upp till sina egna ofta mycket ambitiösa målsättningar? I den här rapporten kommer vi inte att kunna ge något uttömmande svar på hur verkligheten stämmer med idealen men den innehåller en hel del intressanta indikationer och ledtrådar.

    När vi – Per-Erik Liss, Tommy Svensson och undertecknad – diskuterade upplägget för det här projektet sade vi oss att det var viktigt att angripa problemet från två håll samtidigt; dels att titta närmare på kommunernas målsättningar, dels att dyka ned i verkligheten och försöka ta reda på hur omsorgen fungerar i praktiken. Uppgiften rörande målsättningarna var först och främst att ta reda på vilka de var och hur de var formulerade. Det var bl a väsentligt att se hur målen var relaterade ”uppåt”, d v s hur de stämmer överens med de mål och prioriteringar som görs på ett nationellt plan. Inte minst borde prioriteringsprinciperna i Hälso- och sjukvårdslagen vara central, inte bara för hur landstingen, utan även kommunerna väljer att fördela sina vårdresurser. I vilken mån spelar exempelvis rättviseprincipen om att fördela efter ”vårdbehov” en roll inom den kommunala sektorn? Och vad utgör ”behov” när det gäller äldre människor? Vad behövs det för hjälp för att vara gammal på ett bra sätt?

    En annan väsentlig fråga är hur de kommunala vård- och omsorgsmålsättningarna relaterar till varandra internt. Vilka är de övergripande målsättningarna och vilka är blott operativa mål eller delmål? Om det exempelvis fastställs ett delmål att hemtjänsten skall vara behjälplig med städning men inte med att sitta ned och prata så har det därmed bestämts att det förra är nödvändigare än det andra för att nå övergripande syften. Det har gjorts en bedömning att den första åtgärden bättre fyller ett väsentligt behov hos de äldre än den andra.

    Men hur har man gått tillväga för att komma fram till denna slutsats? Är det så säkert att de olika delmålen verkligen leder mot de stolta proklamationerna i den övergripande visionen? När vi sedan kontemplerade dykt ner i verkligheten så stod det ganska snart klart att det borde bli en djupdykning snarare än blott ett snorklande vid ytan. Det vill säga, vi skulle kanske inte se så mycket av den övergripande statistiken beträffande budgetar och antal människor under åtgärd. Men för att nå de intressanta skikten där vi kan hoppas på att få syn på enskilda människors, i synnerhet äldre människors, behov av vård, trygghet och värdighet så måste vi dyka på djupet. Vi måste lyssna på enskilda människors berättelser om vilka de är, hur de ser på sina liv och vad som är viktigt för dem. Det är ju först på denna nivå som vi kan börja förstå vilka problem och behov det finns, och hur dessa sedan kan relateras till vårdens och omsorgens målsättningar. Hur betydelsefull är överhuvudtaget den kommunala omsorgsservicen i en människas liv på äldre dagar?

    I detta sammanhang är det också viktigt att beakta det vi kan kalla för ”mellangruppens” erfarenheter, d v s de som har att implementera målen i sin verksamhet; vårdare, biträden och assistenter. Detta är en grupp som ofta hamnar i kläm mellan politiker och allmänhet. I sin dagliga gärning möter de människorna som behöver vård och omsorg. Samtidigt skall deras verksamhet bedrivas i enlighet med de direktiv och riktlinjer som politikerna ställt upp. Går dessa krav ihop? Hur bedömer vårdaren att han/hon kan möta upp mot de dubbla kraven? Deras observationer, erfarenheter och intressen skiljer sig tydligt från de båda andra gruppernas, det utgör ett eget perspektiv.

    När jag, vid slutet av projekttiden, sträckläste först Per-Eriks analytiska diskussion om mål och prioriteringar och sedan Tommys djupintervjuer med hemtjänstens vårdbiträden och gamla, hade jag en stark impuls att vi skulle låta studierna stå helt okommenterade. De utgör alla en del av verkligheten, och jämförelsen inbjuder till många frågor och tankar. Varför inte låta läsaren själv dra sina slutsatser? Hur går dessa vitt skilda bilder ihop?

    Men, trots allt är det här en vetenskaplig rapport och forskare bör kommentera och dra slutsatser. Det hör väl ändå till? Så Per-Erik gör några avslutande kommentarer där han jämför målsättningar med verklighet. Men dessa kommentarer är blott en liten hjälp på traven. Studien om de officiella målsättningarna å ena sidan och studierna av verksamheten bland personal och mottagare å den andra står på egna ben. Att läsa dem tillsammans ger en stark läsupplevelse och mycket att fundera vidare på.

  • 266.
    Luhr, Kristina
    et al.
    University Health Care Research Center, Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
    Eldh, Ann Catrine
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Uppsala University, Sweden.
    Nilsson, Ulrica
    Faculty of Medicine and Health, Örebro University, Sweden.
    Holmefur, Marie
    Faculty of Medicine and Health, Örebro University, Sweden.
    Patient preferences for patient participation: Psychometric evaluation of The 4Ps tool in patients with chronic heart or lung disorders2018In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 38, no 2, p. 68-76Article in journal (Refereed)
    Abstract [en]

    The Patient Preferences for Patient Participation tool (The 4Ps) was developed to aid clinical dialogue and to help patients to 1) depict, 2) prioritise, and 3) evaluate patient participation with 12 pre-set items reiterated in the three sections. An earlier qualitative evaluation of The 4Ps showed promising results. The present study is a psychometric evaluation of The 4Ps in patients with chronic heart or lung disease (n = 108) in primary and outpatient care. Internal scale validity was evaluated using Rasch analysis, and two weeks test–retest reliability of the three sections using kappa/weighted kappa and a prevalence- and bias-adjusted kappa. The 4Ps tool was found to be reasonably valid with a varied reliability. Proposed amendments are rephrasing of two items, and modifications of the rating scale in Section 2. The 4Ps is suggested for use to increase general knowledge of patient participation, but further studies are needed with regards to its implementation.

  • 267.
    Lund, Karin
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Socialstyrelsens nationella riktlinjer och kommunernas prioriteringar2015Report (Other academic)
    Abstract [en]

    In 2010 the National Board of Health and Welfare released its first national guidelines addressing health and social services for dementia. These differed from all previous guidelines in that they encompassed interventions from both health services and social services. Moreover, they included principles for setting priorities using ranked interventions. The intent of the guidelines is to support decision makers at the municipal, county council, and regional levels so they can deliver health and social services via transparent and systematic priority setting.

    The guidelines on health and social services for dementia have been followed by others, common to county councils and municipalities. Hence, both the municipalities and county councils have been given tools by which they should be able to establish priorities in a transparent and structured manner. If they follow the national guidelines, this should enable delivery of services based on scientific evidence and practice, allow better distribution of services based on need, and offer new ways for municipalities and county councils to collaborate.

    This was the starting point for the present interview study. Have the national guidelines led to transparent and structured priority setting?

    Representatives for five municipalities were interviewed primarily via telephone interviews, including chairs of social service boards (or corresponding) and directors of social services (in some cases unit directors).

    Three of the National Board of Health and Welfare guidelines were studied:

    • Health and social services for dementia, since 2011
    • Psychosocial interventions for schizophrenia or schizophrenia-like conditions, since 2001
    • Care for substance abuse and dependency, since 2014

    What these three guidelines have in common is that they encompass the activities of both the municipalities and the county councils.

    A general assessment of the expected effects of the studied guidelines on municipalities is that they lead to changes in at least five areas:

  • 268.
    Lund, Karin
    PrioriteringsCentrum.
    Öppna prioriteringar i kommunernas vård och omsorg?2003Report (Other academic)
    Abstract [sv]

    Denna rapport avser att ge bakgrunden till och analysera de principer och det arbete som styr kommunernas arbete med öppna prioriteringar inom vård och omsorg. Som ett underlag för arbetet med rapporten har intervjuer gjorts med företrädare för fem kommuner; Borlänge, Halmstad, Jönköping, Skurup och Trollhättan.

    Stora krav kommer att ställas på kommunernas vård och omsorg framöver. Medvetna och genomtänkta prioriteringar kommer att krävas. Andelen äldre växer och därmed kostnaderna för de insatser för vilka kommunerna har ansvaret. Ett stort behov av att rekrytera personal kan förutses. Prognoser visar att kommunernas ekonomiska resurser kommer att bli alltmer ansträngda.

    Kommunerna är numera sjukvårdshuvudmän. Genom olika reformer under 90-talet har kommunerna tagit på sig ett stort hälso- och sjukvårdsansvar. Samtidigt har landstingens sjukhusvård genomgått omfattande förändringar med alltmer öppna vårdformer, färre sjukhusplatser och kortare vårdtider. Kommunerna har fått alltmer kvalificerade uppgifter inom vård och omsorg.

    Som sjukvårdshuvudmän omfattas kommunerna av de särskilda regler om prioriteringar som numera finns i Hälso- och sjukvårdslagen. Denna säger att den som har det största behovet av hälso- och sjukvård ska ges företräde till vården. Huvudsakligen styrs emellertid kommunernas handlande på vård- och omsorgsområdet av Socialtjänstlagen. Deras arbete är mycket sammansatt och består av vård, omvårdnad, omsorg och social service. Att begränsa en analys endast till kommunernas ansvar att prioritera inom sin hälso- sjukvård blir därför alltför begränsat. Det gäller istället att diskutera vilka prioriteringsprocesser som bör utvecklas för kommunernas hela ansvarsområde för äldre- och funktionshindrade, d.v.s. både de verksamheter och insatser som syftar till att förebygga eller bota sjukdom och åtgärder för att lindra eller trösta vid tillstånd som inte kan botas, liksom olika former av stöd, service och andra insatser som bidrar till välfärd och välbefinnande.

    En fallbeskrivning har gjorts av en kommun som redovisar några av de svårigheter som kommunerna brottas med för att minska gapet mellan uttalade behov och tillgängliga resurser på ett genomtänkt och rättvist sätt.

    Rapporten visar att kommunerna inte har anammat de principer för öppna prioriteringar som riksdagsbeslutet om prioriteringar inom hälso- och sjukvården förutsätter. En förklaring kan vara att kommunerna av olika anledningar inte känt sig berörda av beslutet, en annan att kommunerna genom lagstiftningen i Socialtjänstlagen och i Lagen om stöd och service till vissa funktionshindrade har flera prioriteringsordningar att följa och att oklarheter finns om vilka behov, de sociala eller hälso- och sjukvårdsbehoven, som i första hand bör lyftas fram. Inte heller fungerar samverkan mellan kommuner och landsting kring prioritering av de grupper med komplexa och sammansatta vårdbehov för vilka dessa har ett gemensamt ansvar. Snarare tycks dessa grupper ha sämre tillgång till vård och omsorg än vad andra delar av befolkningen har.

    Kommunerna står fortfarande ganska oförberedda att ta itu med de krav på öppna prioriteringar som riksdagens beslut om prioriteringar utgår ifrån. De skulle behöva ta ett antal strategiska steg för att komma igång med att utveckla beslutsunderlag och prioriteringsprocesser liknande dem som nu är under utveckling på sina håll inom landstingens hälso- och sjukvård. Arbete t borde inriktas på att utveckla både de teoretiska och de praktiska delarna av hur prioriteringar ska göras inom den kommunala vården och omsorgen och i samverkan med landstingens vård och omsorg.

    Rapporten pekar ut några av de mått och steg som kommunerna skulle kunna ta för att öppna upp för en process som på sikt kan leda till mer öppna och accepterade prioriteringar inom sin vård- och omsorgsverksamhet:

    1. En mer genomgripande diskussion och framtagning av konkreta exempel skulle behövas om prioriteringsprinciper i kommunernas vård och omsorgsverksamhet liknande det arbete som gjordes av Prioriteringsutredningen inom hälso- och sjukvården.
    2. Kommunerna skulle behöva utveckla ett strategiskt tänkande och metoder för öppna prioriteringar inom sitt vård- och omsorgsområde.
    3. Kommunerna skulle behöva utveckla ett förtroendefullt samtal kring öppna prioriteringar mellan de berörda – mellan förtroendevalda, medborgare, vårdtagare och vårdverksamma.
    4. Kommuner och landsting skulle behöva utveckla principer och former för gemensamma prioriteringar - finansiellt, administrativt och i vårdvardagen.
  • 269.
    Lundberg, Johanna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Social status: a state of mind?2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis is concerned with social stratification of psychosocial factors and social position measurement in population samples collected in mid-Sweden 2000-2006. Traditional resource-based measures of social position (occupation, education) and so far less explored prestige-based measures (subjective status, status incongruence) are tested with respect to their associations with psychosocial factors, emotions, and selfrated health. Three papers in this thesis are based on data from the Life Conditions, Stress, and Health (LSH) study, using a randomly selected population sample. Data for the fourth paper is a regional sample drawn from the health-related survey “Liv och Hälsa 2000”. Statistical methods range from correlation analysis to logistic regression and repeated measures analyses.

    Results from studies I and IV show that psychosocial factors are unequally distributed within the population in a linear manner, so that the lower the socioeconomic position (SEP), the more unfavourable levels. This is independent of whether we study this in a highly unequal setting such as Russia, or in a more egalitarian society such as Sweden. The stability of psychometric instruments over two years tend to be lower for all instruments among low SEP groups, and differ significantly for self-esteem and perceived control among groups with high and low education, and for cynicism among groups with high and low occupational status. Results from studies II and III point to the relevance of individuals’ own thoughts about themselves, and the potential impact on the self by normative judgements of social position in a certain hierarchical setting. In paper II, the prestige-based measure of subjective status was influenced by resource-based measures, such as self-rated economy and education, but also by life satisfaction and psychosocial factors. The importance of self-evaluation was especially obvious from the study on status incongruence (study III) where the traditionally protective effecs of a high education seem to disappear when combined with a lowstatus occupation. Shaming experiences may play an important role here for our understanding of self-perception.

    List of papers
    1. Adverse health effects of low levels of perceived control in Swedish and Russian community samples
    Open this publication in new window or tab >>Adverse health effects of low levels of perceived control in Swedish and Russian community samples
    Show others...
    2007 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 7, no 314Article in journal (Refereed) Published
    Abstract [en]

    Background: This cross-sectional study of two middle-aged community samples from Sweden and Russia examined the distribution of perceived control scores in the two populations, investigated differences in individual control items between the populations, and assessed the association between perceived control and self-rated health.

    Methods: The samples consisted of men and women aged 45–69 years, randomly selected from national and local population registers in southeast Sweden (n = 1007) and in Novosibirsk, Russia (n = 9231). Data were collected by structured questionnaires and clinical measures at a visit to a clinic. The questionnaire covered socioeconomic and lifestyle factors, societal circumstances, and psychosocial measures. Self-rated health was assessed by standard single question with five possible answers, with a cut-off point at the top two alternatives.

