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Laleci Erturkmen, G. B., Yuksel, M., Sarigul, B., Arvanitis, T. N., Lindman, P., Chen, R., . . . Kalra, D. (2019). A Collaborative Platform for Management of Chronic Diseases via Guideline-Driven Individualized Care Plans. Computational and structural biotechnology journal, 17, 869-885
Open this publication in new window or tab >>A Collaborative Platform for Management of Chronic Diseases via Guideline-Driven Individualized Care Plans
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2019 (English)In: Computational and structural biotechnology journal, ISSN 2001-0370, Vol. 17, p. 869-885Article in journal (Refereed) Published
Abstract [en]

Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients. Care planning is a prevalent approach of integrated care, where the aim is to deliver more personalized and targeted care creating shared care plans by clearly articulating the role of each provider and patient in the care process. In this paper, we present a method and corresponding implementation of a semi-automatic care plan management tool, integrated with clinical decision support services which can seamlessly access and assess the electronic health records (EHRs) of the patient in comparison with evidence based clinical guidelines to suggest personalized recommendations for goals and interventions to be added to the individualized care plans. We also report the results of usability studies carried out in four pilot sites by patients and clinicians.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Chronic disease management, Clinical decision support systems, Evidence based clinical guidelines, Integrated care
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-163527 (URN)10.1016/j.csbj.2019.06.003 (DOI)31333814 (PubMedID)
Available from: 2019-09-24 Created: 2019-09-24 Last updated: 2019-09-30Bibliographically approved
Traore, L., Assele-Kama, A., Keung, S. N., Karni, L., Klein, G. O., Lilja, M., . . . Jaulent, M.-C. (2019). User-Centered Design of the C3-Cloud Platform for Elderly with Multiple Diseases: Functional Requirements and Application Testing. In: Lucila Ohno-Machado, Brigitte Séroussi (Ed.), MEDINFO 2019: Health and Wellbeing e-Networks for All (pp. 843-847). IOS Press, 264
Open this publication in new window or tab >>User-Centered Design of the C3-Cloud Platform for Elderly with Multiple Diseases: Functional Requirements and Application Testing
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2019 (English)In: MEDINFO 2019: Health and Wellbeing e-Networks for All / [ed] Lucila Ohno-Machado, Brigitte Séroussi, IOS Press, 2019, Vol. 264, p. 843-847Chapter in book (Refereed)
Abstract [en]

The number of patients with multimorbidity has been steadily increasing in the modern aging societies. The European C3-Cloud project provides a multidisciplinary and patient-centered "Collaborative Care and Cure-system" for the management of elderly with multimorbidity, enabling continuous coordination of care activities between multidisciplinary care teams (MDTs), patients and informal caregivers (ICG). In this study various components of the infrastructure were tested to fulfill the functional requirements and the entire system was subjected to an early application testing involving different groups of end-users. MDTs from participating European regions were involved in requirement elicitation and test formulation, resulting in 57 questions, distributed via an internet platform to 48 test participants (22 MDTs, 26 patients) from three pilot sites. The results indicate a high level of satisfaction with all components. Early testing also provided feedback for technical improvement of the entire system, and the paper points out useful evaluation methods.

Place, publisher, year, edition, pages
IOS Press, 2019
Series
Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365 ; 264
Keywords
Evaluation Studies, Multimorbidity, User-computer Interface
National Category
Public Health, Global Health, Social Medicine and Epidemiology Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-163526 (URN)10.3233/SHTI190342 (DOI)31438043 (PubMedID)978-1-64368-002-6 (ISBN)978-1-64368-003-3 (ISBN)
Available from: 2019-09-24 Created: 2019-09-24 Last updated: 2019-09-30Bibliographically approved
Hultstrand Ahlin, C., Hörnsten, Å., Coe, A.-B., Lilja, M. & Hajdarevic, S. (2019). Wishing to be perceived as a capable and resourceful person: A qualitative study of melanoma patients’ experiences of the contact and interaction with healthcare professionals. Journal of Clinical Nursing, 28(7–8), 1223-1232
Open this publication in new window or tab >>Wishing to be perceived as a capable and resourceful person: A qualitative study of melanoma patients’ experiences of the contact and interaction with healthcare professionals
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2019 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 7–8, p. 1223-1232Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: To explore patients' experiences of contact and interaction with healthcare professionals (HCPs) during the diagnostic process of melanoma.

