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Brunström, M., Ng, N., Dahlström, J., Lindholm, L. H., Lönnberg, G., Norberg, M., . . . Carlberg, B. (2020). Association of Physician Education and Feedback on Hypertension Management With Patient Blood Pressure and Hypertension Control. JAMA Network Open, 3(1), Article ID e1918625.
Open this publication in new window or tab >>Association of Physician Education and Feedback on Hypertension Management With Patient Blood Pressure and Hypertension Control
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2020 (English)In: JAMA Network Open, ISSN 2574-3805, Vol. 3, no 1, article id e1918625Article in journal (Refereed) Published
Abstract [en]

Importance: Elevated systolic blood pressure (SBP) is the most important risk factor for premature death worldwide. However, hypertension detection and control rates continue to be suboptimal.

Objective: To assess the association of education and feedback to primary care physicians with population-level SBP and hypertension control rates.

Design, Setting, and Participants: This pooled series of 108 population-based cohort studies involving 283 079 patients used data from primary care centers in 2 counties (Västerbotten and Södermanland) in Sweden from 2001 to 2009. Participants were individuals aged 18 years or older who had their blood pressure (BP) measured and recorded in either county during the intervention period. All analyses were performed in February 2019.

Exposures: An intervention comprising education and feedback for primary care physicians in Västerbotten County (intervention group) compared with usual care in Södermanland County (control group).

Main Outcomes and Measures: Difference in mean SBP levels between counties and likelihood of hypertension control in the intervention county compared with the control county during 24 months of follow-up.

Results: A total of 136 541 unique individuals (mean [SD] age at inclusion, 64.6 [16.1] years; 57.0% female; mean inclusion BP, 142/82 mm Hg) in the intervention county were compared with 146 538 individuals (mean [SD] age at inclusion, 65.7 [15.9] years; 58.3% female; mean inclusion BP, 144/80 mm Hg) in the control county. Mean SBP difference between counties during follow-up, adjusted for inclusion BP and other covariates, was 1.1 mm Hg (95% CI, 1.0-1.1 mm Hg). Hypertension control improved by 8.4 percentage points, and control was achieved in 37.8% of participants in the intervention county compared with 29.4% in the control county (adjusted odds ratio, 1.30; 95% CI, 1.29-1.31). Differences between counties increased during the intervention period and were more pronounced in participants with higher SBP at inclusion. Results were consistent across all subgroups.

Conclusions and Relevance: This study suggests that SBP levels and hypertension control rates in a county population may be improved by educational approaches directed at physicians and other health care workers. Similar strategies may be adopted to reinforce the implementation of clinical practice guidelines for hypertension management.

Place, publisher, year, edition, pages
American Medical Association, 2020
National Category
General Practice Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-167169 (URN)10.1001/jamanetworkopen.2019.18625 (DOI)31913490 (PubMedID)
Available from: 2020-01-10 Created: 2020-01-10 Last updated: 2020-01-10Bibliographically approved
Schunemann, H. J., Lerda, D., Quinn, C., Follmann, M., Alonso-Coello, P., Rossi, P. G., . . . Saz-Parkinson, Z. (2020). Breast Cancer Screening and Diagnosis: A Synopsis of the European Breast Guidelines. Annals of Internal Medicine, 172(1), 46-56
Open this publication in new window or tab >>Breast Cancer Screening and Diagnosis: A Synopsis of the European Breast Guidelines
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2020 (English)In: Annals of Internal Medicine, ISSN 0003-4819, E-ISSN 1539-3704, Vol. 172, no 1, p. 46-56Article in journal (Refereed) Published
Abstract [en]

Description: The European Commission Initiative for Breast Cancer Screening and Diagnosis guidelines (European Breast Guidelines) are coordinated by the European Commission's Joint Research Centre. The target audience for the guidelines includes women, health professionals, and policymakers.