    Results: 32.2 % of Swedish men and women reported good health, compared to 10.3 % of Russian men and women. Levels of perceived control were also significantly lower in Russia than in Sweden and varied by socio-demographic parameters in both populations. Sub-item analysis of the control questionnaire revealed substantial differences between the populations both in the perception of control over life and over health. Logistic regression analysis revealed that the odds ratios (OR) of poor self-rated health were significantly increased in men and women with low perceived control in both countries (OR between 2.61 and 4.26).

    Conclusions: Although the cross-sectional design does not allow causal inference, these results support the view that perceived control influences health, and that it may mediate the link between socioeconomic hardship and health.

    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-15548 (URN)10.1186/1471-2458-7-314 (DOI)
    Note
    Original Publication: Johanna Lundberg, Martin Bobak, Sofia Malyutina, Margareta Kristenson and Hynek Pikhart, Adverse health effects of low levels of perceived control in Swedish and Russian community samples, 2007, BMC Public Health, (7), 314. http://dx.doi.org/10.1186/1471-2458-7-314 Licensee: BioMed Central http://www.biomedcentral.com/ Available from: 2008-12-21 Created: 2008-11-17 Last updated: 2017-12-14Bibliographically approved
    2. Is Subjective Status Influenced by Psychosocial Factors?
    Open this publication in new window or tab >>Is Subjective Status Influenced by Psychosocial Factors?
    2008 (English)In: Social Indicators Research, ISSN 0303-8300, E-ISSN 1573-0921, Vol. 89, no 3, p. 375-390Article in journal (Refereed) Published
    Abstract [en]

    Objective Associations between subjective status and health are still relatively unexplored. This study aimed at testing whether subjective status is uniquely confounded by psychosocial factors compared to objective status, and what factors that may predict subjective status. Design A cross-sectional analysis of a population-based, random sample of 795 middle-aged men and women from the southeast of Sweden. Questionnaires included subjective status, objective measures of socioeconomic status, life satisfaction, and a battery of psychosocial factors. Associations were controlled for effects of age and sex. Results Both subjective status and occupation were significantly associated with self-rated health also after control for psychosocial factors. Stepwise regression showed that subjective status was significantly influenced by self-rated economy, education, life satisfaction, self-esteem, trust, perceived control, and mastery. Conclusion The association between subjective status and self-rated health does not seem to be uniquely confounded by psychosocial factors. Both resource-based measures and psychological dimensions seem to influence subjective status ratings. Comparative studies are required to study whether predictors of subjective status vary between countries with different socio-political profiles.

    Keywords
    Subjective status, Social status, Socioeconomic status, Psychosocial factors, Life satisfaction, Self-anchored ladder, Self-perceived status, Self-rated health, Psychological resources, Psychological risk factors
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-15549 (URN)10.1007/s11205-008-9238-3 (DOI)
    Note
    The original publication is available at www.springerlink.com: Johanna Lundberg and Margareta Kristenson, Is Subjective Status Influenced by Psychosocial Factors?, 2008, Social Indicators Research, (89), 3, 375-390. http://dx.doi.org/10.1007/s11205-008-9238-3 Copyright: Springer Science Business Media http://www.springerlink.com/ Available from: 2008-12-17 Created: 2008-11-17 Last updated: 2017-12-14Bibliographically approved
    3. Status incongruence revisited - associations with shame and mental well-being (GHQ)
    Open this publication in new window or tab >>Status incongruence revisited - associations with shame and mental well-being (GHQ)
    2009 (English)In: Sociology of Health and Illness, ISSN 0141-9889, E-ISSN 1467-9566, Vol. 31, no 4, p. 478-493Article in journal (Refereed) Published
    Abstract [en]

    Study purpose: Status incongruence has been related to poor health and all-cause mortality, and could be a growing public health problem due to changes in the labour market in later decades. Shaming experiences have been suggested as playing a part in the aetiology. Our aim was to study the risk for shaming experiences, pessimism, anxiety, depressive feelings, and poor mental well-being (GHQ) with a special focus on shame, in four status categories: negatively and positively incongruent individuals, and low-status and high-status congruent individuals.

    Method: Data comprised 14 854 working men and women from a regional sample of randomly selected respondents, 18-79 years. Logistic regression was used to study differences in risk for negative emotional outcomes. Results: The negative incongruent category persisted as the group most at risk for all negative emotional outcomes (OR 1.5-1.9; p<0.05-<0.001). When testing the risk for poor mental well-being among the status categories with and without shaming experiences, OR for all groups with shaming experiences were elevated. Among groups without shame, only the negative incongruent category remained at risk (OR 2.7; p<0.05) after adjustment.

    Conclusion: Negative incongruent status is associated with adverse emotional outcomes, among them shame, which is a previously unappreciated aspect of status incongruence.

    Keywords
    social status • public health • status incongruence • GHQ • shame • mental wellbeing
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-15550 (URN)10.1111/j.1467-9566.2008.01148.x (DOI)
    Note
    This is the author version of the following article: Johanna Lundberg, Margareta Kristenson and Bengt Starrin, Status incongruence revisited: associations with shame and mental wellbeing, 2009, SOCIOLOGY OF HEALTH and ILLNESS, (31), 4, 478-493. which has been published in final form at: http://dx.doi.org/10.1111/j.1467-9566.2008.01148.x Copyright: Blackwell Publishing Ltd http://www.blackwellpublishing.com/ Available from: 2009-06-10 Created: 2008-11-17 Last updated: 2017-12-14Bibliographically approved
    4. Does two-year stability for scale scores of psychosocial factors differ by socioeconomic position?
    Open this publication in new window or tab >>Does two-year stability for scale scores of psychosocial factors differ by socioeconomic position?
    2009 (English)In: Psychological Reports, ISSN 0033-2941, E-ISSN 1558-691X, Vol. 105, no 3, p. 1009-1022Article in journal (Refereed) Published
    Abstract [en]

    Previous longitudinal studies have demonstrated the importance of measuring stability of risk factors over time to correct for attenuation bias. The present aim was to assess the stability of scores for eight psychometric scales over a 2-yr. period and whether stability differed by socioeconomic position. Baseline data were collected during 2003–2004 from 1,007 men and women ages 45 to 69 years. Follow-up data were collected in 2006 from a total of 795 men and women. Analysis showed that stability over 2 yr. was moderate and tended to be lower in groups of low socioeconomic position. It is suggested that correction of attenuation bias is relevant in longitudinal studies for psychosocial factors, especially for groups of low socioeconomic position.

    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-15551 (URN)10.2466/PR0.105.F.1009-1022 (DOI)000274967100002 ()20229904 (PubMedID)
    Note

    Tidigare titel: Does 2-year stability of psychosocial factors differ by socioeconomic position? Original Publication: Johanna Lundberg, Nadine Karlsson and Margareta Kristenson, DOES TWO-YEAR STABILITY FOR SCALE SCORES OF PSYCHOSOCIAL FACTORS DIFFER BY SOCIOECONOMIC POSITION?, 2009, PSYCHOLOGICAL REPORTS, (105), 3, 1009-1022. http://dx.doi.org/10.2466/PR0.105.F.1009-1022 Copyright: Perceptual and Motor Skills http://www.ammonsscientific.com/ :Test-retest correlations of self-esteem, mastery, perceived control, sense of coherence, cynicism, hopelessness, vital exhaustion and depression in a middle-aged Swedish normal population

    Available from: 2008-11-17 Created: 2008-11-17 Last updated: 2017-12-14Bibliographically approved
  • 270.
    Lundberg, Johanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bobak, Martin
    International Institute for Society and Health, Department of Epidemiology and Public Health, UCL, London, UK.
    Malyutina, Sofia
    Institute of Internal Medicine, Russian Academy of Medical Sciences, Novosibirsk, Russia.
    Kristenson, Margareta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Pikhart, Hynek
    International Institute for Society and Health, Department of Epidemiology and Public Health, UCL, London, UK.
    Adverse health effects of low levels of perceived control in Swedish and Russian community samples2007In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 7, no 314Article in journal (Refereed)
    Abstract [en]

    Background: This cross-sectional study of two middle-aged community samples from Sweden and Russia examined the distribution of perceived control scores in the two populations, investigated differences in individual control items between the populations, and assessed the association between perceived control and self-rated health.

    Methods: The samples consisted of men and women aged 45–69 years, randomly selected from national and local population registers in southeast Sweden (n = 1007) and in Novosibirsk, Russia (n = 9231). Data were collected by structured questionnaires and clinical measures at a visit to a clinic. The questionnaire covered socioeconomic and lifestyle factors, societal circumstances, and psychosocial measures. Self-rated health was assessed by standard single question with five possible answers, with a cut-off point at the top two alternatives.

    Results: 32.2 % of Swedish men and women reported good health, compared to 10.3 % of Russian men and women. Levels of perceived control were also significantly lower in Russia than in Sweden and varied by socio-demographic parameters in both populations. Sub-item analysis of the control questionnaire revealed substantial differences between the populations both in the perception of control over life and over health. Logistic regression analysis revealed that the odds ratios (OR) of poor self-rated health were significantly increased in men and women with low perceived control in both countries (OR between 2.61 and 4.26).

    Conclusions: Although the cross-sectional design does not allow causal inference, these results support the view that perceived control influences health, and that it may mediate the link between socioeconomic hardship and health.

  • 271.
    Lundberg, Johanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Karlsson, Nadine
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Does two-year stability for scale scores of psychosocial factors differ by socioeconomic position?2009In: Psychological Reports, ISSN 0033-2941, E-ISSN 1558-691X, Vol. 105, no 3, p. 1009-1022Article in journal (Refereed)
    Abstract [en]

    Previous longitudinal studies have demonstrated the importance of measuring stability of risk factors over time to correct for attenuation bias. The present aim was to assess the stability of scores for eight psychometric scales over a 2-yr. period and whether stability differed by socioeconomic position. Baseline data were collected during 2003–2004 from 1,007 men and women ages 45 to 69 years. Follow-up data were collected in 2006 from a total of 795 men and women. Analysis showed that stability over 2 yr. was moderate and tended to be lower in groups of low socioeconomic position. It is suggested that correction of attenuation bias is relevant in longitudinal studies for psychosocial factors, especially for groups of low socioeconomic position.

  • 272.
    Lundberg, Johanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Is Subjective Status Influenced by Psychosocial Factors?2008In: Social Indicators Research, ISSN 0303-8300, E-ISSN 1573-0921, Vol. 89, no 3, p. 375-390Article in journal (Refereed)
    Abstract [en]

    Objective Associations between subjective status and health are still relatively unexplored. This study aimed at testing whether subjective status is uniquely confounded by psychosocial factors compared to objective status, and what factors that may predict subjective status. Design A cross-sectional analysis of a population-based, random sample of 795 middle-aged men and women from the southeast of Sweden. Questionnaires included subjective status, objective measures of socioeconomic status, life satisfaction, and a battery of psychosocial factors. Associations were controlled for effects of age and sex. Results Both subjective status and occupation were significantly associated with self-rated health also after control for psychosocial factors. Stepwise regression showed that subjective status was significantly influenced by self-rated economy, education, life satisfaction, self-esteem, trust, perceived control, and mastery. Conclusion The association between subjective status and self-rated health does not seem to be uniquely confounded by psychosocial factors. Both resource-based measures and psychological dimensions seem to influence subjective status ratings. Comparative studies are required to study whether predictors of subjective status vary between countries with different socio-political profiles.

  • 273.
    Lundberg, Johanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Starrin, Bengt
    Department of Social Sciences, Karlstad University, Sweden.
    Status incongruence revisited - associations with shame and mental well-being (GHQ)2009In: Sociology of Health and Illness, ISSN 0141-9889, E-ISSN 1467-9566, Vol. 31, no 4, p. 478-493Article in journal (Refereed)
    Abstract [en]

    Study purpose: Status incongruence has been related to poor health and all-cause mortality, and could be a growing public health problem due to changes in the labour market in later decades. Shaming experiences have been suggested as playing a part in the aetiology. Our aim was to study the risk for shaming experiences, pessimism, anxiety, depressive feelings, and poor mental well-being (GHQ) with a special focus on shame, in four status categories: negatively and positively incongruent individuals, and low-status and high-status congruent individuals.

    Method: Data comprised 14 854 working men and women from a regional sample of randomly selected respondents, 18-79 years. Logistic regression was used to study differences in risk for negative emotional outcomes. Results: The negative incongruent category persisted as the group most at risk for all negative emotional outcomes (OR 1.5-1.9; p<0.05-<0.001). When testing the risk for poor mental well-being among the status categories with and without shaming experiences, OR for all groups with shaming experiences were elevated. Among groups without shame, only the negative incongruent category remained at risk (OR 2.7; p<0.05) after adjustment.

    Conclusion: Negative incongruent status is associated with adverse emotional outcomes, among them shame, which is a previously unappreciated aspect of status incongruence.

  • 274.
    Lundin, Christina
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Organizing Language Interpreting Services in Elderly and Emergency Healthcare2018Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    With an increasing migrant population there is a growing need to organize interpreting practices in healthcare in order to deliver equitable high-quality care.

    This thesis focuses on healthcare institutions’ organization of interpreting services. The aim of the study was to explore interpreting practices in a healthcare context by comparing two different healthcare areas – elderly and emergency healthcare. The study aimed to highlight the impact of the organizational and institutional context.

    This study was designed as an explorative and descriptive qualitative study including 79 healthcare professionals with experience of interpreting practices recruited via purposeful sampling in elderly and emergency healthcare. Data were collected through individual and focus-group interviews and analysed with inductive qualitative content analysis.

    The main findings show that the processes and structures around interpreting practices were complex and mainly linked to individual and interpersonal levels and, to a limited extent, to the institutional level. On the institutional level the Public Procurement Act was the only formal policy to follow. On individual and interpersonal level interpreting practices were structured by self-established informal workplace routines developed by the professional groups. The norms and routines used was determined by access to interpreters, time aspects, characteristics of the care given, health conditions and the person’s problem, expectations and requests from the person and also from healthcare professionals. There were wishes for improvement, with better flexibility in access to professional interpreters, training for users and interpreters, and also better technical solutions and equipment.

    In conclusion, the use of interpreters was rooted in the organizational environment of interpreting practice, including the availability of laws, policy and guidelines, and closely related to individuals’ language skills, cultural values and social factors. The use of professional interpreters was based on the nature of care in context and access to interpreters and determined by health professionals’ estimation of the person’s current health status in order to deliver fast and individualized care based on humanistic values.

    Thus, it is important to consider organizational framework and cultural awareness when formulating interpreting practices adapted to the context, and formal guidelines in order to achieve the aim of personcentered and equal health care.