BACKGROUND: In Sweden, most patients with suspected skin lesions seek care at the primary level of services in the first instance. Previous research describes the diagnostic process as a complex journey with uncertainty. Nonetheless, the importance of contact and interaction between patient and HCPs during the diagnostic process is rarely explored.

DESIGN: This study adopted a qualitative design in which semi-structured interviews were conducted and the COREQ-checklist for qualitative studies employed (EQUATOR guidelines).

METHODS: A sample of 30 patients (15 women, 15 men) diagnosed with melanoma was included. Secondary analysis of interviews was carried out using qualitative content analysis.

RESULTS: One theme emerged: Wishing to be perceived as a capable and resourceful person that consisted of three categories: (a) The need of being valued, (b) The need of being informed and (c) The need of taking actions.

CONCLUSIONS: Our results suggest that patients wish to be valued as capable and resourceful persons as well as to be provided with honest and sufficient information about the diagnosis and subsequent procedures. By fulfilling these wishes, HCPs can involve patients in the diagnostic process and reduce patients' uncertainty. A need of supportive and accessible health care to manage the diagnostic process and to reduce patients' struggle for care was also identified.

RELEVANCE TO THE CLINICAL PRACTICE: Patients are satisfied when health care is organised in a patient-/person-centred manner, that is, in accordance with patients' needs, avoiding gatekeeping, and when HCPs interact respectfully in encounters. Accessible HCPs during the diagnostic process of melanoma are required to inform, support and navigate patients within the healthcare system and through their diagnostic journey.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
cancer, care needs, healthcare professional-patient relationship, patient-centred care, patients’ experience, qualitative study
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-155315 (URN)10.1111/jocn.14730 (DOI)000460767400018 ()30549354 (PubMedID)2-s2.0-85059608526 (Scopus ID)
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-10-16Bibliographically approved
Julin, B., Willers, C., Leksell, J., Lindgren, P., Looström Muth, K., Svensson, A.-M., . . . Dahlström, T. (2018). Association between sociodemographic determinants and health outcomes in individuals with type 2 diabetes in Sweden. Diabetes/Metabolism Research Reviews, 34(4), Article ID e2984.
Open this publication in new window or tab >>Association between sociodemographic determinants and health outcomes in individuals with type 2 diabetes in Sweden
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2018 (English)In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 34, no 4, article id e2984Article in journal (Refereed) Published
Abstract [en]

Background: Concurrent multifactorial treatment is needed to reduce consequent risks of diabetes, yet most studies investigating the relationship between sociodemographic factors and health outcomes have focused on only one risk factor at a time. Swedish health care is mainly tax-funded, thus providing an environment that should facilitate equal health outcomes in patients, independent of background, socioeconomic status, or health profile. This study aimed at investigating the association between several sociodemographic factors and diabetes-related health outcomes represented by HbA(1c), systolic blood pressure, low-density lipoprotein cholesterol, predicted 5-year risk of cardiovascular disease, and statin use.

Methods: This large retrospective registry study was based on patient-level data from individuals diagnosed with type 2 diabetes during 2010 to 2011 (n=416,228) in any of 7 Swedish regions (similar to 65% of the Swedish population). Health equity in diabetes care analysed through multivariate regression analyses on intermediary outcomes (HbA(1c), systolic blood pressure, and low-density lipoprotein), predicted 5-year risk of cardiovascular disease and process (i.e., statin use) after 1-year follow-up, adjusting for several sociodemographic factors.

Results: We observed differences in intermediary risk measures, predicted 5-year risk of cardiovascular disease, and process dependent on place of birth, sex, age, education, and social setting, despite Sweden's articulated vision of equal health care.