Methods: An international guideline panel of 28 multidisciplinary members, including patients, developed questions and corresponding recommendations that were informed by systematic reviews of the evidence conducted between March 2016 and December 2018. GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision frameworks were used to structure the process and minimize the influence of competing interests by enhancing transparency. Questions and recommendations, expressed as strong or conditional, focused on outcomes that matter to women and provided a rating of the certainty of evidence.

Recommendations: This synopsis of the European Breast Guidelines provides recommendations regarding organized screening programs for women aged 40 to 75 years who are at average risk. The recommendations address digital mammography screening and the addition of hand-held ultrasonography, automated breast ultrasonography, or magnetic resonance imaging compared with mammography alone. The recommendations also discuss the frequency of screening and inform decision making for women at average risk who are recalled for suspicious lesions or who have high breast density.

Place, publisher, year, edition, pages
Amer Coll Physicians, 2020
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-167646 (URN)10.7326/M19-2125 (DOI)000506650200008 ()31766052 (PubMedID)2-s2.0-85077931254 (Scopus ID)
Available from: 2020-02-03 Created: 2020-02-03 Last updated: 2020-02-03Bibliographically approved
Andersson, A., von Wachenfeldt Väppling, A., de Jong, A. & Nyström, L. (2019). Adherence to adjuvant endocrine therapy after breast cancer in Sweden 2008-2010: a nationwide survey. In: : . Paper presented at Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO), MAY 31-JUN 04, 2019, Chicago, IL (pp. 523-523). American Society of Clinical Oncology, 37(15)
Open this publication in new window or tab >>Adherence to adjuvant endocrine therapy after breast cancer in Sweden 2008-2010: a nationwide survey
2019 (English)Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

Background: In estrogen receptor (ER) positive early breast cancer (EBC) adjuvant endocrine therapy (AET) is crucial to reduce recurrence and mortality. Previous studies have shown that adherence to AET is lower than expected and could negatively affect outcome. Since the year of 2000, BC patients in Sweden are treated in accordance to national guidelines. Treatment is offered at a low cost for the patient. The aim of the study was to estimate the adherence to AET in Sweden by regions and age groups. Methods: Women with a first primary EBC diagnosis 2008-2010 were identified through the Swedish Cancer Registry (SCR). Individual tumour and treatment data were retrieved from the Swedish National Breast Cancer Registry (SNBCR). Patients with ER negative tumours, small tumours (≤ 10 mm) and metastatic disease was excluded from the study since there were no indication to AET. Likewise, were individuals with AET registered to be administered by a third part excluded. Dispensed treatment from pharmacies was obtained through the Swedish Prescription Registry and medication possession rate (MPR) was calculated as number of dispensed doses divided by treatment duration in days. Good adherence to treatment in a patient was set at MPR ≥ 80 %. Adherence was calculated for 3 and 5 years. Results: Twenty-one thousand sixteen (21 016) individuals with a first primary BC between 2008 and 2010 was identified through SCR of which 20 596 were registered in the SNBCR. A total of 10 176 met the inclusion criteria in the study. Adherence after 3 years was 88.0 % and after 5 years 82.5 %. Adherence differed between regions in Sweden and was positively associated with age at diagnosis between 41-74 years. Urban areas had a lower adherence than rural areas (80.7 % vs 83.6 %; p= <0.001). Conclusions: Adherence to AET in Sweden was good, although there were differences by age and urban and rural areas. Further studies are needed to identify factors affecting differences in adherence, with the purpose of initiate actions to increase adherence to AET in ER positive EBC patients.