    List of papers
    1. Boundaries and conditions of interpretation in multilingual and multicultural elderly healthcare
    Open this publication in new window or tab >>Boundaries and conditions of interpretation in multilingual and multicultural elderly healthcare
    2015 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 15, no 458Article in journal (Refereed) Published
    Abstract [en]

    Background: Elderly migrants who do not speak the official language of their host country have increased due to extensive international migration, and will further increase in the future. This entails major challenges to ensure good communication and avoid communication barriers that can be overcome by the use of adequate interpreter services. To our knowledge, there are no previous investigations on interpreting practices in multilingual elderly healthcare from different healthcare professionals perspectives. This study examines issues concerning communication and healthcare through a particular focus on interpretation between health professionals and patients of different ethnic and linguistic backgrounds. The central aim of the project is to explore interpretation practices in multilingual elderly healthcare. Methods: A purposive sample of 33 healthcare professionals with experience of using interpreters in community multilingual elderly healthcare. Data were collected between October 2013 and March 2014 by 18 individual and four focus group interviews and analysed with qualitative content analysis. Results: The main results showed that interpreting practice in multilingual elderly healthcare was closely linked to institutional, interpersonal and individual levels. On the organizational level, however, guidelines for arranging the use of interpreters at workplaces were lacking. Professional interpreters were used on predictable occasions planned long in advance, and bilingual healthcare staff and family members acting as interpreters were used at short notice in everyday caring situations on unpredictable occasions. The professional interpreter was perceived as a person who should interpret spoken language word-for-word and who should translate written information. Furthermore, the use of a professional interpreter was not adapted to the context of multilingual elderly healthcare. Conclusion: This study found that interpreter practice in multilingual elderly healthcare is embedded in the organizational environment and closely related to the individuals language skills, cultural beliefs and socio-economic factors. In order to formulate interpreter practice in the context of multilingual elderly healthcare it is important to consider organizational framework and cultural competence, cultural health knowledge, beliefs and customs.

    Place, publisher, year, edition, pages
    BIOMED CENTRAL LTD, 2015
    Keywords
    Ethnicity; Multilingual elderly healthcare; Interpretation; Interpretation practices; Organization
    National Category
    Sociology
    Identifiers
    urn:nbn:se:liu:diva-122194 (URN)10.1186/s12913-015-1124-5 (DOI)000362254600001 ()26444009 (PubMedID)
    Note

    Funding Agencies|Vetenskapsradet (The Swedish Research Council), Sweden [521-2013-2533]

    Available from: 2015-10-26 Created: 2015-10-23 Last updated: 2018-02-20
  • 275.
    Lundqvist, Martina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Alwin, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Henriksson, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    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 trial2018In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 18, article id 32Article in journal (Refereed)
    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.

  • 276.
    Lundqvist, Martina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Hälsoekonomisk analys av hemtandvård jämfört med tandvård på stationära kliniker för äldre vid särskilda boenden2013Report (Other academic)
    Abstract [en]

    Background: The number and age of the elderly population in Sweden is increasing, and the cost of dental care is expected to increase  substantially during the next decades. Improved dental status among elderly, has led to a majority of elderly with most of their own teeth relatively intact, often in combination with dental restorations, or prosthetics (e.g. crowns, bridges, dental implants). Ageing leads to increased morbidity, and hospitalization or dependence on the care of others lead to a risk for severe deterioration of oral health. The county councils subsidize dental care for elderly nursing home residents in Sweden. Elderly nursing home residents are entitled to limited dental care, for the same fixed patient fee as in outpatient health care. The patient is free to choose provider of dental care. Dental care is usually offered at stationary dental clinics, but domiciliary dental care is an alternative.

    Purpose: The aim was to analyze economic consequences of domiciliary dental care, compared to dentistry at a stationary clinic, for elderly nursing home residents in Sweden.

    Methods: Nursing home staff, officials at county councils, and academic experts in geriatric dentistry, were interviewed. Cost analyses and costeffectiveness analyses were done. The market of dental care was analyzed from a societal perspective, to identify aspects of importance for the choice of stationary clinic or domiciliary dental care for elderly nursing home residents. Risks of asymmetric information between the involved participants (i.e. county council, dental care providers, municipalities, nursing homes, and patients) were analyzed, together with respective incentives to gain benefits.

    Results: For elderly nursing home residents the mean societal cost of domiciliary dental care was lower compared to dental care at stationary dental clinic. Domiciliary dental care was expected to increase the quality of life, and was cost effective compared to dental care at a stationary clinic.

    Conclusions: Domiciliary dental care has lower societal cost, is expected to improve the quality of life, and is cost-effective compared to dental care at stationary clinics, for elderly nursing home residents in Sweden. Since the prerequisites for seeking dental care among the elderly differ, it is important that dental care can be provided at different settings. Increased collaboration between the involved participants is needed in order to improve the efficiency and cost-effectiveness of dental care for elderly nursing home residents.

  • 277.
    Lundqvist, Martina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Ordell, Sven
    Region Östergötland, Public Dental Health Care.
    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 Sweden2015In: Community Dental Health, ISSN 0265-539X, Vol. 32, no 1, p. 39-43Article in journal (Refereed)
    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.

  • 278.
    Lundqvist, Martina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Ennab Vogel, Nicklas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Effects of eating breakfast and school breakfast programmes on children and adolescents: a systematic review2018Report (Other academic)
    Abstract [en]

    Background: Breakfast is often described as the most important meal of the day. The regularity of wholesome, daily meal patterns comprised of healthy foods is important for the physical and mental development of children and adolescents. One way to make sure that children and adolescents eat breakfast on a regular basis is to serve it at school. Several published reviews have examined the effects of eating breakfast and studied effects of school breakfast programmes on children and adolescents. Informed decisions of whether to promote eating breakfast or to introduce a school breakfast programme require a broader perspective.

    The aim was to conduct a systematic review of scientific publications that study the effects potentially relevant for economic evaluations of eating breakfast or implementing school breakfast programmes for children and adolescents.

    Method: In the systematic literature review, studies were identified by searching the electronic databases PubMed, CINAHL, Web of Science and PsycINFO from January 2000 through October 2017. The following inclusion criteria guided the selection of the identified studies: published articles from peer-reviewed journals with full text in English, studies collecting primary data, quantitative studies, studies performed in countries comparable to Sweden in terms of access and quality of nutrients, economic and social conditions and publications studying at least one of the topics; academic achievement, quality of life and wellbeing, risk factors/morbidity or cognitive performance.

    Results: Twenty-six studies on eating breakfast and eleven studies on school breakfast programmes fulfilled the inclusion criteria and were judged to be of at least moderate quality were included in the analysis. The results of the review of studies on eating breakfast showed positive and conclusive effects on cognitive performance, academic achievement, quality of life, well-being and risk factors/morbidity. This indicates that eating breakfast is important. The results of the studies on school breakfast varied. Minor positive effects were seen on cognitive performance and academic achievement. Most studies showed no effects and all studies suffered from different methodological weaknesses.

    Conclusions: The overall assessment of the studies on eating breakfast indicated positive effects. The studies on school breakfast programmes showed minor positive effects, but the majority of the studies showed no effects and all studies suffered from different methodological weaknesses. In order to assess the cost-effectiveness of eating breakfast and of school breakfast programmes we need to know more about how the identified affects influence the societal cost and the individuals gain in quality-adjusted life years both in the short and the long term.

  • 279.
    Lundvall, Lise-Lott
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Radiography in Practice: Work and Learning in Medical Imaging2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Those following the profession of radiographer mainly work in the healthcare sector, with image production in medical imaging or with radiotherapy treatments. Radiographers are responsible for patient care and handling technology in this profession al field. Radiographers’ practice is interesting to study in relation to technical developments and changing conditions for performing professional work.

    The general aim of this thesis was to empirically explore the main features of radiographers’ work, how advances in tech n ology affect radiographers’ practice, interconnections with other practices and students learn in g in practice on the way to becoming professionals.

    Methods: Data was collected using interviews and observations (Papers I, II & IV). For Paper III, individual interviews were conducted. Data was analysed using a phenomenological interpretative method (Paper I) and practice theory perspective (Papers II–IV).

    Findings: Radiographers’ professional work with image production was seen as a process comprising three phases: planning the examination, producing the images, and evaluating the images. During this process, radiographers make judgements to ensure patient safety and adapt the technology in use to the individual patient. When conventional imaging techniques are converted into examinations performed by Computer Tomography, the planning phase of radiographers’ work process becomes more important. Technology improvements also mean that the technical aspects of radiographers’ work with image production are easier to foresee in scheduling examinations. The caring aspects however are difficult to plan for because of little information about the patient before the examination. The professional practices involved in medical imaging interconnect to ensure patient safety through materiality and common tasks and/ or projects. The content and quality of two artefacts, the referral and the image, in these interconnections are important in collaborative work to ensure patient safety within medical imaging. Radiography students learn professional knowing in practice i.e. practice-as-work, practice-as language and practice-as-morality, during their clinical placements through alternating between two modes of participation: either observing and listening or acting by themselves. The students developed knowing in practice if the other practitioners allowed them to alternate between these two modes of participation.

    Implications: The description of radiographers’ general tasks an d responsibilities in a work process can be used for both educational and professionalization purposes. The identified interconnections between involved professions are useful for quality improvement to secure patient safety. The findings about development of knowing in practice can be used in the planning and evaluation of clinical placements for students.

    List of papers
    1. Professionals' experiences of imaging in the radiography process – A phenomenological approach
    Open this publication in new window or tab >>Professionals' experiences of imaging in the radiography process – A phenomenological approach
    2014 (English)In: Radiography, ISSN 1078-8174, E-ISSN 1532-2831, Vol. 20, no 1, p. 48-52Article in journal (Refereed) Published
    Abstract [en]

    Introduction

    Previous studies on radiographers' professional work have shown that this practice covers both technology and patient care. How these two competence areas blend together in practice needs to be investigated. The professionals' experiences of their work have not been studied in depth, and there is a need to focus on their experiences of the main features of their practice.

    The aim

    To explore, from the perspective of the radiographer, the general tasks and responsibilities of their work.

    Method

    Data were generated through a combination of open interviews with radiographers and observations of their work with Computer Tomography (CT) and Magnetic Resonance Imaging (MRI). The interviews and observations were analysed using an interpretative phenomenological method.

    Result

    Radiographers' professional work with diagnostic imaging, in a Swedish context, can be viewed as a problem-solving process involving judgments and responsibility for obtaining images that can be used for diagnosis. The examination process comprises three phases; planning, producing the images, and evaluation. In the first phase the radiographer makes judgments on adapting the method to the individual patient, and the second phase involves responsibilities and practical skills for image production. In the third phase, the quality of the images is judged in relation to the actual patient and the imaging process itself.

    Conclusions

    Radiographers consider that the main features of their professional work are patient safety aspects and their knowledge and skills regarding how to produce images of optimal quality, in the actual circumstances of each examination.

    Place, publisher, year, edition, pages
    Elsevier, 2014
    Keywords
    Radiography process, Radiographer, Phenomenology, Diagnostic radiography
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-103181 (URN)10.1016/j.radi.2013.10.002 (DOI)2-s2.0-84891740515 (Scopus ID)
    Available from: 2014-01-14 Created: 2014-01-14 Last updated: 2019-03-06Bibliographically approved
    2. How do technical improvements change radiographers’ practice: a practice theory perspective
    Open this publication in new window or tab >>How do technical improvements change radiographers’ practice: a practice theory perspective
    2015 (English)In: Radiography, ISSN 1078-8174, E-ISSN 1532-2831, Vol. 21, no 3, p. 231-235Article in journal (Refereed) Published
    Abstract [en]

    Introduction: Technical improvements in medical imaging have led to the replacement of two-plane imaging techniques by multidimensional imaging. How this affects radiographers’ professional practice has not been investigated.

    Aim: To explore how technical development affects the relations between different actors and their actions in the practice of computed tomography.

    Method: A qualitative design was used with data collection by open interviews (n=8) and open observations (n=10) of radiographers during their work with computed tomography. Data was first analysed inductively, resulting in seven preliminary codes. The initial analysis was followed by a phase of abduction, in which the preliminary codes were interpreted theoretically through the lens of practice theory. This resulted in four final themes.

    Result: First theme: Changed materiality makes practical action easier. The actual image production has become practically easier. Second theme: New machines cause conflict between the structural arrangements of the work and the patient’s needs. The time required for the scanner to carry out image production is easy to foresee, but information about the patient’s individual status and needs is missing and this leads to difficulties in giving individual planned care. Third theme: Changing materiality prefigures learning. The different apparatus in use and the continuously changing methods of image production are coconstitutive of the practitioner’s activities and learning. Fourth theme: How the connections between different practices lead to moments of practical reasoning in the radiography process with CT. The practice of image production with computed tomography takes account of patient safety in relation to radiation doses and medical security risks. The different professions in CT practice are interconnected through common material objects such as computers and machines. However, the radiographers, who meet the patients, have to check the accuracy of the planned examination in relation to the clinical observed information about patient safety risks during the examination.

    Place, publisher, year, edition, pages
    Elsevier, 2015
    Keywords
    Practice, Radiographer, Radiography, Practice theory
    National Category
    Radiology, Nuclear Medicine and Medical Imaging
    Identifiers
    urn:nbn:se:liu:diva-111721 (URN)10.1016/j.radi.2014.12.002 (DOI)
    Note

    When defending the Ph.D. thesis the status of this article was Manuscript.

    Available from: 2014-10-29 Created: 2014-10-29 Last updated: 2019-03-06Bibliographically approved
  • 280.
    Lyth, Johan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regional Board, Research and Development Unit.
    Lind, Leili
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Persson, Hans L.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Respiratory Medicine.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regional Board, Research and Development Unit.
    Can a telemonitoring system lead to decreased hospitalization in elderly patients?2019In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, article id UNSP 1357633X19858178Article in journal (Refereed)
    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.

  • 281.
    Lämås, Kristina
    et al.
    Institutionen för omvårdnad, Umeå Universitet.
    Jacobsson, Catrine
    Institutionen för omvårdnad, Umeå Universitet.
    Sjuksköterskors resonemang om patientnära prioriteringar: en intervjustudie2004Report (Other academic)
    Abstract [sv]

    I varje möte mellan vårdare och patient finns prioriteringar i form av hur mycket tid som ska avsättas och med vilken kompetens patienten ska mötas, vilka insatser som ska göras och i vilken utsträckning. Liten uppmärksamhet har riktats mot de konkreta prioriteringsbeslut som bland annat sjuksköterskor gör i den dagliga omvårdnaden. Dessa prioriteringar kan dock ha stor betydelse för den enskilde vårdtagarens upplevelser av kvalitet i vården.