Conclusions: Diabetes patients' health was associated with sociodemographic prerequisites. Furthermore, in addition to demographics (age and sex) and disease history, educational level, marital status, and region of birth are important factors to consider when benchmarking health outcomes, e.g., average HbA(1c) level, and evaluating the level of health equity between organizational units or between different administrative regions.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
type 2 diabetes mellitus, sociodemographics, HbA(1c), systolic blood pressure, statin use, cardiovascular disease
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-148023 (URN)10.1002/dmrr.2984 (DOI)000431984700008 ()29377503 (PubMedID)
Available from: 2018-05-30 Created: 2018-05-30 Last updated: 2019-05-20Bibliographically approved
Lilja, M., Hellgren, M. & Jansson, S. (2018). Diagnos och behandlingsmål vid diabetes typ 2. Läkartidningen, 115, Article ID EYWX.
Open this publication in new window or tab >>Diagnos och behandlingsmål vid diabetes typ 2
2018 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, article id EYWXArticle in journal (Refereed) Published
Abstract [en]

The article presents diagnostic criteria for diabetes and treatment goals for diabetes type 2.

Place, publisher, year, edition, pages
Sveriges läkarförbund, 2018
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-149334 (URN)29461567 (PubMedID)
Available from: 2018-06-19 Created: 2018-06-19 Last updated: 2019-05-20Bibliographically approved
Lilja, M., Widerström, M. & Lindh, J. (2018). Persisting post-infection symptoms 2 years after a large waterborne outbreak of Cryptosporidium hominis in northern Sweden. BMC Research Notes, 11(1), Article ID 625.
Open this publication in new window or tab >>Persisting post-infection symptoms 2 years after a large waterborne outbreak of Cryptosporidium hominis in northern Sweden
2018 (English)In: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 11, no 1, article id 625Article in journal (Refereed) Published
Abstract [en]

Objectives: In 2010–2011, a large waterborne outbreak of Cryptosporidium hominis affected the city of Östersund in Sweden. Previous findings had suggested that gastrointestinal symptoms can persist for up to 11 months after the initial infection. Here we investigated whether the parasite could cause sequelae in infected individuals up to 28 months after the outbreak. We compared cases linked to the outbreak and the previous follow-up study with non-cases regarding symptoms present up to 28 months after the initial infection. We investigated whether cases were more likely to report a list of symptoms at follow-up compared to non-cases, calculating odds ratio and 95% confidence interval obtained through logistic regression.

Results: A total of 559 individuals (215 cases) were included in the study. Forty-eight percent of the outbreak cases reported symptoms at follow-up. Compared to non-cases, cases were more likely to report watery diarrhea, diarrhea, abdominal pain, fatigue, nausea, headache, or joint stiffness/pain/discomfort at follow-up after adjusting for age and sex. Our findings suggest that gastrointestinal symptoms and joint pain can persist several years after the initial Cryptosporidium infection and should be regarded as a potential cause of unexplained gastrointestinal symptoms or joint pain in people who have had this infection.

Keywords
Cryptosporidium, Diarrhea, Sequelae
National Category
Infectious Medicine
Identifiers
urn:nbn:se:umu:diva-152574 (URN)10.1186/s13104-018-3721-y (DOI)30165888 (PubMedID)2-s2.0-85052726607 (Scopus ID)
Available from: 2018-10-12 Created: 2018-10-12 Last updated: 2019-05-27Bibliographically approved
Laleci Erturkmen, G. B., Yuksel, M., Sarigul, B., Lilja, M., Chen, R. & Arvanitis, T. N. (2018). Personalised Care Plan Management Utilizing Guideline-Driven Clinical Decision Support Systems. Studies in Health Technology and Informatics, 247, 750-754
Open this publication in new window or tab >>Personalised Care Plan Management Utilizing Guideline-Driven Clinical Decision Support Systems
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2018 (English)In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 247, p. 750-754Article in journal (Refereed) Published
Abstract [en]

Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients. Care planning is a prevalent approach of integrated care, where the aim is to deliver more personalized and targeted care creating shared care plans by clearly articulating the role of each provider and patient in the care process. In this paper, we present a method and corresponding implementation of a semi-automatic care plan management tool, integrated with clinical decision support services which can seamlessly access and assess the electronic health records (EHRs) of the patient in comparison with evidence based clinical guidelines to suggest personalized recommendations for goals and interventions to be added to the individualized care plans.