Place, publisher, year, edition, pages
American Society of Clinical Oncology, 2019
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-164080 (URN)10.1200/JCO.2019.37.15_suppl.523 (DOI)000487345803516 ()
Conference
Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO), MAY 31-JUN 04, 2019, Chicago, IL
Note

Supplement: S (May 20, 2019) 

Meeting Abstract: 523

Available from: 2019-10-14 Created: 2019-10-14 Last updated: 2020-01-17Bibliographically approved
Pujilestari, C. U., Nyström, L., Norberg, M. & Ng, N. (2019). Association between changes in waist circumferences and disability among older adults: WHO-INDEPTH study on global ageing and adult health (SAGE) in Indonesia. Obesity Research and Clinical Practice, 13(5), 462-468
Open this publication in new window or tab >>Association between changes in waist circumferences and disability among older adults: WHO-INDEPTH study on global ageing and adult health (SAGE) in Indonesia
2019 (English)In: Obesity Research and Clinical Practice, ISSN 1871-403X, E-ISSN 1878-0318, Vol. 13, no 5, p. 462-468Article in journal (Refereed) Published
Abstract [en]

Background: There is a lack of evidence regarding the impact of changes in waist circumference on disability among older populations in low- and middle-income countries (LMICs). This research examines the association between changes in waist circumference with disability in the older populations of Indonesia, and whether the associations are dependent on wealth or baseline abdominal obesity levels.

Methods: In 2007 the INDEPTH-WHO Study on global AGEing and adult health (SAGE) was conducted among 11,753 individuals aged 50 years and older in Purworejo District, Central Java Province, Indonesia. Of these, a total of 8,089 were followed up in 2010. On both occasions, individuals’ waist circumferences were measured and the 12-item version of the WHO Disability Assessment Schedule version 2 (WHODAS-II) was implemented to measure disability.

Results: A significant positive association was observed between waist circumference and disability at the baseline (β = 0.066; p < 0.001), and between the increase in waist circumference and the level of disability during the three-year follow-up period (β = 0.094; p < 0.001) after adjusting for baseline variables. This association was also significant among the poor, non-obese men, as well as poor and rich obese women. Among the non-obese women, a decrease in waist circumference was associated with more disabilities.

Conclusions: An increase in waist circumference is associated with increased disability among older people in Purworejo, Indonesia. Health promotion programmes aiming to prevent obesity could have positive effects in preventing and reducing disability among older adults.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Abdominal obesity, Waist circumference, Disability, Older people, Indonesia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-165103 (URN)10.1016/j.orcp.2019.07.004 (DOI)000492674200007 ()31474381 (PubMedID)
Available from: 2019-11-13 Created: 2019-11-13 Last updated: 2019-11-13Bibliographically approved
Blomstedt, Y., Norberg, M., Ng, N., Nyström, L., Boman, K., Lönnberg, G., . . . Weinehall, L. (2019). Flawed conclusions on the Vasterbotten Intervention Program by San Sebastian et .al [Letter to the editor]. BMC Public Health, 19(1), Article ID 1095.
Open this publication in new window or tab >>Flawed conclusions on the Vasterbotten Intervention Program by San Sebastian et .al
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2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, no 1, article id 1095Article in journal, Letter (Refereed) Published
Abstract [en]

An evaluation of Vasterbotten Intervention Programme (VIP) was recently conducted by San Sebastian et al. (BMC Public Health 19:202, 2019). Evaluation of health care interventions of this kind require 1) an understanding of both the design and the nature of the intervention, 2) correct definition of the target population, and 3) careful choice of the appropriate evaluation method. In this correspondence, we review the approach used by San Sebastian et al. as relates to these three criteria. Within this framework, we suggest important explanations for why the conclusions drawn by these authors contradict a large body of research on the effectiveness of the VIP.