    Sammanlagt genomfördes 20 intervjuer i två landsting, Västerbotten och Norrbottens läns landsting. För att få så stor mångfald från olika vårdverksamheter som möjligt representerade respondenterna både tekniktäta arbetsplatser, arbetsplatser där teknisk utrustning är sparsamt förekommande, män och kvinnor samt att personerna av arbetsledare bedömdes ge god omvårdnad. I varje landsting genomfördes intervjuer med tre avdelningschefer och fem erfarna sjuksköterskor verksamma inom somatisk sjukhusvård samt med två erfarna sjuksköterskor i primärvård.

    Inledningsvis ombads respondenten att fritt berätta om sina upplevelser av prioriteringar i allmänhet och egna erfarenheter av prioriteringar i vårdarbetet. Dessutom ställdes frågor utifrån en frågeguide om respondentens syn på sin delaktighet i prioriteringar, kännedom om begreppet öppna prioriteringar, vinster och hinder för öppna prioriteringar och kännedom omprioriteringsutredningen.

    Alla intervjuer genomfördes på respondenternas egna arbetsplatser under våren 2003. Intervjuerna bandades och skrevs ut i sin helhet och i analysarbetet användes kvalitativ innehållsanalys. Metoden innebär en stegvis process med noggrann genomläsning och analys genom kodning och tematisering av intervjutexten utifrån syftet.

    I sjuksköterskornas berättelser framkom att prioritering i det dagliga vårdarbetet innefattar att göra en mängd val och att skapa en arbetsordning. Hela arbetssituationen beskrevs bestå av prioriteringsbeslut. Många uttryckte dock att prioriteringsbesluten är intuitiva och fattas automatiskt och omedvetet och de har därför svårt att berätta hur de går tillväga för att fatta besluten. Trots detta fanns en mängd omständigheter i den aktuella situationen beskrivna som förefaller bilda ett beslutsunderlag för prioriteringsbeslutet. Sjuksköterskorna beskrev också att de använder sin personliga kunskap när beslutet ska fattas. Prioriteringsbeslutet beskrevs präglas av den utbildning sjuksköterskan har tillsammans med inskolningen på arbetsplatsen och gemensamma diskussioner med kollegor. Det framkom även att en känsla för vad som borde prioriteras hade betydelse för prioriteringsbeslut.

    Avsaknad av politiskt stöd i prioriteringsarbetet beskrevs och det fanns även en beskrivning av hur administrativa beslut försämrar omvårdnaden. Sjuksköterskorna berättade hur de för att klara av prioriteringsarbetet på olika sätt söker stöd både hos varandra inom sjuksköterskegruppen och hos personer tillhörande andra yrkesgrupper. Att prioritera beskrevs både som en utmaning och som en börda. En osäkerhet över vad som är rätt prioritering, att inte räcka till för allt och alla, att möta ilska och besvikelse från patienter beskrevs som svårigheterna med prioriteringarna. Prioriteringar framställdes också som att det orsakar konflikter både inom sjuksköterskan, mellan olika personalgrupper och mellan kliniker.

    Sjuksköterskorna beskrev tre olika roller vid patientnära prioriteringar; en självständig roll, en samrådande roll och en osjälvständig roll. I den självständiga rollen beskrevs hon själv fatta prioriteringsbeslut och i den samrådande rollen tas besluten tillsammans med andra i vårdteamet. I den osjälvständiga rollen framställdes sjuksköterskan som underordnad andras prioriteringsbeslut eller att sjuksköterskan kände sig styrd av de förutsättningar som finns i den aktuella situationen. Rollerna framstår som mer situationsberoende än personberoende och samma sjuksköterska kunde beskriva flera roller.

    När det gäller att använda öppna prioriteringar beskrevs det som ett möjligt stöd men risker lyfts också fram. Öppna prioriteringar kan ge stöd i prioriteringsarbetet om arbetsbelastningen är hög eller om det är oerfaren personal. Riskerna beskrevs bestå i att de öppna prioriteringarna kan bli för styrande så att nödvändig flexibilitet kan gå förlorad och den enskilde patienten kan komma i kläm. Det finns också en risk att de ökar stressen hos personalen när omständigheter i den aktuella situationen gör att riktlinjen inte kan följas.

    Prioriteringsprinciperna förefaller vara accepterade men det framkom behov av diskussioner om hur de generella principerna ska kunna tillämpas konkret i verksamheterna. När det gäller begreppet kostnadseffektivitet uttryckte några att det är nödvändigt att mäta kostnader och effekter. Några uppfattade kostnadseffektivitetsbegreppet som ett rent ekonomiskt begrepp och misstänksamhet och i vissa fall motstånd riktades mot utförandet av kostnadseffektivitetsberäkningar inom hälso- och sjukvården.

    Studien visar att det finns ett stort behov av att diskutera konkreta prioriteringar i det dagliga vårdarbetet och utveckla gemensamma principer. På så sätt skulle möjligheten öka att patientnära prioriteringsbeslut i större utsträckning fattas på övertänkta och genomarbetade beslutsunderlag. Detta kanske också kunde bidra till det stöd som beskrivs saknas idag. Studien pekar också på att det finns oklarheter i förståelsen av de etiska principerna i hälso- och sjukvårdslagen och då särskilt när det gäller principen om kostnadseffektivitet. Därmed finns anledning att lyfta och diskutera de centrala etiska principerna i mer konkreta termer.

    Ytterligare studier behövs som syftar till att undersöka hur arbetet med riktlinjer för prioriteringar inom omvårdnad konkret skulle kunna bedrivas. För att formulera riktlinjer behöver vi definiera lämpliga omvårdnadsområden med tillhörande omvårdnadsmetoder och dess effekter. Detta är en stor utmaning men skulle troligen kunna bidra med det stöd som efterfrågas av omvårdnadspersonal. Huruvida riktlinjer för prioriteringar också skulle bidra till ökad effektivitet och mera rättvis vård återstår att visa.

  • 282.
    Lämås, Kristina
    et al.
    Institutionen för omvårdnad, Umeå Universitet.
    Jacobsson, Catrine
    Institutionen för omvårdnad, Umeå Universitet.
    Lindholm, Lars
    Institutionen för omvårdnad, Umeå Universitet.
    Engström, Birgitta
    Institutionen för omvårdnad, Umeå Universitet.
    Hinder och möjligheter att använda hälsoekonomiska analyser inom omvårdnad: en litteraturstudie2004Report (Other academic)
    Abstract [sv]

    Prioriteringar är och kommer också fortsättningsvis att vara nödvändiga. Det finns ett växande gap mellan å ena sidan allt som kan göras och de vårdbehov som finns och å andra sidan tillgängliga resurser inom hälso- och sjukvårdsområdet. Prioriteringsutredningen har presenterat generella riktlinjer i en ”etisk plattform” som ska ligga till grund för en öppen diskussion om hur prioriteringar ska genomföras. Utredningen har dock mött kritik från omvårdnadshåll där man menar att utredningen har ett övervägande biomedicinskt perspektiv och i lägre grad berör de ställningstaganden som dagligen sker inom omvårdnadsområdet.

    När prioriteringar ska genomföras kan principen om kostnadseffektivitet vara en del i beslutsunderlaget och för detta krävs lämpliga utvärderingsmodeller. För att belysa vad som har studerats inom omvårdnad när det gäller effekter och kostnader genomfördes sökningar i databaserna CINAHL och MEDLINE. Sökningarna gjordes från år 1993 och framåt. Sökorden var; “nursing”, “nursing care”, “nursing intervention”, “effect of nursing”, “nursing outcome”, “cost analysis”, “cost effective”, “cost effectiveness”, “outcome”, “measure”, “cost measure”, “health economic”, “cost utility” och “cost benefit” var för sig och i olika kombinationer. Femtiosju artiklar bedömdes vara relevanta utifrån uppsatta kriterier och ordnades i åtta domäner utifrån vad som varit i fokus för utvärdering. Av de femtiosju artiklarna bedömdes nio studier använda sig av hälsoekonomiska analysmetoder. Det var olika typer av hälsoekonomiska analysmetoder varav en använde sig av kostnadsnyttoanalys (CUA). Kostnadsnyttoanalys tillämpades när det gällde utvärdering av specifik omvårdnad för personer med ätsvårigheter efter stroke. Analysmetoden (QALY) befanns vara möjlig att tillämpa inom specifik omvårdnad men bedömdes inte vara optimal med avseende på synen på hälsa och hälsomaximering.

    Syftet med föreliggande litteraturstudie var att belysa möjligheter och hinder för att utvärdera kostnadseffektivitet av omvårdnadsinsatser med hälsoekonomiska analysmetoder.

    Då studien om hälsoekonomisk analys av ätträning endast berörde specifik omvårdnad men inte allmän omvårdnad beskrevs begreppen närmare för att belysa om det föreligger en skillnad som påverkar behovet av hälsoekonomisk analys. Begreppen beskrevs utifrån socialstyrelsens definition. Dock verkar det sannolikt att närhelst det är möjligt att mäta tillstånd/hälsa före och efter en åtgärd och den kostnad åtgärden tagit i anspråk förefaller hälsoekonomiska analysmetoder tillämpbara. Detta oberoende av om det gäller allmän eller specifik omvårdnad.

    Jacobsson, Lindholm, Engström och Norberg (2001) och Jenkins-Clarke (1999) är till viss del kritiska när det gäller användandet av hälsoekonomiska analysmetoder inom omvårdnad. Jacobsson m. fl. (2001) diskuterar att det finns skillnader i synsätt som kan ha betydelse för tillämpning av hälsoekonomiska analysmetoder inom omvårdnad. För att tydliggöra skillnader genomfördes en jämförelse mellan omvårdnad och hälsoekonomi där begrepp och aspekter valdes utifrån erfarenheter från studien av Jacobsson m. fl. (2000). I första hand har nordisk litteratur använts.

    Hälsobegreppet förefaller ha en vidare betydelse inom omvårdnad än inom hälsoekonomi. Inom omvårdnad innebär hälsa också en balans mellan kapacitet och mål och en förmåga att lösa de kriser som möter en människa under livet. Två personer med lika hälsorelaterade livskvalitet skattat med ett vanligt förekommande livskvalitetinstrument som t ex EQ-5D skulle då kunna ha olika hälsa sett ur omvårdnadsperspektiv. Hälsorelaterad livskvalitet bör vara ett relevant mått för att mäta omvårdnadsresultat. Det är dock viktigt att de instrument som används mäter värden som är relevanta för omvårdnad. Då synen på hälsa delvis skiljer sig åt mellan omvårdnad och hälsoekonomi är det är rimligt att tänka att ett instrument lämpligt för omvårdnad bör utgå ifrån de värden som speglar hälsa som den definieras inom omvårdnad. Nästa steg kan vara att konkret utvärdera en omvårdnadsmetod med QALY skattat med EQ-5D för att närmare studera detta instruments lämplighet.

    Utifrån den litteratur som används förefaller det vara en möjlig väg att utvärdera effekten av omvårdnadshandlingar uttryckt som vunna kvalitetsjusterade levnadsår (QALY). Det största hindret som kunde ses var vid en fördelning av resurser utifrån hälsomaximeringsprincipen som enda gällande princip. Detta generella tänkandet utan hänsyn till individ är ett otillräckligt synsätt om vi vill se den enskilde som värdefull. Detta är dock redan tidigare starkt kritiserat från många andra håll inklusive från hälsoekonomer.

    Denna litteraturstudie är ett försök att jämföra synsätt inom omvårdnad och hälsoekonomi utifrån några aspekter. Om hinder för att använda hälsoekonomi inom omvårdnad kan tydliggöras kan ett brobygge mellan de båda  ämnesområdena påbörjas.

  • 283.
    MacEachen, Ellen
    et al.
    School of Public Health and Health Systems, University Of Waterloo, Canada.
    Du, Bronson
    School of Public Health and Health Systems, University Of Waterloo, Canada.
    Bartel, Emma
    School of Public Health and Health Systems, University Of Waterloo, Canada.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Tompa, E.
    Institute for Work & Health, Toronto, Canada.
    Kosny, A.
    Institute for Work & Health, Toronto, Canada.
    Petricone, I.
    IAVGO Community Legal Clinic, Canada.
    Stapleton, J.
    School of Public Health and Health Systems, University Of Waterloo, Canada.
    Scoping Review of Work Disability Policies and Programs2017In: International Journal of Disability Mangement Research, ISSN 1833-8550, E-ISSN 1834-4887, Vol. 12, p. 1-11Article in journal (Refereed)
    Abstract [en]

    Purpose: This scoping review identifies the foci of research articles that address government laws, policies and programs designed to foster labour market integration of people who, due to illness or disability, face challenges entering or staying in the workforce. Method: A systematic search of English-language peer-reviewed articles published between 2000 and 2014 yielded 14,474 articles. Title and abstract review identified 723 included articles that addressed government-led programs, policy or legislation on work integration and/or income support after injury, illness or impairment. These were sorted by theme, work disability program or policy, disability type, jurisdiction and year published. Results: The number of articles published that address work disability laws, policies and programs increased steadily. Most articles addressed disability in general. Among articles with a specific health focus, mental health was the most common. Research gaps are identified for mixed method study designs, chronic and episodic conditions, illness and cancer, and for work disability policy studies outside of North America, Northern Europe and Australia. Conclusions: We find a growing number of published articles about work disability and policy and identify specific areas where is a need for further research. Copyright © 2017 The Author(s).

  • 284.
    Magnusson, Carl
    et al.
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Axelsson, Christer
    Univ Boras, Sweden.
    Nilsson, Lena
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Stromsoe, Anneli
    Dalarna Univ Falun, Sweden; Cty Council Dalarna, Sweden.
    Munters, Monica
    Reg Dalarna, Sweden.
    Herlitz, Johan
    Univ Boras, Sweden.
    Hagiwara, Magnus Andersson
    Univ Boras, Sweden.
    The final assessment and its association with field assessment in patients who were transported by the emergency medical service2018In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, article id 111Article in journal (Refereed)
    Abstract [en]

    BackgroundIn patients who call for the emergency medical service (EMS), there is a knowledge gap with regard to the final assessment after arriving at hospital and its association with field assessment.AimIn a representative population of patients who call for the EMS, to describe a) the final assessment at hospital discharge and b) the association between the assessment in the field and the assessment at hospital discharge.MethodsThirty randomly selected patients reached by a dispatched ambulance each month between 1 Jan and 31 Dec 2016 in one urban, one rural and one mixed ambulance organisation in Sweden took part in the study. The exclusion criteria were ageamp;lt;18years, dead on arrival, transport between health-care facilities and secondary missions. Each patient received a unique code based on the ICD code at hospital discharge and field assessment.ResultsIn all, 1080 patients took part in the study, of which 1076 (99.6%) had a field assessment code. A total of 894 patients (83%) were brought to a hospital and an ICD code (ICD-10-SE) was available in 814 patients (91% of these cases and 76% of all cases included in the study). According to these ICD codes, the most frequent conditions were infection (15%), trauma (15%) and vascular disease (9%). The most frequent body localisation of the condition was the thorax (24%), head (16%) and abdomen (13%). In 118 patients (14% of all ICD codes), the condition according to the ICD code was judged as time critical. Among these cases, field assessment was assessed as potentially appropriate in 75% and potentially inappropriate in 12%.ConclusionAmong patients reached by ambulance in Sweden, 83% were transported to hospital and, among them, 14% had a time-critical condition. In these cases, the majority were assessed in the field as potentially appropriate, but 12% had a potentially inappropriate field assessment. The consequences of these findings need to be further explored.