Place, publisher, year, edition, pages
European Federation for Medical Informatics (EFMI) and IOS Press, 2018
Keywords
Chronic disease management, multimorbidity, personalized care plans
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-149333 (URN)10.3233/978-1-61499-852-5-750 (DOI)29678061 (PubMedID)
Available from: 2018-06-19 Created: 2018-06-19 Last updated: 2018-11-09Bibliographically approved
Willers, C., Lekander, I., Ekstrand, E., Lilja, M., Pessah-Rasmussen, H., Sunnerhagen, K. S. & von Euler, M. (2018). Sex as predictor for achieved health outcomes and received care in ischemic stroke and intracerebral hemorrhage: a register-based study. Biology of Sex Differences, 9, Article ID 11.
Open this publication in new window or tab >>Sex as predictor for achieved health outcomes and received care in ischemic stroke and intracerebral hemorrhage: a register-based study
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2018 (English)In: Biology of Sex Differences, ISSN 2042-6410, Vol. 9, article id 11Article in journal (Refereed) Published
Abstract [en]

Background: Differences in stroke care and health outcomes between men and women are debated. The objective of this study was to explore the relationship between patients' sex and post-stroke health outcomes and received care in a Swedish setting.

Methods: Patients with a registered diagnosis of acute intracerebral hemorrhage (ICH) or ischemic stroke (IS) within regional administrative systems (ICD-10 codes I61* or I63*) and the Swedish Stroke Register during 2010-2011 were included and followed for 1 year. Data linkage to multiple other data sources on individual level was performed. Adjustments were performed for age, socioeconomic factors, living arrangements, ADL dependency, and stroke severity in multivariate regression analyses of health outcomes and received care. Health outcomes (e.g., survival, functioning, satisfaction) and received care measures (regional and municipal resources and processes) were studied.

Results: Study population: 13,775 women and 13,916 men. After case-mix adjustments for the above factors, we found women to have higher 1-year survival rates after both IS (ORfemale = 1.17, p < 0.001) and ICH (ORfemale = 1.65, p < 0.001). Initial inpatient stay at hospital was, however, shorter for women βfemale, IS = -0.05, p < 0.001; βfemale, ICH = -0.08, p < 0.005). For IS, good function (mRS <= 2) was more common in men (ORfemale = 0.86, p < 0.001) who also received more inpatient care during the first year βfemale = -0.05, p < 0.001).

Conclusions: A lower proportion of women had good functioning, a difference that remained in IS after adjustments for age, socioeconomic factors, living arrangements, ADL dependency, and stroke severity. The amount of received hospital care was lower for women after adjustments. Whether shorter hospital stay results in lower function or is a consequence of lower function cannot be elucidated. One-year survival was higher in men when no adjustments were made but lower after adjustments. This likely reflects that women were older at time of stroke, had more severe strokes, and more disability pre-stroke-factors that make a direct comparison between the sexes intricate.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
stroke, sex, health outcomes, resources, utilization, epidemiology
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-146212 (URN)10.1186/s13293-018-0170-1 (DOI)000427179000001 ()29514685 (PubMedID)
Available from: 2018-05-14 Created: 2018-05-14 Last updated: 2019-05-20Bibliographically approved
Ridderstedt, F., Widerström, M., Lindh, J. & Lilja, M. (2018). Sick leave due to diarrhea caused by contamination of drinking water supply with Cryptosporidium hominis in Sweden: a retrospective study. Journal of Water and Health, 16(5), 704-710
Open this publication in new window or tab >>Sick leave due to diarrhea caused by contamination of drinking water supply with Cryptosporidium hominis in Sweden: a retrospective study
2018 (English)In: Journal of Water and Health, ISSN 1477-8920, E-ISSN 1996-7829, Vol. 16, no 5, p. 704-710Article in journal (Refereed) Published
Abstract [en]

We investigated sick leave from work, studies, preschool, and kindergarten occurring between 1 November 2010 and 31 January 2011 and associated with a waterborne outbreak of diarrhea caused by Cryptosporidium hominis in late November 2010 in Östersund, Sweden with 45.2% of 60,000 residents being symptomatic. A questionnaire defining acute watery diarrhoea and/or ≥3 diarrhea episodes/day as cryptosporidiosis was sent to 1,508 residents in late January 2011 (response rate 69.2%). Among adults aged 18–60 years, 24.0% took sick leave for a mean of 4.6 (SD ± 4.0) days due to cryptosporidiosis, and an additional 10.6% were absent from work a mean of 4.0 (±2.2) days to care for symptomatic children. Among children (aged ≤17 years), 35.0% stayed home sick from kindergarten/preschool or school/university for a mean of 5.2 (±3.8) days resulting in 5.1 (±4.4) days of absence from work per sick child shared between parents/guardians. The estimated total number of sick leave days was 50,000 for adults and 20,700 for children, with an estimated direct cost of €7 million for employers. The potential impact on society of sick leave caused by waterborne diseases must be considered in decisions regarding the quality of drinking water.

Place, publisher, year, edition, pages
IWA Publishing, 2018
Keywords
cryptosporidiosis, disease outbreaks, drinking water, sick leave
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-152575 (URN)10.2166/wh.2017.311 (DOI)000446334800003 ()30285952 (PubMedID)
Available from: 2018-10-12 Created: 2018-10-12 Last updated: 2019-05-20Bibliographically approved
Willers, C., Iderberg, H., Axelsen, M., Dahlström, T., Julin, B., Leksell, J., . . . Lilja, M. (2018). Sociodemographic determinants and health outcome variation in individuals with type 1 diabetes mellitus: A register-based study. PLoS ONE, 13(6), Article ID e0199170.
Open this publication in new window or tab >>Sociodemographic determinants and health outcome variation in individuals with type 1 diabetes mellitus: A register-based study
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 6, article id e0199170Article in journal (Refereed) Published
Abstract [en]

Background: Socioeconomic status, origin or demographic attributes shall not determine the quality of healthcare delivery, according to e.g. United Nations and European Union rules. Health equity has been defined as the absence of systematic disparities and unwarranted differences between groups defined by differences in social advantages. A study was performed to investigate whether this was applicable to type 1 diabetes mellitus (T1D) care in a setting with universal, tax-funded healthcare. Methods: This retrospective registry-study was based on patient-level data from individuals diagnosed with T1D during 2010-2011 (n = 16,367) in any of seven Swedish county councils (covering -65% of the Swedish population). Health equity in T1D care was analysed through multivariate regression analyses on absolute HbA1c level at one-year follow-up, one-year change in estimated glomerular filtration rate (eGFR) and one-year change in cardiovascular risk score, using selected sociodemographic dimensions as case-mix factors. Results: Higher educational level was consistently associated with lower levels of HbA1c, and so was being married. Never married was associated with worse eGFR development, and lower educational level was associated with higher cardiovascular risk. Women had higher HbA1c levels than men, and glucose control was significantly worse in patients below the age of 25. Conclusion: Patients' sociodemographic profile was strongly associated with absolute levels of risk factor control in T1 D, but also with an increased annual deterioration in eGFR. Whether these systematic differences stem from patient-related problems or healthcare organisational shortcomings is a matter for further research. The results, though, highlight the need for intensified diabetes management education and secondary prevention directed towards T1D patients, taking sociodemographic characteristics into account.

Place, publisher, year, edition, pages
Public library science, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-150768 (URN)10.1371/journal.pone.0199170 (DOI)000436793500006 ()29958293 (PubMedID)
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2019-05-20Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-5203-9877

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