Keywords
Prevention, Community intervention, Evaluation, CVD
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-163072 (URN)10.1186/s12889-019-7444-3 (DOI)000480751900003 ()31409308 (PubMedID)
Available from: 2019-11-27 Created: 2019-11-27 Last updated: 2020-05-20Bibliographically approved
Schunemann, H. J., Lerda, D., Dimitrova, N., Alonso-Coello, P., Grawingholt, A., Quinn, C., . . . Parmelli, E. (2019). Methods for Development of the European Commission Initiative on Breast Cancer Guidelines Recommendations in the Era of Guideline Transparency. Annals of Internal Medicine, 171(4), 273-280
Open this publication in new window or tab >>Methods for Development of the European Commission Initiative on Breast Cancer Guidelines Recommendations in the Era of Guideline Transparency
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2019 (English)In: Annals of Internal Medicine, ISSN 0003-4819, E-ISSN 1539-3704, Vol. 171, no 4, p. 273-280Article in journal (Refereed) Published
Abstract [en]

Neither breast cancer prevention and early-detection programs, nor their outcomes, are uniform across Europe. This article describes the rationale, methods, and process for development of the European Commission ( EC) Initiative on Breast Cancer Screening and Diagnosis Guidelines. To be consistent with standards set by the Institute of Medicine and others, the EC followed 6 general principles. First, the EC selected, via an open call, a panel with broad representation of areas of expertise. Second, it ensured that all recommendations were supported by systematic reviews. Third, the EC separately considered important subgroups of women, included patient advocates in the guidelines development group, and focused on good communication to inform women's decisions. Fourth, EC rules on conflicts of interest were followed and the GRADE ( Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision frameworks were used to structure the process and minimize the influence of competing interests. Fifth, it focused its recommendations on outcomes that matter to women, and certainty of the evidence is rated for each. Sixth, the EC elicited stakeholder feedback to ensure that the recommendations remain up to date and relevant to practice. This article describes the approach and highlights ways of disseminating and adapting the recommendations both within and outside Europe, using innovative information technology tools.

Place, publisher, year, edition, pages
American College of Physicians, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-162845 (URN)10.7326/M18-3445 (DOI)000481642800019 ()31330534 (PubMedID)
Available from: 2019-09-13 Created: 2019-09-13 Last updated: 2019-09-13Bibliographically approved
Mgaya, A. H., Kidanto, H. L., Nyström, L. & Essen, B. (2019). Use of a criteria-based audit to optimize uptake of cesarean delivery in a low-resource setting. International Journal of Gynecology & Obstetrics, 144(2), 199-209
Open this publication in new window or tab >>Use of a criteria-based audit to optimize uptake of cesarean delivery in a low-resource setting
2019 (English)In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 144, no 2, p. 199-209Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the impact of a criteria‐based audit (CBA) of obstructed labor and fetal distress on cesarean delivery and perinatal outcomes.

Methods: A cross‐sectional study was performed at a tertiary referral hospital in Tanzania. Data were collected before and after CBA (January 2013–November 2013 and July 2015–June 2016). Outcomes of fetal distress (baseline CBA, n=248; re‐audit, n=251) and obstructed labor (baseline CBA, n=260; re‐audit n=250) were assessed using a checklist. Additionally, 27 960 parturients were assessed using the Robson classification.

Results: Perinatal morbidity and mortality decreased from 42 of 260 (16.2%) to 22 of 250 (8.8%) among patients with obstructed labor after CBA (P=0.012). Cesarean delivery rate decreased for referred term multiparas with induced labor or prelabor cesarean delivery (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.09–0.82). Cesarean delivery rate for preterm pregnancies increased among both referred (OR 1.28, 95% CI 1.02–1.63) and non‐referred (OR 2.78, 95% CI 1.98–3.90) groups. Neonatal distress rate decreased for referred term multiparas (OR 0.72, 95% CI 0.56–0.92), referred preterm pregnancies (OR 0.32, 95% CI 0.25–0.39), and non‐referred preterm pregnancies (OR 0.26, 95% CI 0.18–0.36).

Conclusion: Use of CBA reduced poor perinatal outcomes of obstructed labor and increased uptake of cesarean delivery.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2019
Keywords
Cesarean delivery, Criteria-based audit, Fetal distress, Low-resource setting, Obstructed labor, Robson classification
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-155628 (URN)10.1002/ijgo.12726 (DOI)000454953100012 ()30499099 (PubMedID)
Available from: 2019-01-28 Created: 2019-01-28 Last updated: 2019-01-28Bibliographically approved
Pujilestari, C. U., Nyström, L., Norberg, M. & Ng, N. (2019). Waist circumference and all-cause mortality among older adults in rural Indonesia. International Journal of Environmental Research and Public Health, 16, Article ID 116.
Open this publication in new window or tab >>Waist circumference and all-cause mortality among older adults in rural Indonesia
2019 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, article id 116Article in journal (Refereed) Published
Abstract [en]

Waist circumference, a measure of abdominal obesity, is associated with all-cause mortality in general adult population. However, the link between abdominal obesity with all-cause mortality in the studies of older adults is unclear. This study aims to determine the association between waist circumference and all-cause mortality in older adults in Indonesia. The association between waist circumference and all-cause mortality was examined in 10,997 men and women aged 50 years and older, in the World Health Organization (WHO) and International Network of field sites for continuous Demographic Evaluation of Populations and their Health in developing countries (INDEPTH) collaboration Study on global AGEing and adult health (SAGE) in Purworejo District Central Java, Indonesia during 2007–2010. Multivariate Cox regression analysis with restricted cubic splines was used to assess the non-linear association between waist circumference and all-cause mortality. During the 3-year follow-up, a total of 511 men and 470 women died. The hazard ratio plot shows a pattern of U-shape relationship between waist circumference and all-cause mortality among rich women, though the result was significant only for women in the lower end of waist circumference distribution (p < 0.05). Poor men with a low waist circumference (5th percentile) have a two times higher mortality risk (HR = 2.1; 95% CI = 1.3, 3.3) relative to those with a waist circumference of 90 cm. Poor women with a low waist circumference (25th percentile) have a 1.4 times higher mortality risk (HR = 1.4; 95% CI = 1.1, 1.8) relative to those with a waist circumference of 80 cm. This study shows a significant association between low waist circumference measure and mortality, particularly among poor men and women. Though the association between large waist circumference and mortality was not significant, we observed a trend of higher mortality risk particularly among rich women with large waist circumference measure. Public health intervention should include efforts to improve nutritional status among older people and promoting healthy lifestyle behaviours including healthy food and active lifestyle.

Place, publisher, year, edition, pages
MDPI, 2019
Keywords
abdominal obesity, deaths, Indonesia, older people, waist circumference
National Category
Gerontology, specialising in Medical and Health Sciences Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-152117 (URN)10.3390/ijerph16010116 (DOI)000459111400116 ()30609857 (PubMedID)
Note

Originally included in thesis in manuscript form

Available from: 2018-09-27 Created: 2018-09-27 Last updated: 2019-03-20Bibliographically approved
Wu, W.-Y. Y., Nyström, L. & Jonsson, H. (2018). Estimation of overdiagnosis in breast cancer screening using a non-homogeneous multi-state model: a simulation study. Journal of Medical Screening, 25(4), 183-190
Open this publication in new window or tab >>Estimation of overdiagnosis in breast cancer screening using a non-homogeneous multi-state model: a simulation study
2018 (English)In: Journal of Medical Screening, ISSN 0969-1413, E-ISSN 1475-5793, Vol. 25, no 4, p. 183-190Article in journal (Refereed) Published
Abstract [en]

Objectives: Overdiagnosis is regarded as a harm of screening. We aimed to develop a non-homogeneous multi-state model to consider the age-specific transition rates for estimation of overdiagnosis, to validate the model by a simulation study where the true frequency of overdiagnosis can be calculated, and to compare our estimate with the cumulative incidence method. Methods: We constructed a four-state model to describe the natural history of breast cancer. The latent disease progression and the observed states for each individual were simulated in a trial with biennial screening of women aged 51-69 and a control group of the same size without screening. We performed 100 repetitions of the simulation with one million women to evaluate the performance of estimates. A sensitivity analysis with reduced number of controls was performed to imitate the data from the service screening programme. Results Based on the 100 repetitions, the mean value of the true frequency of overdiagnosis was 12.5% and the average estimates by the cumulative incidence method and the multi-state model were 12.9% (interquartile range: 2.46%) and 13.4% (interquartile range: 2.16%), respectively. The multi-state model had a greater bias of overdiagnosis than the cumulative incidence method, but the variation in the estimates was smaller. When the number of unscreened group was reduced, the variation of multi-state model estimates increased. Conclusions: The multi-state model produces a proper estimate of overdiagnosis and the results are comparable with the cumulative incidence method. The multi-state model can be used in the estimation of overdiagnosis, and might be useful for the ongoing service screening programmes.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Overdiagnosis, breast cancer screening, mammography, multi-state model, cumulative incidence method
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-154901 (URN)10.1177/0969141317733294 (DOI)000452324300004 ()29153013 (PubMedID)
Available from: 2019-01-04 Created: 2019-01-04 Last updated: 2019-01-04Bibliographically approved
Wu, W.-Y. Y., Törnberg, S., Elfström, K. M., Liu, X., Nyström, L. & Jonsson, H. (2018). Overdiagnosis in the population-based organized breast cancer screening program estimated by a non-homogeneous multi-state model: a cohort study using individual data with long-term follow-up. Breast Cancer Research, 20, Article ID 153.
Open this publication in new window or tab >>Overdiagnosis in the population-based organized breast cancer screening program estimated by a non-homogeneous multi-state model: a cohort study using individual data with long-term follow-up
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2018 (English)In: Breast Cancer Research, ISSN 1465-5411, E-ISSN 1465-542X, Vol. 20, article id 153Article in journal (Refereed) Published
Abstract [en]

Background: Overdiagnosis, defined as the detection of a cancer that would not become clinically apparent in a woman’s lifetime without screening, has become a growing concern. Similar underlying risk of breast cancer in the screened and control groups is a prerequisite for unbiased estimates of overdiagnosis, but a contemporary control group is usually not available in organized screening programs.

Methods: We estimated the frequency of overdiagnosis of breast cancer due to screening in women 50–69 years old by using individual screening data from the population-based organized screening program in Stockholm County 1989–2014. A hidden Markov model with four latent states and three observed states was constructed to estimate the natural progression of breast cancer and the test sensitivity. Piecewise transition rates were used to consider the time-varying transition rates. The expected number of detected non-progressive breast cancer cases was calculated.

Results: During the study period, 2,333,153 invitations were sent out; on average, the participation rate in the screening program was 72.7% and the average recall rate was 2.48%. In total, 14,648 invasive breast cancer cases were diagnosed; among the 8305 screen-detected cases, the expected number of non-progressive breast cancer cases was 35.9, which is equivalent to 0.43% (95% confidence interval (CI) 0.10%–2.2%) overdiagnosis. The corresponding estimates for the prevalent and subsequent rounds were 15.6 (0.87%, 95% CI 0.20%–4.3%) and 20.3 (0.31%, 95% CI 0.07%–1.6%), respectively. The likelihood ratio test showed that the non-homogeneous model fitted the data better than an age-homogeneous model (P<0.001).

Conclusions: Our findings suggest that overdiagnosis in the organized biennial mammographic screening for women 50–69 in Stockholm County is a minor phenomenon. The frequency of overdiagnosis in the prevalent screening round was higher than that in subsequent rounds. The non-homogeneous model performed better than the simpler, traditional homogeneous model.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Overdiagnosis, Breast cancer, Organized screening program, Mammography, Multi-state model
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-155103 (URN)10.1186/s13058-018-1082-z (DOI)000453551900001 ()30558679 (PubMedID)
Funder
Swedish Research CouncilVästerbotten County Council
Available from: 2019-01-10 Created: 2019-01-10 Last updated: 2019-01-10Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5095-3454

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