  • 285.
    Marcusson, Jan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Nord, Magnus
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Johansson, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Alwin, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Dannapfel, Petra
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Thomas, Kristin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Poksinska, Bozena
    Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering.
    Sverker, Annette
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Olaison, Anna
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Cedersund, Elisabet
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Kelfve, Susanne
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Motel-Klingebiel, Andreas
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Hellstrom, Ingrid
    Norrkoping Univ, Sweden.
    Kullberg, Agneta
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Böttiger, Ylva
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Pharmacology.
    Dong, Huan-Ji
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Wass, Malin
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Lyth, Johan
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regional Board, Research and Development Unit.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regional Board, Research and Development Unit.
    Proactive healthcare for frail elderly persons: study protocol for a prospective controlled primary care intervention in Sweden2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 5, article id e027847Article in journal (Refereed)
    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.

  • 286.
    Marie Aimee Nyampame Umutesi, Isis
    Linköping University, Department of Department of Health and Society.
    Assessing the impact of Migration and Integration on the Health of African: An in-depth interview conducted in the city of Linköping with African immigrants who have lived in Sweden for between 5 to 20 years and more2005Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    There is an on going debate in academia on the health of immigrants in their host countries. Many studies have indicated that immigrants tend to have poor health as compared to the native born population. Researchers in this field however hold divergent views on the causes of the poor health of immigrants. One school of thought attributes poor health of immigrants to premigration period. The contenders of this theory argue that during this period immigrants experience and are subjected to hardships which will affect their health later on in their lives. On the other hand, some researchers view post migration period as an ultimate determinant of the poor health of immigrants in their host country. These researchers ascertain that during this

    period immigrants are faced with many challenges of adaptation and most often lack good integration in their host countries which hampers their health.

    The aim of this study is to explore and describe the impact of migration and integration on the health of African immigrants in the Swedish society. A combination of both qualitative and quantitative methods was used to collect and analyze data with the help of the “triangulation “technique. A structured questionnaire was used as a guideline to the in-depth interviews conducted with African immigrants who have lived in Sweden for a period of five to twenty

    years and plus. Twentyfive African immigrants from fourteen African countries took part in this research. This study was conducted in the city of Linköping in Sweden.

    Results from this study revealed that majority of African immigrants self rated their health as being good. Many affirm to be in good health. However, a majority of African immigrants reported psychosomatic symptoms such as stress, fatigue, and other illnesses such as high blood pressure, and diabetes. It was also observed that African immigrants hardly seek medical help except when necessary. Health as defined by immigrants is “a combination of physical and

    mental well being”,” health is ” happiness and joy”, health is “self realization and self esteem”, health is “vitality”, Health is a “sine qua non condition to good life”. However mastery of the Swedish language, and flexible opportunities, which will enable immigrants to access the labor market and be self-sufficient, may improve the immigrants health condition. Also integration of immigrants’ health professionals in the Swedish health care system may be a vital tool to

    encourage immigrants to seek health attention and improve their health condition.

  • 287.
    Mauthner, Oliver
    et al.
    University of Toronto, Canada.
    De Luca, Enza
    University Hospital Network, Canada.
    Poole, Jennifer
    Ryerson University, Canada.
    Abbey, Susan
    University health network, Canada.
    Shildrick, Margrit
    Linköping University, Department of Thematic Studies, The Department of Gender Studies. Linköping University, Faculty of Arts and Sciences.
    Ross, Heather
    University health network, Canada.
    Heart transplants:: Identity disruption, bodily integrity and interconnectedness2015In: Health, ISSN 1363-4593, Vol. 19, no 6, p. 578-594Article in journal (Refereed)
    Abstract [en]

    Of heart transplant recipients, 30 per cent report ongoing or episodic emotional issues post-transplant, which are not attributable to medications or pathophysiological changes. To this end, our team theorized that cardiac transplantation introduces pressing new questions about how patients incorporate a transplanted heart into their sense of self and how this impacts their identity. The work of Merleau-Ponty provided the theoretical underpinning for this project as it rationalizes how corporeal changes  affect one’s self and offer an innovative framework to access these complex aspects of living with a transplanted heart. We  used visual methodology and recorded 25 semi-structured interviews videographically. Both visual and verbal data were analyzed  at the same time in an iterative process. The most common theme was that participants expressed a disruption to their own identity and bodily integrity. Additionally, participants reported interconnectedness with the donor, even when the transplanted  heart was perceived as an intruder or stranger. Finally, transplant recipients were very vivid in their descriptions and speculation of how they imagined the donor. Receiving an anonymous donor organ from a stranger often leaves the recipient with questions  about who they themselves are now. Our study provides a nuanced understanding of heart transplant recipients’ embodied experiences of self and identity. Insights gained are valuable to educate transplant professionals to develop new supportive interventions both pre- and post-transplant, and to improve the process of informed consent. Ultimately, such insights could be used to enable heart transplant recipients to incorporate the graft optimally over time, easing distress and improving recovery.

  • 288.
    McKee, Gabrielle
    et al.
    European Soc Cardiol, France; Trinity Coll Dublin, Ireland.
    Kerins, Mary
    European Soc Cardiol, France; St James Hospital, Ireland.
    Hamilton, Glenys
    European Soc Cardiol, France; Massachusetts Gen Hospital, MA 02114 USA.
    Hansen, Tina
    European Soc Cardiol, France; Zealand University Hospital, Denmark.
    Hendriks, Jeroen
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. European Soc Cardiol, France; S Australian Health and Medical Research Institute, Australia.
    Kletsiou, Eleni
    European Soc Cardiol, France; University of Gen Hospital ATTIKON, Greece.
    Lambrinou, Ekaterini
    European Soc Cardiol, France; Cyprus University of Technology, Cyprus.
    Jennings, Catriona
    European Soc Cardiol, France; National Heart and Lung Institute, England.
    Fitzsimons, Donna
    European Soc Cardiol, France; Queens University, North Ireland.
    Barriers to ESC guideline implementation: results of a survey from the European Council on Cardiovascular Nursing and Allied Professions (CCNAP)2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 8, p. 678-686Article in journal (Refereed)
    Abstract [en]

    Background: The European Society of Cardiology (ESC) has a comprehensive clinical guideline development programme, relevant for all clinicians. However, implementation of guidelines is not always optimal. Aim: The aim of this study was to determine nurses and allied professionals awareness and barriers regarding clinical guideline implementation. Methods: A cross-sectional survey was administrated online and in print at EuroHeartCare 2015. A questionnaire was developed which examined awareness and barriers to implementation of ESC guidelines on cardiovascular disease prevention in clinical practice (2012) and ESC guidelines in general. Results: Of the 298 respondents, 12% reported that the prevention guidelines were used in their practice area. Respondents identified, in order of magnitude, that lack of leadership, workload, time, resources and a perception that they were unable to influence current practice were barriers to the use of the prevention guidelines. When asked to rank barriers to use of any ESC guidelines, time (22%) and leadership (23%) were ranked highest. Conclusions: Implementation of ESC guidelines by nurses, the majority responders in this survey, is a serious problem, requiring urgent improvement to ensure patients receive optimal evidence based care. Issues of leadership, workload, time and resources are significant barriers to guideline implementation. It is of concern that these professionals perceive both that they have little influence on implementation decisions and lack of leadership regarding guideline implementation. Educational and organisational strategies to improve leadership skills are imperative. These will build self-efficacy and empower nurses and allied professionals to advocate for evidence-based care in the clinical environment.

  • 289.
    Medin, Jennie
    Linköping University, Department of Department of Health and Society, National Centre for Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Stroke among people of working age: from a public health and working life perspective2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Stroke is a major cause of serious disability and death. In Sweden approximately 30,000 people suffer from stroke each year, and 20% of them are under 65 years of age.

    Aim: The aim of this thesis was to study stroke among people aged 30-65 years. Specific aims were: a) to compare the incidence of stroke in Sweden between the periods 1989-1991 and 1998-2000 in persons aged 30-65 years, b) to explore sick leave, disability pension and health-care-seeking behaviour among people 30-65 years of age prior to their stroke in year 2001 in the county of Östergötland, Sweden, c) to explore whether organisational change and work-related stress, as measured by the Job Content Questionnaire, was associated with first-ever stroke among working people aged 30-65, d) to describe the experience of return to work (RTW) after stroke from the patient’s perspective in comparison with experiences of patients on long-term sick leave.

    Material and methods: Studies I and II are based on retrospective register data. Study I is based on data from the SHDR and the CDR during 1989-2000, and NSR Östergötland during the period 1989-2000. Study II is based on data from the HCDWÖ and the social insurance office. Study III is a case–control study where the cases are obtained from four hospitals in the south-east of Sweden and the controls come from the base populations at each respective hospital. Studies IV and V are qualitative studies and the informants in study IV are cases from Linköping and Norrköping included in study III. Study V is a case study based upon a focus group interview with 7 women who had undergone a problem-based rehabilitation.

    Results: Stroke incidence increased in Sweden for both men and women between 1989 and 2000, especially for women. Future stroke patients showed more sick leave compared with the general population. For men, accumulated sick leave of more than 29 days was associated with an increased risk of later stroke. Frequent health-care-seeking behaviour is not a tool for identifying women who develop stroke, while it may be an indicator for men. We found partial support for an association between organisational change, work-related stress and stroke. The likelihood of stroke was significantly lower for people in active job situations. The individual stroke patient’s capacity and ability to return to work was perceived as enhanced by motivation or ‘will’ and self-efficacy, in combination with external support. Self-efficacy was not only a personal trait or internal factor; it was enhanced and encouraged in interaction with contextual conditions. When the more medically oriented rehabilitation is finished, other aspects of the individual’s abilities should be in focus. There seem to be similarities between the RTW process and processes of health promotion.

    Conclusion: Stroke among younger people in regard to work related risk factors and work related rehabilitation is a field where few studies have been carried out, and further research is needed in order to investigate risk factors and planning for prevention, health promotion and rehabilitation. The thesis also indicates the need for gender-specific studies.

    List of papers
    1. Increasing stroke incidence in Sweden between 1989 and 2000 among persons aged 30 to 65 years: evidence from the Swedish Hospital Discharge Register
    Open this publication in new window or tab >>Increasing stroke incidence in Sweden between 1989 and 2000 among persons aged 30 to 65 years: evidence from the Swedish Hospital Discharge Register
    2004 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 35, no 5, p. 1047-1051Article in journal (Refereed) Published
    Abstract [en]

    Background and Purpose— Stroke mortality is decreasing in Sweden, as is the case in other Western European countries. However, both decreases and increases have been reported in Sweden for persons younger than age 65 years. The aim of this study was to compare the incidence of stroke in Sweden between the periods 1989 and 1991 and 1998 and 2000 in persons aged 30 to 65 years.

    Methods— All first-ever stroke patients aged 30 to 65 years in the Swedish Hospital Discharge Register between 1989 and 2000 were included.

    Results— The age-standardized, 3-year average incidence increased by 19%, from 98.9 to 118.0 per 100 000 among men, and by 33%, from 48.4 to 64.4 among women, between 1989 and 1991 and 1998 and 2000. The largest increase was seen among those younger than 60 years. On a county level, the change in age-standardized stroke incidence varied from small decreases (−3%) to large increases (82%).

    Conclusion— Stroke incidence increased in Sweden for both men and women between 1989 and 2000. The increase was larger among women. This calls for action when it comes to studying risk factors and planning for prevention and health promotion and indicates the need for gender-specific studies.

    Keywords
    Epidemiology, Incidence, Stroke
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-45752 (URN)10.1161/01.STR.0000125866.78674.96 (DOI)
    Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
    2. Sick leave, disability pension and health-care-seeking behaviour prior to stroke, among people aged 30–65: a case–control study
    Open this publication in new window or tab >>Sick leave, disability pension and health-care-seeking behaviour prior to stroke, among people aged 30–65: a case–control study
    2007 (English)In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 21, no 5, p. 457-463Article in journal (Refereed) Published
    Abstract [en]

    Primary objective: To explore sick leave, disability pension and health-care-seeking behaviour among people 30–65 years of age prior to their stroke in 2001 in the county of Östergötland, Sweden.

    Research design: A register-based, retrospective case–control study for the period 1 January 1998–31 December 2000. Cases (n = 212): patients aged 30–65 with first-ever stroke in 2001. Controls (n = 4606): people aged 30–65, randomly selected from the same base population.

    Main outcomes and results: More than 91 days of accumulated sick leave among women was associated with increased likelihood of developing stroke (OR = 1.89). Among men, 29–90 days and more than 91 days on sick leave increased the likelihood of stroke (OR = 2.34 and OR = 3.43, respectively).

    Conclusion: Frequent health-care-seeking behaviour is not a tool for identifying women who develop stroke, while it may be an indicator for men. Accumulated sick leave may be a tool for identifying men and women with higher risk of stroke.

    Read More: http://informahealthcare.com/doi/abs/10.1080/02699050701317643

    Keywords
    Sick-leave, stroke, public health, health-care seeking behaviour
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-38631 (URN)10.1080/02699050701317643 (DOI)45108 (Local ID)45108 (Archive number)45108 (OAI)
    Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
    3. Organisational change, job strain and increased risk of stroke?: a pilot study
    Open this publication in new window or tab >>Organisational change, job strain and increased risk of stroke?: a pilot study
    2008 (English)In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 31, no 4, p. 443-449Article in journal (Refereed) Published
    Abstract [en]

    Aims: The objective of this pilot study was to explore whether organisational change and work-related stress, as measured by the Job Content Questionnaire, were associated with first-ever stroke among working people aged 30–65.

    Methods: In a case-control study a total of 65 consecutive cases, aged 30–65 years of age, with first-ever stroke were recruited from four hospitals in Sweden during 2000–2002. During the same period, 103 random population controls in the same age interval were recruited. Data on job-related stress and traditional medical risk factors were collected by a questionnaire.

    Results: In the multivariate analyses, organisational change (OR 3.38) increased the likelihood of stroke, while experiencing an active job (OR 0.37) decreased the likelihood of stroke. Regarding risk factors outside work, age (OR 1.11), low physical activity (OR 5.21), low education (OR 2.48) and family history of stroke (OR 2.59) were associated with increased likelihood of stroke.

    Conclusion: This study suggests an association between organisational change, work-related stress and stroke. The likelihood of stroke was lower for people in active job situations.

    Keywords
    Stroke, downsizing, work-related stress
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16715 (URN)
    Available from: 2009-02-14 Created: 2009-02-13 Last updated: 2017-12-14Bibliographically approved
    4. Stroke patients' experiences of return to work
    Open this publication in new window or tab >>Stroke patients' experiences of return to work
    2006 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 28, no 17, p. 1051-1060Article in journal (Refereed) Published
    Abstract [en]

    Purpose. The aim of this study was to describe the experience of return to work (RTW) after stroke from the patient's perspective.

    Method. Six patients who had their first ever stroke in 2001, were <65 years of age and were working at the time of their stroke were included. Information was obtained via an open-ended interview. The material was transcribed verbatim and analysed using Giorgi's empirical phenomenology.

    Results. Rehabilitation was perceived as primarily aimed at restoring bodily functions and a return to everyday activities, rather than at promoting a return to work. It was not experienced as adapted to the participants' needs or their age. The workplace was experienced as very important in the rehabilitation process. When the informants experienced that the rehabilitation professionals were not taking action, they took control of the situation themselves. The informants expressed pride in their own capacity to take the initiative and in their ability to take action. Both self-employed and employed informants said they had possibilities and opportunities to take action since their work situation was flexible. The informants' adaptation to a new role at work was perceived as facilitated by the understanding and positive attitude of co-workers.

    Conclusion. Among this group of stroke patients, the individual patient's capacity and ability to return to work was enhanced by motivation or “will” and self-efficacy in combination with external support. Self-efficacy was not only a personal trait or internal factor; it was enhanced and encouraged in interaction with contextual conditions. There are similarities between the RTW process and processes of health promotion.

    Keywords
    Return-to-work, rehabilitation, stroke
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-36610 (URN)10.1080/09638280500494819 (DOI)31744 (Local ID)31744 (Archive number)31744 (OAI)
    Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
    5. Health promotion and rehabilitation: a case study
    Open this publication in new window or tab >>Health promotion and rehabilitation: a case study
    2003 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 25, no 16, p. 908-915Article in journal (Refereed) Published
    Abstract [en]

    Background: Since the number of people in Sweden on long-term sick leave has rapidly increased since 1996, new non-biomedical models of occupational rehabilitation are at stake. A group of seven women who had finished medical treatment and rehabilitation but were still on sick leave or temporary disability pension for several years, worked in a problem-based rehabilitation group for 6 months. Focus for the group was on a process of change towards health and work ability.

    Purpose: The aim of this case study was to improve understanding of effects of a problem-based rehabilitation model (PBR) on health promoting processes amongst a group of women on long-term sick leave. Method: Data source was a focus group interview. The analysis follows the guidelines of qualitative analysis that emerges from grounded theory.

    Results: The pedagogical model of PBR enhanced the participant's internal resources such as self-confidence and ability to act in a social setting. External resources such as social support were improved. An individual follow-up was conducted 2 years after the rehabilitation process and four out of seven women had returned to work.

    Conclusion: Among this group of women PBR launched health-promoting processes. When the more medically oriented treatment is finished or is not able to contribute further to the individual's recovery, other aspects of the individuals abilities and health resources will be focused upon.

    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-26255 (URN)10.1080/0963828031000122212 (DOI)10761 (Local ID)10761 (Archive number)10761 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
  • 290.
    Melin, Anders
    PrioriteringsCentrum.
    Etiska riktlinjer och principer för prioriteringar inom hälso- och sjukvård: en internationell översikt2007Report (Other academic)
    Abstract [sv]

    Vad gäller de länder som formulerat nationella etiska riktlinjer och principer för prioriteringar, d v s Norge, Danmark, Finland, Nederländerna och Nya Zeeland, finns det stora likheter. Detsamma gäller även delstaten Oregon i USA. I samtliga fall utgör behov eller svårighetsgrad en central prioriteringsprincip. Enligt den norska utredningen NOU (1997:18) är svårighetsgrad en viktig grund för prioriteringar. Patienter som riskerar att dö eller upplever en hög grad av psykisk eller fysisk funktionsförlust eller en hög grad av smärta bör behandlas i första hand. Enligt det danska Etiske Råds rapport bör patienter med stort behov av vård prioriteras. Behov bestäms utifrån sjukdomens allvar, tidsmässig nödvändighet och möjlig hälsomässig vinst. Den danska rapporten beskriver solidaritet som en grundläggande samhällsvärdering. Även i den finska rapporten From Values to Choices beskrivs behov som en viktig grund för prioriteringar, definierat utifrån vad som krävs för att återställa patientens åldersspecifika funktionella kapacitet. Även i Nya Zeelands riktlinjer för prioriteringar utgör behov en viktig grund för att bestämma om en behandling är rättvis. Enligt den nederländska prioriteringsrapporten bör endast den vård som är nödvändig ingå i det obligatoriska baspaketet. Nödvändighet definieras utifrån ett samhällsperspektiv som det som återställer patientens normala funktionsförmåga. Även i Oregons hälsoplan har en prioritering enligt nödvändighet gjorts.

    Även en behandlings nytta eller verkan utgör en viktig grund för prioriteringar i de olika länderna. Enligt de norska, danska, finska, nederländska och nyzeeländska utredningarna bör behandlingar med dokumenterad nytta prioriteras. Detsamma gäller enligt Oregons hälsoplan. I samtliga av de ovannämnda utredningarna framställs också kostnadseffektivitet som en viktig prioriteringsprincip. Man bör välja de behandlingar som ger störst effekt i förhållande till kostnaden. Att principerna om allvarlighetsgrad, nytta och kostnadseffektivitet återfinns i samtliga rapporter bör kanske tolkas som att de uppfattas som grundläggande och självklara utgångspunkter för prioriteringar. En annan förklaring kan vara att författarna till de olika rapporterna naturligtvis känt till vad som presenterats i andra länder.

    En annan central utgångspunkt för prioriteringar enligt vissa av rapporterna är rättvisa eller likabehandling. I den senaste norska utredningen (NOU 1997:18) framhålls att om en viss patient erbjuds en hälsotjänst, bör alla patienter i samma situation ges samma erbjudande.

    Den danska och finska rapporten menar att personer i samma situation skall ges lika tillgång till hälso- och sjukvårdens utbud.

    I vissa av utredningarna beskrivs även egenansvar som en grund för prioriteringar. Den nederländska rapporten menar att de behandlingar som patienterna själva kan genomföra kan uteslutas ur baspaketet. Enligt Oregons hälsoplan bör det personliga ansvaret för hälsan uppmuntras.

    I den senaste norska utredningen behandlas även hur avvägningar mellan olika prioriteringsprinciper bör göras. Den tar avstånd från en strikt rangordning mellan principerna om allvarlighetsgrad, förväntad nytta och kostnadseffektivitet. Man menar att det inte är rimligt att i alla lägen prioritera de mest sjuka oavsett behandlingens nytta. Det skulle innebära för stora försakelser för dem som har mindre allvarliga besvär men som skulle kunna bli väsentligt bättre av en behandling. Inte heller kan någon strikt rangordning mellan allvarlighetsgrad och kostnadseffektivitet göras.

    Av de länder som presenterat nationella riktlinjer för prioritering har Danmark en särställning, eftersom avsikten där aldrig varit att presentera en offentlig prioriteringsmodell. Den danska rapporten är mer skriven som ett diskussionsunderlag medan övriga länders rapporter har en mer formell status.

    I förhållande till de övriga länderna utgör Storbritannien och Kanada undantag, eftersom man där inte formulerat några nationella etiska riktlinjer för prioriteringar. I Storbritannien har dock frågor om prioriteringar behandlats av NICE’s medborgarpanel och på en regional nivå i Oxfordshire Priorities Forum. Liksom de olika ländernas rapporter beskriver NICE’s medborgarpanel sjukdomars allvarlighetsgrad och nyttan av behandlingar som viktiga utgångspunkter för prioriteringar. Vidare menar man att åldersdifferentiering kan vara rimlig då ålder påverkar risken att få en sjukdom eller effektiviteten av en behandling. Behandlingars nytta är en betydelsefull grund för prioriteringar också enligt det etiska ramverk, som etablerats av Oxfordshire Priorities Forum. I detta ramverk återfinns också principen om likabehandling. I Kanada har inga generella etiska riktlinjer för prioriteringar formulerats, varken på nationell eller regional nivå. Den teoretiska diskussionen har ofta utgått från Daniels och Sabins begrepp ”ansvar för rimlighet”.

    Vad gäller riktlinjernas inflytande på det praktiska prioriteringsarbetet har det i många fall varit begränsat. I Norge har man exempelvis trots en långvarig teoretisk debatt inte kommit särskilt långt i det praktiska prioriteringsarbetet. I Danmark har ambitionen aldrig varit att etablera en offentlig prioriteringsmodell och Det Etiske Råds rapport har haft ett begränsat inflytande.

    För Nederländernas del har det visat sig svårt att tillämpa prioriteringsprinciperna i praktiken. De flesta av de hälso- och sjukvårdstjänster som lyfts ur förmånssystemet har lyfts tillbaka igen efter politiska påtryckningar. I Nya Zeeland har debatten om prioriteringar avstannat under senare år, delvis till följd av förbättrad ekonomi. I Oregons fall har dock de etiska riktlinjerna fått ett tydligt genomslag på det praktiska prioriteringsarbetet, eftersom de legat till grund för lagstiftning. Emellertid har man efterhand tagit med fler och fler behandlingar på listan över dem som skall finansieras offentligt, vilket indikerar att det också där varit svårt att tillämpa en öppen och strikt prioritering.

    De tre principerna i den svenska etiska plattformen förekommer även i många av de rapporter som lagts fram i andra länder. Behov eller allvarlighetsgrad förekommer som princip hos alla de länder som presenterat nationella etiska riktlinjer. Detsamma gäller kostnadseffektivitet. Till skillnad från övriga länders rapporter förekommer inte nytta eller verkan som en uttrycklig princip i den svenska utredningen. Människovärdesprincipen som finns i den svenska utredningen motsvaras av likabehandlingsprincipen i de norska, danska och finska rapporterna. Egenansvar eller personligt ansvar som förekommer i den nederländska rapporten och i Oregons hälsoplan finns inte i den svenska etiska plattformen. Den svenska behovs- och solidaritetsprincipen innebär dock att de allvarligaste sjukdomarna skall prioriteras, vilket implicerar en nedprioritering av mindre allvarliga tillstånd som patienterna kan behandla själva.

    Till skillnad från den svenska utredningen är de olika prioriteringsprinciperna inte strikt rangordnade i de andra ländernas rapporter. Den norska rapporten tar dessutom uttryckligen avstånd från att en sådan strikt rangordning bör göras.

    Det finns också stora likheter mellan den svenska rapporten och övriga länders vad gäller beskrivningen av vad som inte bör utgöra en grund för prioriteringar. I det svenska betänkandet tar man särskilt avstånd från att patienter med hög ålder bortprioriteras. Man anser att det är en form av diskriminering att inte behandla gamla patienter. Enligt utredningen är det dock nödvändigt att ta hänsyn till vilka medicinska åtgärder äldre patienter kan tolerera och tillgodogöra sig (SOU 1995:5). En liknande inställning till prioriteringar på grund av ålder återfinns i de norska, danska, finska, nederländska och nyzeeländska rapporterna samt i de riktlinjer som presenterats av NICE:s medborgarpanel i Storbritannien.

    Likaså menar utredningen att de som har självförvållade skador inte heller bör utsättas för negativ särbehandling. Som skäl anges bl a att det kan vara svårt att avgöra i vilken utsträckning vissa sjukdomar är orsakade av ärftliga faktorer eller av en viss livsstil.

    Man menar också att vissa skadliga beteenden såsom drogmissbruk ofta förvärvas relativt tidigt i livet och är mer frekventa bland individer med låg utbildning och social status. Att bortprioritera sjukdomar som kan vara orsakade av exempelvis drogmissbruk strider mot behovs- och solidaritetsprincipen och kan leda till att klassklyftorna i samhället ökar (SOU 1995:5). Vad gäller självförvållade skador finns ett liknande resonemang i de norska, danska, finska och nederländska rapporterna.

    Något som är specifikt för den svenska utredningen är dock att man tar avstånd från nyttoprincipen, d v s att de åtgärder som gör störst nytta för flest människor skall väljas. Enligt den svenska utredningen skall man exempelvis inte prioritera lindriga besvär, som är billiga att bota (SOU 1995:5).

    En av de viktigaste skillnaderna mellan de svenska riktlinjerna och övriga länders är att de svenska förordar en strikt rangordning mellan de olika prioriteringsprinciperna. Debatten i andra länder visar att det kan vara problematiskt med en sådan strikt rangordning mellan behovs- och solidaritetsprincipen. I den senaste norska utredningen sägs det exempelvis att det leder till orimliga försakelser för dem som är lindrigt sjuka och kan bli väsentligt bättre av en behandling om man alltid skall prioritera de svårast sjuka oberoende av behandlingens nytta. Det kan alltså finnas anledning att ifrågasätta om den strikta rangordningen i den svenska etiska plattformen är rimlig.

    Med anledning av debatten och de praktiska erfarenheterna i andra länder finns det också skäl att fråga sig vilket värde generella etiska riktlinjer egentligen har. Det har ofta visat sig svårt att tillämpa strikta prioriteringsprinciper och behandlingar som uteslutits från offentlig finansiering har ofta medtagits senare p g a politiska påtryckningar.

    I de olika ländernas rapporter finns det också en medvetenhet om svårigheterna att tillämpa generella principer. Den danska rapporten ställer sig exempelvis skeptisk till att utarbeta en offentlig prioriteringsmodell, eftersom man menar att generella principer ofta blir så allmänt formulerade att de ger begränsad vägledning i konkreta fall. I en genomgång av internationella erfarenheter av prioritering hävdar Chris Ham och Angela Coulter dessutom att det ofta finns ett gap mellan de principer som formulerats på nationell nivå och vad som i praktiken händer på den lokala (Ham, Coulter 2003).

    Problemen med att tillämpa generella etiska riktlinjer har lett till större fokus på att utforma rimliga och rättvisa procedurer för beslutsfattande.

    Den teoretiska debatten i Kanada har exempelvis utgått från Daniels och Sabins begrepp ”ansvar för rimlighet”, vilket bygger på att rättvisa procedurer snarare än generella principer bör ligga till grund för prioriteringar. Denna ansats utgör en viktig utmaning för det svenska förhållningssättet.

  • 291.
    Melin, Anders
    Linköping University, Department of Religion and Culture, Center for Applied Ethics. Linköping University, Faculty of Arts and Sciences.
    Rättvisa prioriteringar inom hälso- och sjukvård: etiska teorier och jämförelser med prioriteringsutredningens principer2003Report (Other academic)
    Abstract [sv]

    Rapporten börjar med att beskriva den syn på rättvisa prioriteringar, som lades fram i Prioriteringsutredningens slutbetänkande. Här presenteras följande tre rättviseprinciper:

    1. Människovärdesprincipen, vilken innebär att alla människor har lika värde och därmed samma rättigheter, oberoende av personliga egenskaper och funktioner i samhälle, såsom begåvning, social ställning eller ålder.
    2. Behovs- eller solidaritetsprincipen, enligt vilken de med störst behov skall prioriteras. De med de svåraste sjukdomarna och den sämsta livskvaliteten ska behandlas i första hand. Solidaritetsprincipen innebär dessutom att behoven hos de svagaste särskilt skall uppmärksammas, exempelvis behoven hos de som har svårt att göra sina röster hörda eller utnyttja sina rättigheter. Dit räknas bl.a. barn, åldersdementa och gravt psykiskt störda.
    3. Kostnadseffektivitetsprincipen: en rimlig relation mellan kostnad och effektivitet i form av förbättrad hälsa och höjd livskvalitet bör eftersträvas. De tre principerna är rangordnade på så sätt att människovärdesprincipen går före behovs- och solidaritetsprincipen, som i sin tur går före kostnadseffektivitetsprincipen. Att människovärdesprincipen rangordnas först betyder enligt utredningen att den anger den grundläggande yttre ramen för prioriteringar. Att behovs- och solidaritetsprincipen går före kostnadseffektivitetsprincipen innebär att svåra sjukdomar skall prioriteras före lindringare, även om vården av svåra sjukdomar är mer kostsam.

    Härefter följer en redogörelse för de vanligaste formerna av generella rättviseteorier, som förekommer inom den politiska filosofin. Enligt libertarianismen har alla individer en okränkbar rätt att bestämma över sitt liv och sin egendom. Denna rätt är oförenlig med offentlig sjukvård, som finansieras genom beskattning. Utifrån ett libertarianskt synsätt blir diskussionen om prioriteringar överflödig, eftersom det är individers betalningsförmåga som avgör vilken sjukvård de kan få tillgång till. Övriga rättviseteorier tillåter offentligt finansierad sjukvård, men deras syn på vad som är rättvist skiljer sig från varandra. Enligt utilitarismen räknas alla individers nytta lika mycket. De handlingar och de samhällsinstitutioner, som leder till störst total nytta bör väljas. Hänsyn till hur nyttan fördelas mellan samhällsmedborgarna är av underordnad betydelse.

    I motsats till utilitarismen anger liberala rättviseteorier att fördelningen av samhällets nyttigheter är viktig. Alla skall ges samma möjligheter att leva ett gott liv. Dessutom bör staten vara neutral i förhållande till olika uppfattningar om vad ett gott liv innebär. Kommunitarismen föreskriver istället att samhället bör grundas på en gemensam uppfattning om vad som utgör ett gott liv. Individerna bör anpassa sig till de värderingar som präglar det samhälle de är en del av. Till skillnad från övriga teorier bygger diskursiva rättviseteorier på ett avståndstagande från uppfattningen att den politiska filosofin skall formulera substantiella och generella rättviseprinciper. Istället menar man att det endast är genom konkreta diskussioner, d.v.s. diskurser, mellan berörda parter som giltiga rättvisenormer kan etableras. Den politiska filosofin skall endast beskriva de diskurser som leder till rättfärdiga normer.

    En genomgång görs av ett antal författare, som behandlat frågan om rättvisa prioriteringar inom hälso- och sjukvård utifrån de tre sistnämnda generella rättviseteorierna. Norman Daniels representerar ett liberalt rättviseperspektiv. Hans teori om prioriteringar utgår från en behovsteori. Daniels menar att människors grundläggande behov av sjukvård kan fastställas objektivt. Vi har behov av sådant vi måste få för att kunna fungera på ett sätt som är normalt för vår art. Enligt Daniels är en viktig grund för prioriteringar att sjukvård ska bidra till att återställa människors normala funktionsduglighet. Det är viktigast att förebygga eller bota de sjukdomstillstånd, som mest begränsar en individs möjligheter. Daniels menar att samhället har en plikt att garantera människor likvärdiga möjligheter i livet.

    Vidare hävdar Daniels att prioriteringar med avseende på ålder kan vara legitima. Eftersom alla är eller har varit unga och de flesta förr eller senare blir gamla behöver åldersprioriteringar inte vara diskriminerande på samma sätt som prioriteringar med avseende på exempelvis kön, etnisk tillhörighet eller religion. Prioriteringar mellan åldersgrupper kan i själva verket ses som prioriteringar mellan olika stadier i medborgarnas livsförlopp.

    Daniel Callahan företräder en kommunitarisk syn på prioriteringar. Han menar att en gemensam uppfattning måste formuleras i samhället om vad som är ålderdomens innebörd och vilken uppgift de gamla bör ha. Denna uppfattning måste få genomslag på vår syn på de gamlas rätt till sjukvård. Callahan menar att vi inte kan acceptera att en allt större del av samhällets resurser går till de gamlas sjukvård. Enligt Callahan bör de äldre träda tillbaka för de unga och inte enbart tänka på sin egen livskvalitet.

    Utgångspunkten för Callahans syn på åldersprioriteringar är hans begrepp om individers möjlighetsomfång. Sjukvårdens uppgift är att hjälpa människor att kunna realisera de möjligheter som man vanligtvis erbjuds under ett liv, såsom att göra karriär och bilda familj. De patienter som uppnått en naturlig livslängd, enligt Callahan ungefär 80 år, har haft tid på sig att göra det man kan förvänta sig av livet. I situationer av resursknapphet då prioriteringar är nödvändiga har samhället därför inte någon moralisk skyldighet att erbjuda dem livsförlängande behandling. Sjukvården för gamla patienter skall ha som främsta uppgift att lindra lidande så att de gamla kan få ett värdigt slut. Callahan menar att det är oetiskt att lägga ned en stor andel av samhällets resurser på att förlänga livet på gamla patienter med starkt nedsatt mental och fysisk kapacitet.

    Norman Daniels och James Sabin pläderar för ett diskursivt perspektiv på rättvisa prioriteringar. De utgår från det amerikanska systemet med privata sjukvårdsfinansiärer, men deras resonemang är även relevant för offentligt finansierade system. Daniels och Sabin menar att diskursiva procedurer utgör en bättre grund för prioriteringar än substantiella och generella principer. Procedurer kan på ett bättre sätt hantera prioriteringar i enskilda fall. Daniels och Sabin hävdar dessutom att rättvisa procedurer är att föredra eftersom vi inte kan förvänta oss att människor skall kunna enas om vissa generella principer.

    Daniels och Sabin ställer upp vissa villkor för att beslutsprocedurer om sjukvårdssubventionering ska uppfattas som rättvisa. Först och främst bör de rationella grunderna för beslut om subventionering vara offentliga. Det är viktigt för att kunna visa att försäkringsbolagen gjort konsekventa bedömningar från fall till fall och att de därför handlat rättvist. Dessutom ska dessa rationella grunder visa att organisationerna eftersträvar att effektivt tillgodose befolkningens hälsobehov. Argumentationen för detta bör vara rimlig i den mening att alla inblandade ska kunna uppfatta de skäl som anges som relevanta. Enligt Daniels och Sabin måste det också finnas mekanismer för att ifrågasätta beslut om subventionering. För att se till att de ovanstående tre villkoren uppfylls måste det finns en reglering av beslutsprocesserna, antingen i privat eller offentlig regi.

    Det finns tydliga skillnader mellan samtliga teoretiska perspektiv och Prioriteringsutredningens principer. Utilitarismen är minst förenlig med behovseller solidaritetsprincipen, eftersom den leder till att man skall prioritera de medicinska åtgärder som ger störst nyttotillskott. Enligt utilitarismen bör inte särskild hänsyn, utöver nyttan, tas till sjukdomens eller skadans svårighetsgrad eller till patientens autonomi. Daniels’ liberala perspektiv medger att man i vissa situationer bör prioritera de sjukaste patienterna, eftersom han menar att det är viktigast att behandla de tillstånd som mest begränsar en individs möjligheter. I detta avseende är hans teori förenlig med utredningens principer. Daniels teori ger oss dock mindre starka skäl för att behandla kroniskt sjuka individer. Dessutom hävdar Daniels till skillnad från Prioriteringsutredningen att det kan vara moraliskt legitimt att beakta ålder vid prioriteringar.

    Callahans teori är oförenlig med Prioriteringsutredningen människovärdesprincip och dess behovs- och solidaritetsprincip. Han menar att samhället i speciella situationer inte är skyldigt att ge patienter som har uppnått en normal livslängd någon livsförlängande behandling. Dessutom hävdar Callahan att gravt dementa äldre patienter bara har en begränsad rätt till sjukvård. Daniels och Sabin tar i sin artikel avstånd från den typ av generella och substantiella principer, som Prioriteringsutredningen har presenterat. Istället menar de att prioriteringar bättre kan avgöras genom att diskursiva procedurer tillämpas från fall till fall.

    Ovannämnda skillnader mellan olika etiska perspektiv och Prioriteringsutredningens betänkande tydliggör behovet av ytterligare forskning på området. Det är viktigt att klarlägga i vilken utsträckning de olika ståndpunkterna är välgrundade och rimliga.

  • 292.
    Mettler, Tobias
    et al.
    Institute of Information Management, University of St. Gallen, St. Gallen, Switzerland.
    Vimarlund, Vivian
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering.
    Evaluation of E-Health Strategies: A Portfolio Approach2011In: Proceedings of the 15th International Symposium on Health Information Management Research - ISHIMR 2011 / [ed] Bath, Peter A.; Mettler, Tobias; Raptis, Dimitri A. & Sen, Barbara A., 2011, p. 296-305Conference paper (Other academic)
    Abstract [en]

    Today it is a general belief that e-health has a positive effect on costs as well as on quality of health service delivery. Nevertheless, lots of projects failed in the past to clearly demonstrate a positive value proposition. Difficulties arise especially when not only evaluating a single action but a whole strategy for adopting national or provincial e-health. Grounding on the experience of an ex ante evaluation of the Swiss e-health strategy, a first attempt how to practically demonstrate the value of the planned health system’s changes is discussed in this article. On the basis of a “utility” and a “readiness” portfolio, generic allocation decisions are formulated for prioritising investments as well as for identifying weak points in the defined e-health strategy.

  • 293.
    Meunier, Andreas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Posadzy, Kinga
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Arts and Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Aspenberg, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Risk preferences and attitudes to surgery in decision making2017In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 88, no 5, p. 466-471Article in journal (Refereed)
    Abstract [en]

    Background and purpose — There is increasing evidence that several commonly performed surgical procedures provide little advantage over nonoperative treatment, suggesting that doctors may sometimes be inappropriately optimistic about surgical ben- efit when suggesting treatment for individual patients. We investi- gated whether attitudes to risk influenced the choice of operative treatment and nonoperative treatment.

    Methods — 946 Swedish orthopedic surgeons were invited to participate in an online survey. A radiograph of a 4-fragment proximal humeral fracture was presented together with 5 differ- ent patient characteristics, and the surgeons could choose between 3 different operative treatments and 1 nonoperative treatment. This was followed by an economic risk-preference test, and then by an instrument designed to measure 6 attitudes to surgery that are thought to be hazardous. We then investigated if choice of non-operative treatment was associated with risk aversion, and thereafter with the other variables, by regression analysis.

    Results — 388 surgeons responded. Nonoperative treatment for all cases was suggested by 64 of them. There was no significant association between risk aversion and tendency to avoid surgery. However, there was a statistically significant association between suggesting to operate at least 1 of the cases and a “macho” atti- tude to surgery or resignation regarding the chances of influenc- ing the outcome of surgery. Choosing nonoperative treatment for all cases was associated with long experience as a surgeon.

    Interpretation — The discrepancy between available evidence for surgery and clinical practice does not appear to be related to risk preference, but relates to hazardous attitudes. It appears that choosing nonoperative treatment requires experience and a feel- ing that one can make a difference (i.e. a low score for resigna- tion). There is a need for better awareness of available evidence for surgical indications. 

  • 294.
    Michelsen, Halldora Ogmundsdottir
    et al.
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Sjolin, Ingela
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Schlyter, Mona
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Hagstrom, Emil
    Uppsala Univ, Sweden.
    Kiessling, Anna
    Karolinska Inst, Sweden.
    Henriksson, Peter
    Karolinska Inst, Sweden.
    Held, Claes
    Uppsala Univ, Sweden.
    Hag, Emma
    Cty Hosp Ryhov, Sweden.
    Nilsson, Lennart
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Schiopu, Alexandru
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Zaman, M. Justin
    James Paget Univ Hosp, England.
    Leosdottir, Margret
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Cardiac rehabilitation after acute myocardial infarction in Sweden - evaluation of programme characteristics: and adherence to European guidelines: The Perfect Cardiac Rehabilitation (Perfect-CR) study2019In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, article id UNSP 2047487319865729Article in journal (Refereed)
    Abstract [en]

    Background While patient performance after participating in cardiac rehabilitation programmes after acute myocardial infarction is regularly reported through registry and survey data, information on cardiac rehabilitation programme characteristics is less well described. Aim The aim of this study was to evaluate Swedish cardiac rehabilitation programme characteristics and adherence to European Guidelines on Cardiovascular Disease Prevention. Method Cardiac rehabilitation programme characteristics at all 78 cardiac rehabilitation centres in Sweden in 2016 were surveyed using a web-based questionnaire (100% response rate). The questions were based on core components of cardiac rehabilitation as recommended by European Guidelines. Results There was a wide variation in programme duration (2-14 months). All programmes reported offering an individual post-discharge visit with a nurse, and 90% (n = 70) did so within three weeks from discharge. Most programmes offered centre-based exercise training (n = 76, 97%) and group educational sessions (n = 61, 78%). All programmes reported to the national audit, SWEDEHEART, and 60% (n = 47) reported that performance was regularly assessed using audit data, to improve quality of care. Ninety-six per cent (n = 75) had a core team consisting of a cardiologist, a physiotherapist and a nurse and 76% (n = 59) reported having a medical director. Having other allied healthcare professionals included in the cardiac rehabilitation team varied. Forty per cent (n = 31) reported having regular team meetings where nurses, physiotherapists and cardiologist could discuss patient cases. Conclusion The overall quality of cardiac rehabilitation programmes provided in Sweden is high. Still, there are several areas of potential improvement. Monitoring programme characteristics as well as patient outcomes might improve programme quality and patient outcomes both at a local and a national level.

  • 295.
    Miller, Paul S. J.
    et al.
    Miller Econ Ltd, England.
    Hill, Harry
    University of Manchester, England.
    Andersson, Fredrik L.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Global Health Econ and Outcomes Research, Denmark.
    Nocturia Work Productivity and Activity Impairment Compared with Other Common Chronic Diseases2016In: PharmacoEconomics (Auckland), ISSN 1170-7690, E-ISSN 1179-2027, Vol. 34, no 12, p. 1277-1297Article in journal (Refereed)
    Abstract [en]

    The International Continence Society defines nocturia as the need to void one or more times during the night, with each of the voids preceded and followed by sleep. The chronic sleep disturbance and sleep deprivation experienced by patients with nocturia affects quality of life, compromising both mental and physical well-being. This paper aims to characterise the burden of nocturia by comparing published data from patients with nocturia with data from patients with any of 12 other common chronic conditions, specifically focusing on its impact on work productivity and activity impairment, as measured by the instrument of the same name (WPAI). A systematic literature review of multiple data sources identified evaluable studies for inclusion in the analysis. Study eligibility criteria included use of the WPAI instrument in patients with one of a predefined list of chronic conditions. We assessed the quality of each included study using the Newcastle-Ottawa scale and extracted basic study information, work and activity impairment data. To assess how work and activity impairment from nocturia compares with impairment from other common chronic diseases, we conducted two data syntheses (pooled and unpooled). The number of evaluable studies and the range of overall work productivity impairment reported, respectively, were as follows: nocturia (3; 14-39 %), overactive bladder (5; 11-41 %), irritable bowel syndrome/constipation (14; 21-51 %), gastroesophageal reflux disease (GERD) (13; 6-42 %), asthma/allergies (11; 6-40 %), chronic obstructive pulmonary disease (COPD) (7; 19-42 %), sleep problems (3; 12-37 %), arthritis (13; 21-69 %), pain (9; 29-64 %), depression (4; 15-43 %) and gout (2; 20-37 %). The overall work productivity impairment as a result of nocturia is substantial and was found to be similar to impairment observed as a result of several other more frequently researched common chronic diseases. Greater awareness of the burden of nocturia, a highly bothersome and prevalent condition, will help policy makers and healthcare decision makers provide appropriate management of nocturia.

  • 296.
    Mohammad, Moman A.
    et al.
    Lund Univ, Sweden.
    Koul, Sasha
    Lund Univ, Sweden.
    Rylance, Rebecca
    Lund Univ, Sweden.
    Frobert, Ole
    Orebro Univ, Sweden.
    Alfredsson, Joakim
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Sahlen, Anders
    Karolinska Inst, Sweden; Natl Heart Ctr Singapore, Singapore.
    Witt, Nils
    Soder Sjukhuset, Sweden.
    Jernberg, Tomas
    Karolinska Inst, Sweden.
    Muller, James
    Brigham and Womens Hosp, MA 02115 USA.
    Erlinge, David
    Lund Univ, Sweden.
    Association of Weather With Day-to-Day Incidence of Myocardial Infarction A SWEDEHEART Nationwide Observational Study2018In: JAMA cardiology, ISSN 2380-6583, E-ISSN 2380-6591, Vol. 3, no 11, p. 1081-1089Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE Whether certain weather conditions modulate the onset of myocardial infarction (MI) is of great interest to clinicians because it could be used to prevent MIs as well as guide allocation of health care resources. OBJECTIVE To determine if weather is associated with day-to-day incidence of MI. DESIGN, SETTING, AND PARTICIPANTS In this prospective, population-based and nationwide setting, daily weather data from the Swedish Meteorological and Hydrological Institute were extracted for all MIs reported to the Swedish nationwide coronary care unit registry, Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART), during 1998 to 2013 and then merged with each MI on date of symptom onset and coronary care unit. All patients admitted to any coronary care unit in Sweden owing to MI were included, A total of 280 873 patients were included, of whom 92 044 were diagnosed as having ST-elevation MI. Weather data were available for 274 029 patients (97.6%), which composed the final study population. Data were analyzed between February 2017 and April 2018. EXPOSURES The nationwide daily mean air temperature, minimum air temperature, maximum air temperature, wind velocity, sunshine duration, atmospheric air pressure, air humidity, snow precipitation, rain precipitation, and change in air temperature. MAIN OUTCOMES AND MEASURES The nationwide daily counts of MI as outcome. RESULTS In 274 029 patients, mean (SD) age was 71.7 (12) years. Incidence of MI increased with lower air temperature, lower atmospheric air pressure, higher wind velocity, and shorter sunshine duration. The most pronounced association was observed for air temperature, where a 1-SD increase in air temperature (7.4 degrees C) was associated with a 2.8% reduction in risk of MI (unadjusted incidence ratio, 0.972; 95% CI, 0.967-0.977; P amp;lt;.001). Results were consistent for non-ST-elevation MI as well as ST-elevation MI and across a large range of subgroups and health care regions. CONCLUSIONS AND RELEVANCE In this large, nationwide study, low air temperature, low atmospheric air pressure, high wind velocity, and shorter sunshine duration were associated with risk of MI with the most evident association observed for air temperature.

  • 297.
    Monachino, Michelle Sara
    Linköping University, Department of Culture and Communication. Linköping University, Faculty of Arts and Sciences. Escola Nacional de Saúde Pública, Lisboa, Portugal.
    The Corporate Social Responsibility (CSR) approach as a framework for business involvement in health promotion in the welfare state2016Doctoral thesis, monograph (Other academic)
    Abstract [en]

    This dissertation is to be situated in the debate about the development of the contemporary Western European welfare state, its displacement of responsibilities from state to non-state societal actors and the resulting concerns vis-à-vis the optimal distribution of responsibilities. Drawing, in interdisciplinary fashion, from the fields of political sociology, political economics, welfare studies, public health policy, and management, it focuses upon the involvement of for-profit, non-state actors into a field traditionally of state competence, that of public health. In order to do so, are considered two spheres of research and practice that frame and motivate the involvement of business actors in public health in the welfare state, and that have been seldom crossed: the Corporate Social Responsibility (CSR) approach and the health promotion approach. Through the means of a qualitative policy analysis relying on a variety of methods, literature review, document analysis, case studies and participant observation, this dissertation sets out to identify the features of business involvement in health promotion through CSR, and to examine and discuss the issues arising from such involvement in the context of the Western European welfare state. Specifically, the purpose is that of participating to the clarification and discussion of the potential contributions and dilemmas CSR initiatives pose for health promotion policy and practice, as well as unveiling the limits to such contribution. The findings suggest that initiatives formulated within the CSR framework are apt to allow business actors to further contextual health promotion priorities and approaches, as well as enabling the advancing of social capital and trust building at local level. Nevertheless, such contributions were found to be partial, limited by a number of specific boundaries inherent to the way the CSR approach is configured and to the way it is applied. Boundaries are resumed in terms of: coexistent rationalities and partial understandings concerning the CSR approach; lack of awareness of business actors concerning the health promotion approach and its dimensions; positive understanding of social responsibility; and limited instruments for cross-sectoral negotiation and collaboration. On the basis of the findings, the dissertation refutes the dilemmas, presented in literature, concerning the potential for CSR initiatives to constitute a mean for the scaling back of governmental responsibilities or the divulgation of a narrow understanding of health. On the other hand, it confirms their potential instrumentality to the pursuit of opportunistic objectives, such as market differentiation and regulation avoidance. The information collected did not allow discussing the aptitude for CSR initiatives to constitute channels for the direct lobbying of political élites or the exercise of organizational control upon employees. The dissertation further warns that the selection of causes, beneficiaries, and social partners operated in absence of mechanisms of alignment with contextual priorities and of inclusion of stakeholder interest into business decision-making may lead to CSR initiatives emphasising, rather than counterbalancing, inequalities in the access to resources and opportunities for health. Ultimately, it is recommended for the term CSR to be modified as to better fit the ensemble of business actors that may engage in the approach, for instance, substituting it with the more encompassing term social responsibility of businesses, or with any other term apt to the depict the dialogic purpose of CSR.

  • 298.
    Mossberg, Lennart
    et al.
    LM Bild & Bokstav.
    Kernell-Tolf, Malin
    PrioriteringsCentrum.
    Perspektiv på prioritering: Rapportering från den första nationella prioriteringskonferensen i Linköping den 1-2 oktober 20012002Report (Other academic)
    Abstract [sv]

    Gapet mellan befolkningens behov av vård och tillgängliga resurser inom vård och omsorg tvingar oss till svåra val. Det råder stor enighet om att dessa val inte skall vara godtyckliga eller slumpartade. För att undvika detta krävs det principer för vägledning och metoder för det praktiska genomförandet.

    Den första nationella konferensen om principer och arbetsformer för prioritering inom vård och omsorg anordnades i Linköping den 1 och 2 oktober 2001. Syftet med konferensen var att bidra till utbyte av kunskap om principer och praktiska erfarenheter av prioriteringar inom vård och omsorg.

    Konferensen vände sig till politiker, administratörer och personer verksamma inom vård och omsorg samt till övriga intresserade av prioriteringar. Konferensen blev välbesökt, då drygt 300 personer kom för att lyssna på internationella samt nationella föredragshållare.

    Värd för konferensen var PrioriteringsCentrum i samverkan med Landstinget i Östergötland, Socialstyrelsen, Landstingsförbundet, Svenska kommunförbundet, Svenska läkaresällskapet, Sveriges Läkarförbund och Vårdförbundet.

    Rapporten är framtagen av Lennart Mossberg, LM Bild & Bokstav och Malin Kernell-Tolf vid PrioriteringsCentrum. Jag vill tacka dem och alla andra personer vid PrioriteringsCentrum, samarbetspartners, föredragshållare och konferensdeltagare som bidragit till den framgångsrika konferensen och till denna intressanta dokumentation.

    Linköping 2001

    Per Carlsson

    PrioriteringsCentrum

  • 299.
    Murphy, Patrick J.
    et al.
    NUI Galway, Ireland.
    Mc Sharry, Jenny
    NUI Galway, Ireland.
    Casey, Dympna
    NUI Galway, Ireland.
    Doherty, Sally
    Royal Coll Surgeons Ireland, Ireland.
    Gillespie, Paddy
    NUI Galway, Ireland.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Murphy, Andrew W.
    NUI Galway, Ireland.
    Newell, John
    NUI Galway, Ireland.
    ODonnell, Martin
    NUI Galway, Ireland.
    Steinke, Elaine E.
    Wichita State University, KS 67260 USA.
    Toomey, Elaine
    University of Coll Dublin, Ireland.
    Byrne, Molly
    NUI Galway, Ireland.
    Sexual counselling for patients with cardiovascular disease: protocol for a pilot study of the CHARMS sexual counselling intervention2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 6, article id e011219Article in journal (Refereed)
    Abstract [en]

    Introduction Sexual problems are common with cardiovascular disease, and can negatively impact quality of life. To address sexual problems, guidelines have identified the importance of sexual counselling during cardiac rehabilitation, yet this is rarely provided. The Cardiac Health and Relationship Management and Sexuality (CHARMS) intervention aims to improve the provision of sexual counselling in cardiac rehabilitation in Ireland. Methods and analysis This is a multicentre pilot study for the CHARMS intervention, a complex, multilevel intervention delivered within hospital-based cardiac rehabilitation programmes. The intervention includes (1) training in sexual counselling for staff, (2) a staff-led patient education and support intervention embedded within the cardiac rehabilitation programme, (3) a patient information booklet and (4) an awareness raising poster. The intervention will be delivered in two randomly selected cardiac rehabilitation centres. In each centre 30 patients will be recruited, and partners will also be invited to participate. Data will be collected from staff and patients/partners at T1 (study entry), T2 (3-month follow-up) and T3 (6-month follow-up). The primary outcome for patients/partners will be scores on the Sexual Self-Perception and Adjustment Questionnaire. Secondary outcomes for patients/partners will include relationship satisfaction; satisfaction with and barriers to sexual counselling in services; sexual activity, functioning and knowledge; physical and psychological well-being. Secondary outcomes for staff will include sexuality-related practice; barriers to sexual counselling; self-ratings of capability, opportunity and motivation; sexual attitudes and beliefs; knowledge of cardiovascular disease and sex. Fidelity of intervention delivery will be assessed using trainer self-reports, researcher-coded audio recordings and exit interviews. Longitudinal feasibility data will be gathered from patients/partners and staff via questionnaires and interviews. Ethics and dissemination This study is approved by the Research Ethics Committee (REC) of the National University of Ireland, Galway. Findings will be disseminated to cardiac rehabilitation staff, patients/partners and relevant policymakers via appropriate publications and presentations.

  • 300.
    Murphy, Patrick J.
    et al.
    Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Ireland; 2Disciplines of Occupational Therapy and Radiation Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland; 12Room 2.77, Discipline of Occupational Therapy, Trinity Centre for Health Sciences, St. Jamess Hospital, Dublin 8, Ireland.
    Noone, Chris
    Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Ireland.
    DEath, Maureen
    Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Ireland.
    Casey, Dympna
    School of Nursing and Midwifery, NUI Galway, Galway, Ireland.
    Doherty, Sally
    Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Murphy, Andrew W.
    Department of General Practice, NUI Galway, Galway, Ireland.
    ODonnell, Martin
    HRB Clinical Research Facility, NUI Galway, Galway, Ireland.
    Fallon, Noeleen
    Cardiac Rehabilitation Unit, Tallaght Hospital, Dublin, Ireland.
    Gillespie, Paddy
    School of Business and Economics, NUI Galway, Galway, Ireland.
    Jalali, Amirhossein
    HRB Clinical Research Facility, NUI Galway, Galway, Ireland; 10School of Mathematics, Statistics, and Applied Mathematics, NUI Galway, Galway, Ireland.
    Sharry, Jenny Mc
    Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Ireland.
    Newell, John
    HRB Clinical Research Facility, NUI Galway, Galway, Ireland; 10School of Mathematics, Statistics, and Applied Mathematics, NUI Galway, Galway, Ireland.
    Toomey, Elaine
    Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Ireland.
    Steinke, Elaine E.
    School of Nursing, Wichita State University, Kansas, USA.
    Byrne, Molly
    Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Ireland.
    The CHARMS pilot study: a multi-method assessment of the feasibility of a sexual counselling implementation intervention in cardiac rehabilitation in Ireland2018In: Pilot and feasibility studies, ISSN 2055-5784, Vol. 4, article id 88Article in journal (Refereed)
    Abstract [en]

    Many people living with cardiovascular disease (CVD) are affected by sexual problems associated with the condition. International guidelines recommend all patients with CVD should receive sexual counselling, yet this is rarely provided by health professionals. The current study piloted the Cardiac Health and Relationship Management and Sexuality (CHARMS) intervention, a complex multi-level intervention designed to increase the implementation of sexual counselling guidelines in hospital-based cardiac rehabilitation (CR) in Ireland.

3456789 251 - 300 of 474
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf