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  • 101.
    Kien, Vu Duy
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Center for Population Health Sciences, Hanoi School of Public Health, Hanoi, Vietnam.
    Minh, HV
    Giang, KB
    Dao, A
    Tuan, LT
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Socioeconomic inequalities in catastrophic health expenditure and impoverishment associated with non-communicable diseases in urban Hanoi, Vietnam2016In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 15, article id 169Article in journal (Refereed)
    Abstract [en]

    Background: The catastrophic health expenditure and impoverishment indices offer guidance for developing appropriate health policies and intervention programs to decrease financial inequity. This study assesses socioeconomic inequalities in catastrophic health expenditure and impoverishment in relation to self-reported non-communicable diseases (NCD) in urban Hanoi, Vietnam. Methods: A cross-sectional survey was conducted from February to March 2013 in Hanoi, the capital city of Vietnam. We estimated catastrophic health expenditure and impoverishment using information from 492 slum household and 528 non-slum households. We calculated concentration indexes to assess socioeconomic inequalities in catastrophic health expenditure and impoverishment. Factors associated with catastrophic health expenditure and impoverishment were modelled using logistic regression analysis. Results: The poor households in both slum and non-slum areas were at higher risk of experiencing catastrophic health expenditure, while only the poor households in slum areas were at higher risk of impoverishment because of healthcare spending. Households with at least one member reporting an NCD were significantly more likely to face catastrophic health expenditure (odds ratio [OR] = 2.4; 95 % confidence interval [CI], 1.8-4.0) and impoverishment (OR = 2.3; 95 % CI, 1.1-6.3) compared to households without NCDs. In addition, households in slum areas, with people age 60 years and above, and belonging to the poorest socioeconomic group were significantly associated with increased catastrophic health expenditure, while only households that lived in slum areas, and belonging to the poor or poorest socioeconomic groups were significantly associated with increased impoverishment because of healthcare spending. Conclusion: Financial interventions to prevent catastrophic health expenditure and impoverishment should target poor households, especially those with family members suffering from NCDs, with older members and those located in slum areas in Hanoi Vietnam. Potential interventions derived from this study include targeting and monitoring of health insurance enrolment, and developing a specialized NCD service package for Vietnam's social health insurance program.

  • 102.
    Kien, Vu Duy
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Minh, HV
    Giang, KB
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Viet, N
    Eriksson, Malin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Responsiveness of commune health stations to non-communicable disease in urban VietnamArticle in journal (Refereed)
  • 103. Kiwanuka, Suzanne Namusoke
    et al.
    Akulume, Martha
    Tetui, Moses
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Makerere University School of Public Health (MakSPH), Department of Health Policy Planning and Management, Makerere University, Kampala, Uganda.
    Kananura, Rornald Muhumuza
    Bua, John
    Ekirapa-Kiracho, Elizabeth
    Balancing the cost of leaving with the cost of living: drivers of long-term retention of health workers: an explorative study in three rural districts in Eastern Uganda2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1345494Article in journal (Refereed)
    Abstract [en]

    Background: Health worker retention in rural and underserved areas remains a persisting problem in many low and middle income countries, and this directly affects the quality of health services offered.

    Objective: This paper explores the drivers of long-term retention and describes health worker coping mechanisms in rural Uganda.

    Methods: A descriptive qualitative study explored the factors that motivated health workers to stay, in three rural districts of Uganda: Kamuli, Pallisa, and Kibuku. In-depth interviews conducted among health workers who have been retained for at least 10 years explored factors motivating the health workers to stay within the district, opportunities, and the benefits of staying.

    Results: Twenty-one health workers participated. Ten of them male and 11 female with the age range of 33-51 years. The mean duration of stay among the participants was 13, 15, and 26 years for Kamuli, Kibuku, and Pallisa respectively. Long-term retention was related to personal factors, such as having family ties, community ties, and opportunities to invest. The decentralization policy and pension benefits also kept workers in place. Opportunities for promotion or leadership motivated long stay only if they came with financial benefits. Workload reportedly increased over the years, but staffing and emoluments had not increased. Multiple job, family support, and community support helped health workers cope with the costs of living, and holding a secure pensionable government job was valued more highly than seeking uncertain job opportunities elsewhere.

    Conclusion: The interplay between the costs of leaving and the benefit of staying is demonstrated. Family proximity, community ties, job security, and pension enhance staying, while higher costs of living and an unpredictable employment market make leaving risky. Health workers should be able to access investment opportunities in order to cope with inadequate remuneration. Promotions and leadership opportunities only motivate if accompanied by financial benefits.

  • 104. Kjellgren, Helena
    et al.
    Tishelman, Carol
    Macdonald, Alastair
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing. Karolinska Institutet, LIME, MMC, Innovative Care research group, Stockholm, Sweden.
    Goliath, Ida
    Exploring Objects at the End of Life2016In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 52, no 6, p. E37-E37Article in journal (Refereed)
    Abstract [en]

    Objectives: While there has been an increasing recognition that the physical setting matters in end-of-life (EoL) care, objects (e.g. beds, socks, hearing aids) are notably overlooked and it is unknown how they add meaning to care settings, particularly beyond usability and functionality. In our study, we set out to explore the EoL setting from the perspective of family members. Through a preliminary analysis we noted that objects were mentioned throughout the narratives and therefore we focused our analysis on exploring the roles of objects. Methods: We interviewed 25 family members, recruited from residential care facilities, as well as palliative in-patient and homecare units, who had witnessed the dying and death of someone close to them. The interviews were prompted by open inquiries about EoL experiences, rather than specific questions about settings. The narratives were transcribed verbatim and analyzed using thematic analysis. Results: Objects were conceptualized as having interconnected roles relating to temporality, the everyday, and care. Many talked about rearranging objects to mark beginnings and ends in moments of transitions and thus rendering temporality tangible. Simultaneously, objects had roles in transforming everyday life and were assigned new meanings through the contexts they were part of. Objects were also interpreted as signs of care, where lack of sensitivity towards surrounding objects was associated with poor care. Conclusions: Our results indicate that objects are dynamic, in that interaction with objects and the meaning of these interactions change throughout the dying process. This contrasts with other studies, which have tended to approach the EoL settings as discrete with predefined properties, reinforcing instrumental and unidirectional understandings of relationships between people and settings. Our study expands on knowledge of objects in EoL processes and we argue the potential of this knowledge as a means to enhance supportive EoL settings.

  • 105. Kobayashi, H.
    et al.
    Sahlen, Klas-Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Distributed resources and care choice: formulation through the capability approach2016Conference paper (Refereed)
  • 106.
    Krachler, Benno
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jerdén, Lars
    Lindén, Christina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Kunskap om levnadsvanor värderas olika på läkarutbildningarna: en genomgång av 124 skriftliga examinationer2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, article id EWPDArticle in journal (Refereed)
    Abstract [en]

    Lifestyle factors are crucial for prevention and management of many non-communicable diseases such as hypertension, stroke, diabetes, coronary heart disease and chronic obstructive pulmonary disease. Lifestyle medicine is included in national learning outcomes for undergraduate medical education in Sweden. Since assessment drives learning, we reviewed questions from 124 written examinations from all 7 medical schools in Sweden, conducted between 2012 and 2015. There is up to a 5-fold difference between different universities in the weight attached to lifestyle-related knowledge compared to knowledge related to pharmacological treatments.

  • 107. Lekander, Ingrid
    et al.
    Willers, Carl
    von Euler, Mia
    Lilja, Mikael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Sunnerhagen, Katharina S
    Pessah-Rasmussen, Hélène
    Borgström, Fredrik
    Relationship between functional disability and costs one and two years post stroke2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 4, article id e0174861Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Stroke affects mortality, functional ability, quality of life and incurs costs. The primary objective of this study was to estimate the costs of stroke care in Sweden by level of disability and stroke type (ischemic (IS) or hemorrhagic stroke (ICH)).

    METHOD: Resource use during first and second year following a stroke was estimated based on a research database containing linked data from several registries. Costs were estimated for the acute and post-acute management of stroke, including direct (health care consumption and municipal services) and indirect (productivity losses) costs. Resources and costs were estimated per stroke type and functional disability categorised by Modified Rankin Scale (mRS).

    RESULTS: The results indicated that the average costs per patient following a stroke were 350,000SEK/€37,000-480,000SEK/€50,000, dependent on stroke type and whether it was the first or second year post stroke. Large variations were identified between different subgroups of functional disability and stroke type, ranging from annual costs of 100,000SEK/€10,000-1,100,000SEK/€120,000 per patient, with higher costs for patients with ICH compared to IS and increasing costs with more severe functional disability.

    CONCLUSION: Functional outcome is a major determinant on costs of stroke care. The stroke type associated with worse outcome (ICH) was also consistently associated to higher costs. Measures to improve function are not only important to individual patients and their family but may also decrease the societal burden of stroke.

  • 108. Liese, J. G.
    et al.
    Giaquinto, C.
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Carmona, A.
    Larcombe, J.
    Garcia-sicilia, J.
    Fuat, A.
    Munoz Hiraldo, E.
    Arroba Basanta, M. L.
    Sloesen, B.
    Vollmar, J.
    Holl, K.
    Pircon, J. Y.
    Rosenlund, M.
    The effect of acute otitis media in children on parents' quality of life: Development and validation of a questionnaire implemented in a prospective observational cohort study in europe2011In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 14, no 7, p. A509-A509Article in journal (Refereed)
  • 109. Liese, J. G.
    et al.
    Giaquinto, C.
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Carmona, A.
    Larcombe, J.
    Garcia-Sicilia, J.
    Fuat, A.
    Munoz Hiraldo, E.
    Arroba Basanta, M. L.
    Vollmar, J.
    Holl, K.
    Delgleize, E.
    Knerer, G.
    Pircon, J. Y.
    Rosenlund, M.
    The clinical and economic burden of acute otitis media: A large prospective observational cohort study in europe2011In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 14, no 7, p. A508-A509Article in journal (Refereed)
  • 110.
    Lindberg, Jens
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Ägande av ansvar: Ekonomisk och administrativ praktik i svensk våldtäktsvård2017In: Kulturella perspektiv - Svensk etnologisk tidskrift, ISSN 1102-7908, ISSN ISSN 1102-7908, Vol. 26, no 3–4, p. 63-69Article in journal (Refereed)
    Abstract [en]

    Throughout the last 30–40 years, New Public Management (NPM) has come to dominate public administration. The aim of this article is to explore NPM-inspired practices in rape care and analyse how care milieus’ specific responsibilities for economy and results – to own responsibility – effects care and care personnel. That way I want to argue that economy and administration needs to be further acknowledged in ethnological research. In the article interviews with health care professionals are used as empirical material. Focusing on two departments and their owning of responsibility, it highlights how economy and administration is highly valued in rape and health care and, as a consequence, the impact of professionals’ knowledge, experience and ambition is reduced. In practice, this creates intricate situations for health care personnel to handle, but also affect care quality in various ways. Conclusively, I discuss how an increased sensitivity regarding economy and administration can serve to broaden the scope on health care and other organisations, both within ethnology and research on male rape.

  • 111.
    Lindberg, Jens
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Carlsson, Eric
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Digitala vårdlandskap: kritiska reflektioner om e-hälsa i glesbygden2018In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 95, no 1, p. 62-69Article in journal (Refereed)
    Abstract [sv]

    E-hälsa sägs av många kunna förbättra sjukvården. I den här artikeln undersöker vi föreställningar och idéer om e-hälsa för äldre i glesbygden med sär-skilt fokus på virtuella hälsorum. Vi lyfter fram förhoppningar om digital vård och analyserar på en diskursiv nivå. Artikeln belyser ideologiska föreställningar om sjukvård och problematiserar införandet av digital vårdteknologi. Som material har vi använt olika former av policymaterial. I analysen visar vi hur virtuella hälsorum kopplas ihop med diskurser om delaktighet i vård, aktivt åldrande och glesbygden som problem, och framhåller att det kan ge följder för äldres vård och hälsa. Slutligen påtalar vi behovet att närma sig e-hälsa för äldre i glesbygd från ett problematiserande perspektiv och reflektera kring digitaliseringens följder, nu och i framtiden.

  • 112.
    Lindkvist, Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Feldman, Inna
    Assessing outcomes for cost-utility analysis in mental health interventions: mapping mental health specific outcome measure GHQ-12 onto EQ-5D-3L2016In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 14, article id 134Article in journal (Refereed)
    Abstract [en]

    Background: Many intervention-based studies aiming to improve mental health do not include a multi-attribute utility instrument (MAUI) that produces quality-adjusted life-years (QALYs) and it limits the applicability of the health economic analyses. This study aims to develop 'crosswalk' transformation algorithm between a measure for psychological distress General Health Questionnaire (GHQ-12) and MAUI EuroQoL (EQ-5D-3L). Methods: The study is based on a survey questionnaire sent to a random sample in four counties in Sweden in 2012. The survey included GHQ-12 and EQ-5D instruments, as well as a question about self-rated health. The EQ-5D index was calculated using the UK and the Swedish tariff values. Two OLS models were used to estimate the EQ-5D health state values using the GHQ-12 as exposure, based on the respondents (n = 17, 101) of two counties. The algorithms were applied to the data from two other counties, (n = 15, 447) to check the predictive capacity of the models. Results: The final models included gender, age, self-rated health and GHQ-12 scores as a quantitative variable. The regression equations explained 40 % (UK tariff) and 46 % (Swedish tariff) of the variances. The model showed a satisfying predictive capacity between the observed and the predicted EQ-5D index score, with Pearson correlation = 0.65 and 0.69 for the UK and Swedish models, respectively. Conclusion: The algorithms developed in this study can be used to determine cost-effectiveness of services or interventions that use GHQ-12 as a primary outcome where the utility measures are not collected.

  • 113.
    Lindmark, Anita
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Glader, Eva-Lotta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Asplund, Kjell
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Norrving, B
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Socioeconomic disparities in stroke case fatality: observations from Riks-Stroke, the Swedish stroke register2013In: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 35, no Suppl. 3, p. 225-225Article in journal (Other academic)
  • 114. Lindquist, Anna M
    et al.
    Johansson, Pauline E
    Petersson, Göran I
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Nilsson, Gunilla C
    The use of the Personal Digital Assistant (PDA) among personnel and students in health care: a review2008In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 10, no 4, article id e31Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Health care personnel need access to updated information anywhere and at any time, and a Personal Digital Assistant (PDA) has the potential to meet these requirements. A PDA is a mobile tool which has been employed widely for various purposes in health care practice, and the level of its use is expected to increase. Loaded with suitable functions and software applications, a PDA might qualify as the tool that personnel and students in health care need. In Sweden today, despite its leadership role in mobile technologies, PDAs are not commonly used, and there is a lack of suitable functions and software applications.

    OBJECTIVE: The aim of the present review was to obtain an overview of existing research on the use of PDAs among personnel and students in health care.

    METHODS: The literature search included original peer-reviewed research articles written in English and published from 1996 to 2008. All study designs were considered for inclusion. We excluded reviews and studies focusing on the use of PDAs in classroom situations. From March 2006 to the last update in May 2008, we searched PubMed, CINAHL, Cochrane, IngentaConnect, and a local search engine (ELIN@Kalmar). We conducted a content analysis, using Nielsen's Model of System Acceptability as a theoretical framework in structuring and presenting the results.

    RESULTS: From the 900 references initially screened, 172 articles were selected and critically assessed until 48 articles remained. The majority originated in North-America (USA: n=24, Canada: n=11). The categories which emerged from our content analysis coincided to a certain extent to Nielsen's Model of System Acceptability (social and practical acceptability), including usefulness (utility and usability) subcategories such as learnability, efficiency, errors, and satisfaction. The studies showed that health care personnel and students used PDAs in patient care with varied frequency. Most of the users were physicians. There is some evidence that the use of a PDA in health care settings might improve decision-making, reduce the numbers of medical errors, and enhance learning for both students and professionals, but the evidence is not strong, with most studies being descriptive, and only 6 randomized controlled trials. Several special software programs have been created and tested for PDAs, and a wide range of situations for their use have been reported for different patient groups. Drug and medical information were commonly accessed by PDA users, and the PDA was often viewed as the preferred tool when compared to paper-based documents. Some users regarded the PDA easy to operate, while others found it difficult in the beginning.

    CONCLUSIONS: This overview of the use of PDAs revealed a positive attitude towards the PDA, which was regarded as a feasible and convenient tool. The possibility of immediate access to medical information has the potential to improve patient care. The PDA seems to be a valuable tool for personnel and students in health care, but there is a need for further intervention studies, randomized controlled trials, action research, and studies with various health care groups in order to identify its appropriate functions and software applications.

  • 115.
    Lindström, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lindberg, Margareta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Stories of rediscovering agency: home-based occupational therapy for people with severe psychiatric disability2013In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 23, no 6, p. 728-740Article in journal (Other academic)
    Abstract [en]

    As part of a larger study, we offered Everyday Life Rehabilitation (ELR) as a model for integrated occupational therapy in sheltered or supported housing facilities, to enable meaningful daily occupations for people with psychiatric disabilities. Our aim of this article was to understand how participants make sense of their occupational transformations in the context of their everyday life and life history. We carried out qualitative interviews and field observations with 16 participants with psychosis-related disorders. We used narrative analysis and disclosed stories of ‘rediscovering agency’, referring to occupational and identity transformations. A parallel outcome article has shown positive results for participants, and by narrative inquiry we contribute with a deeper understanding of the meaning-making of their transformations and mechanisms of the intervention; i.e. hope, extended value of reaching goals, re-entering the majority world, and transparency of process and attunement to the individual. The findings support the use of the ELR-intervention.

  • 116.
    Lindström, Ulf H.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Johansson, Eva E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Medical students' experiences of shame in professional enculturation2011In: Medical Education, ISSN 0308-0110, E-ISSN 1365-2923, Vol. 45, no 10, p. 1016-1024Article in journal (Refereed)
    Abstract [en]

    Context: Despite the intentions of caregivers not to harm, medical encounters may involve intimidation and induce emotions of shame. Reflection is a critical part of professional learning and training. However, the role of shame in medical education has scarcely been studied. The aim of this study was to explore medical students’ reflections on shame-related experiences in clinical situations and to examine how they tackled these experiences.

    Methods: A 24-credit course in Professional Development is held at the Medical School of Umeå University, Sweden. A 1-day seminar on the theme of shame, which involves individual reflections and group discussions, is held in term 9. Medical students were invited to individually consider and write down their memories of situations in which they had experienced shame in clinical encounters. Of a total of 133 students, 75 were willing to share their written reflections anonymously. Their essays were transcribed to computer text and analysed by means of qualitative content analysis.

    Results: Three themes emerged. These included: Difficulties in disclosing shame; Shame-inducing circumstances, and Avoiding or addressing shame. Initially, students experienced problems in recalling shameful incidents, but successively described various situations which related to being taken by surprise, being exposed, and being associated with staff imprudence. Students disclosed shame avoidance behaviours, but also gave examples of how addressing shame provided them with new insights and restored their dignity.

    Conclusions: Students’ reflections on shameful experiences elucidated the importance of attitudes, manners, standards and hierarchies in clinical situations. These are important issues to highlight in the professional enculturation of medical students; our emphasising of them may encourage medical teachers elsewhere to organise similar activities. Opportunities for mentoring medical students in tackling shame and adverse feelings, and in resolving conflict, are needed in medical curricula.

  • 117. Lippman, Sheri A.
    et al.
    Pettifor, Audrey
    Rebombo, Dumisani
    Julien, Aimee
    Wagner, Ryan G.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand Johannesburg, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa.
    Dufour, Mi-Suk Kang
    Kabudula, Chodziwadziwa Whiteson
    Neilands, Torsten B.
    Twine, Rhian
    Gottert, Ann
    Gomez-Olive, F. Xavier
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand Johannesburg, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa.
    Sanne, Ian
    Peacock, Dean
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand Johannesburg, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa.
    Evaluation of the Tsima community mobilization intervention to improve engagement in HIV testing and care in South Africa: study protocol for a cluster randomized trial2017In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 12, no 9Article in journal (Refereed)
    Abstract [en]

    Background: HIV transmission can be decreased substantially by reducing the burden of undiagnosed HIV infection and expanding early and consistent use of antiretroviral therapy (ART). Treatment as prevention (TasP) has been proposed as key to ending the HIV epidemic. To activate TasP in high prevalence countries, like South Africa, communities must be motivated to know their status, engage in care, and remain in care. Community mobilization (CM) has the potential to significantly increase uptake testing, linkage to and retention in care by addressing the primary social barriers to engagement with HIV care-including poor understanding of HIV care; fear and stigma associated with infection, clinic attendance and disclosure; lack of social support; and gender norms that deter men from accessing care. Methods/design: Using a cluster randomized trial design, we are implementing a 3-year-theory-based CM intervention and comparing gains in HIV testing, linkage, and retention in care among individuals residing in 8 intervention communities to that of individuals residing in 7 control communities. Eligible communities include 15 villages within a health and demographic surveillance site (HDSS) in rural Mpumalanga, South Africa, that were not exposed to previous CM efforts. CM activities conducted in the 8 intervention villages map onto six mobilization domains that comprise the key components for community mobilization around HIV prevention. To evaluate the intervention, we will link a clinic-based electronic clinical tracking system in all area clinics to the HDSS longitudinal census data, thus creating an open, population-based cohort with over 30,000 18-49-year-old residents. We will estimate the marginal effect of the intervention on individual outcomes using generalized estimating equations. In addition, we will evaluate CM processes by conducting baseline and endline surveys among a random sample of 1200 community residents at each time point to monitor intervention exposure and community level change using validated measures of CM. Discussion: Given the known importance of community social factors with regard to uptake of testing and HIV care, and the lack of rigorously evaluated community-level interventions effective in improving testing uptake, linkage and retention, the proposed study will yield much needed data to understand the potential of CM to improve the prevention and care cascade. Further, our work in developing a CM framework and domain measures will permit validation of a CM conceptual framework and process, which should prove valuable for community programming in Africa.

  • 118. Ludvigsson, Jonas F
    et al.
    Homman, Mohammed
    Naumburg, Estelle
    Östersund.
    Olin, Anders I
    Ohlsson, Josefin
    Oli, Anders I
    Missgynna inte forskande ST-läkare!2003In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 100, no 40, p. 3162-3165Article in journal (Refereed)
  • 119.
    Lundell, Sara
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Tistad, Malin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. School of Education, Health and Social Studies, Dalarna University, Sweden.
    Rehn, Börje
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Holmner, Åsa
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Wadell, Karin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Building COPD care on shaky ground: a mixed methods study from Swedish primary care professional perspective2017In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, article id 467Article in journal (Refereed)
    Abstract [en]

    Background: Chronic obstructive pulmonary disease (COPD) is a public health problem. Interprofessional collaboration and health promotion interventions such as exercise training, education, and behaviour change are cost effective, have a good effect on health status, and are recommended in COPD treatment guidelines. There is a gap between the guidelines and the healthcare available to people with COPD. The aim of this study was to increase the understanding of what shapes the provision of primary care services to people with COPD and what healthcare is offered to them from the perspective of healthcare professionals and managers.

    Methods: The study was conducted in primary care in a Swedish county council during January to June 2015. A qualitatively driven mixed methods design was applied. Qualitative and quantitative findings were merged into a joint analysis. Interviews for the qualitative component were performed with healthcare professionals (n = 14) from two primary care centres and analysed with qualitative content analysis. Two questionnaires were used for the quantitative component; one was answered by senior managers or COPD nurses at primary care centres (n = 26) in the county council and the other was answered by healthcare professionals (n = 18) at two primary care centres. The questionnaire data were analysed with descriptive statistics.

    Results: The analysis gave rise to the overarching theme building COPD care on shaky ground. This represents professionals driven to build a supportive COPD care on 'shaky' organisational ground in a fragmented and non-compliant healthcare organisation. The shaky ground is further represented by uninformed patients with a complex disease, which is surrounded with shame. The professionals are autonomous and pragmatic, used to taking responsibility for their work, and with limited involvement of the management. They wish to provide high quality COPD care with interprofessional collaboration, but they lack competence and are hindered by inadequate routines and lack of resources.

    Conclusions: There is a gap between COPD treatment guidelines and the healthcare that is provided in primary care. To facilitate implementation of the guidelines several actions are needed, such as further training for professionals, additional resources, and improved organisational structure for interprofessional collaboration and patient education.

  • 120.
    Lundgren, Britta
    Umeå University, Faculty of Arts, Department of culture and media studies.
    The common cold, influenza, and immunity in post-pandemic times: lay representations of self and other among older people in Sweden2015In: Health, Culture and Society, ISSN 1551-7136, E-ISSN 1175-0928, Vol. 8, no 2, p. 46-59Article in journal (Refereed)
    Abstract [en]

    The need for new knowledge about lay representations of contagions, immunity, vaccination, common colds, and influenza has become clear after the A(H1N1) pandemic and the resulting challenges regarding pandemic preparedness. This article analyzes written responses from 67 persons, mostly women, to a semi-structured questionnaire about colds and the flu. Three themes are discussed: “Common cold and flus as ritualized experiences”, “Me, my body, and my immune defense”, and “Regulations of space, place, and behaviors.” Overall, the narratives were about trust, value, and respect in the body, in lived experiences, and in the capacity to ‘help’ and ‘nurture’ the immune system, but also about the feeling of powerlessness when perceiving inadequacies in other people’s parallel interpretations and actions. Pandemic preparedness policies need to acknowledge the multiple ‘immunity talk’ in the responses to create productive, ongoing relations with the ‘Other’, that rely on people’s trust and resilience, rather than on people´s fear.

  • 121.
    Lundström, Mats
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Handbok för hälso- och sjukvårdspersonal. Hot och våld inom vården: hantering och bemötande.2010Other (Other (popular science, discussion, etc.))
  • 122.
    Lysholm, Jack
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lindahl, Bertil
    Strong development of research based on national quality registries in Sweden2019In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 124, no 1, p. 9-11Article in journal (Refereed)
    Abstract [en]

    The aim of the present paper is to describe how the use of national quality registries (NQRs) for research has evolved over the past decade in Sweden. All Swedish NQRs have reported their scientific activity (publications per year in peer-reviewed scientific journals) to the Swedish Association of Local Authorities and Regions since 2009, and the present report is based on available data from 2009-2016. The yearly number of publications of the 69 registries active in 2009 has increased from 121 to 496 in 2016. Seventeen of these registries published more than 10 papers in 2016; however, 12 NQRs did not publish any papers in 2016. An additional 77 papers were published in 2016 by the 34 NQRs started after 2009. In summary, there has been a strong development of quality registry-based research in Sweden over the last decade. However, there is still room for further increase of the use of research based on NQRs in Sweden.

  • 123.
    Löfroth, Emil
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Centre for Epidemiology, National Board of Health and Welfare, SE-106 30, Stockholm, Sweden.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Wilhelmsen, Lars
    Rosén, Måns
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Centre for Epidemiology, National Board of Health and Welfare, SE-106 30, Stockholm, Sweden.
    Optimising health care within given budgets: primary prevention of cardiovascular disease in different regions of Sweden2006In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 75, no 2, p. 214-229Article in journal (Refereed)
    Abstract [en]

    This study investigated the consequences of applying strict health maximisation to the choice between three different interventions with a defined budget. We analysed three interventions or preventing cardiovascular diseases, through doctor's advice on smoking cessation, through blood-pressure-lowering drugs. and through lipid-lowering drugs. A state transition model has been used to estimate the cost-utility ratios for entire population in three different county Councils in Sweden, where the populations were stratified into mutually excluding risk groups. The incremental cost-utility ratios are being presented in a league table and combined with the local resources and the local epidemiological data as a proxy for need for treatment, All interventions with an incremental cost-utility ratio exceeding the threshold ratios are excluded from being funded, The threshold varied between 1687 EURO and 6192 EURO. The general reallocation of resources between the three interventions Was a 60% reduction of blood-pressure-lowering drugs with redistribution of resources to advice on smoking cessation and to lipid-lowering drugs. One advantage of this method is that the results are very concrete. Recommendations can thereby he more precise which hopefully will create a public debate between decision-makers, practising phsicians and patient groups.

  • 124. Magnusson, Peter
    et al.
    Palm, Andreas
    Branden, Eva
    Mörner, Stellan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Heart Center.
    Misclassification of hypertrophic cardiomyopathy: validation of diagnostic codes2017In: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 9, p. 403-410Article in journal (Refereed)
    Abstract [en]

    Purpose: To validate diagnostic codes for hypertrophic cardiomyopathy (HCM), analyze misclassfications, and estimate the prevalence of HCM in an unselected Swedish regional cohort.

    Patients and methods: Using the hospitals’ electronic medical records (used for the Swedish National Patient Register), we identified 136 patients from 2006 to 2016 with the HCM-related codes 142.1 and 142.2 (International Classification of Diseases).

    Results: Of a total of 129 residents in the catchment area, 88 patients were correctly classified as HCM (positive predictive value 68.2%) and 41 patients (31.8%) were misclassified as HCM. Among the 88 HCM patients (52.2% males), 74 were alive and 14 were dead (15.9%). This yields an HCM prevalence of 74/183,337, that is, 4.0 diagnosed cases per 10,000 in the adult population aged ≥18 years. The underlying diagnoses of misclassified cases were mainly hypertension (31.7%) and aortic stenosis (22.0%). Other types of cardiomyopathies accounted for several cases of misclassification: dilated (nonischemic or ischemic), left ventricular noncompaction, and Takotsubo. Miscellaneous diagnoses were amyloidosis, pulmonary stenosis combined with ventricular septal defect, aortic insufficiency, athelete’s heart, and atrioventricular conduction abnormality. The mean age was not significantly different between HCM and misclassified patients (65.8±15.8 vs 70.1±13.4 years; P=0.177). There were 47.8% females among HCM and 60.8% females among misclassified (P=0.118).

    Conclusion: One-third of patients diagnosed as HCM are misclassified, so registry data should be interpreted with caution. A correct diagnosis is important for decision-making and implementation of optimal HCM care; efforts should be made to increase awareness of HCM and diagnostic competence throughout the health care system.

  • 125. Malterud, Kirsti
    et al.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Reventlow, Susanne
    Qualitative methods in PhD theses from general practice in Scandinavia2017In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 35, no 4, p. 309-312Article in journal (Refereed)
    Abstract [en]

    Qualitative methodology is gaining increasing attention and esteem in medical research, with general practice research taking a lead. With these methods, human and social interaction and meaning can be explored and shared by systematic interpretation of text from talk, observation or video. Qualitative studies are often included in Ph.D. theses from general practice in Scandinavia. Still, the Ph.D. programs across nations and institutions offer only limited training in qualitative methods. In this opinion article, we draw upon our observations and experiences, unpacking and reflecting upon values and challenges at stake when qualitative studies are included in Ph.D. theses. Hypotheses to explain these observations are presented, followed by suggestions for standards of evaluation and improvement of Ph.D. programs. The authors conclude that multimethod Ph.D. theses should be encouraged in general practice research, in order to offer future researchers an appropriate toolbox.

  • 126.
    Markström, Urban
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Fjellfeldt, Maria
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eklund, Mona
    Implementing Freedom of Choice System in Community Mental Health Services2017In: Journal of Mental Health Policy and Economics, ISSN 1091-4358, E-ISSN 1099-176X, Vol. 20, p. S22-S23Article in journal (Refereed)
  • 127. Mazzocato, Pamela
    et al.
    Stenfors-Hayes, Terese
    von Thiele Schwarz, Ulrica
    Hasson, Henna
    Nyström, Monica Elisabeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kaizen practice in healthcare: a qualitative analysis of hospital employees' suggestions for improvement2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 7, article id e012256Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Kaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare.

    METHODS: We analysed 186 structured kaizen documents containing improvement suggestions that were produced by 165 employees at a Swedish hospital. Directed content analysis was used to categorise the suggestions into following categories: type of situation (proactive or reactive) triggering an action; type of process addressed (technical/administrative, support and clinical); complexity level (simple or complex); and type of outcomes aimed for (operational or sociotechnical). Compliance to the kaizen template was calculated.

    RESULTS: 72% of the improvement suggestions were reactions to a perceived problem. Support, technical and administrative, and primary clinical processes were involved in 47%, 38% and 16% of the suggestions, respectively. The majority of the kaizen documents addressed simple situations and focused on operational outcomes. The degree of compliance to the kaizen template was high for several items concerning the identification of problems and the proposed solutions, and low for items related to the test and implementation of solutions.

    CONCLUSIONS: There is a need to combine kaizen practices with improvement and innovation practices that help staff and managers to address complex issues, such as the improvement of clinical care processes. The limited focus on sociotechnical aspects and the partial compliance to kaizen templates may indicate a limited understanding of the entire kaizen process and of how it relates to the overall organisational goals. This in turn can hamper the sustainability of kaizen practices and results.

  • 128. McAlearney, Ann Scheck
    et al.
    Terris, Darcey
    Hardacre, Jeanne
    Spurgeon, Peter
    Brown, Claire
    Baumgart, Andre
    Nyström, Monica E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Organizational coherence in health care organizations: conceptual guidance to facilitate quality improvement and organizational change2013In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 22, no 2, p. 86-99Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations.

    METHODS: We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model.

    RESULTS AND CONCLUSIONS: We suggest that organizational coherence may be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or context.

  • 129. Melder, Cecilia
    et al.
    Santamäki Fischer, Regina
    Umeå University, Faculty of Medicine, Department of Nursing. Åbo Akad Univ, Turku, Finland.
    Nygren, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    DeMarinis, Valerie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Validating WHOQOL-SRPB in Sweden: instrument adaption for measuring existential aspects of health-related quality of life [HRQL] in secular contexts2016Conference paper (Refereed)
  • 130. Minacori, R.
    et al.
    Geale, Kirk
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Is there Evidence of a Difference Between Willingness to Pay and Willingness to Accept Thresholds?: A Review of Nice Technology Appraisals2016Conference paper (Refereed)
  • 131. Minh, Hoang Van
    et al.
    Ngan, Tran Thu
    Mai, Vu Quynh
    My, Nguyen Thi Tuyet
    Chung, Le Hong
    Kien, Vu Duy
    Hanoi School of Public Health.
    Anh, Tran Tuan
    Ngoc, Nguyen Bao
    Giap, Vu Van
    Cuong, Nguyen Manh
    Manh, Pham Duc
    Giang, Kim Bao
    Tobacco Control Policies in Vietnam: Review on MPOWER Implementation Progress and Challenges2016In: Asian Pacific Journal of Cancer Prevention, ISSN 1513-7368, Vol. 17, p. 1-9Article in journal (Refereed)
    Abstract [en]

    In Vietnam, the WHO Framework Convention on Tobacco Control (WHO FCTC) took effect in March 2005 while MPOWER has been implemented since 2008. This paper describes the progress and challenges of implementation of the MPOWER package in Vietnam. We can report that, in term of monitoring, Vietnam is very active in the Global Tobacco Surveillance System, completing two rounds of the Global Adult Tobacco Survey (GATS) and three rounds of the Global Youth Tobacco Survey (GYTS). To protect people from tobacco smoke, Vietnam has issued and enforced a law requiring comprehensive smoking bans at workplaces and public places since 2013. Tobacco advertising and promotion are also prohibited with the exception of points of sale displays of tobacco products. Violations come in the form of promotion girls, corporate social responsibility activities from tobacco manufacturers and packages displayed by retail vendors. Vietnam is one of the 77 countries that require pictorial health warnings to be printed on cigarette packages to warn about the danger of tobacco and the warnings have been implemented effectively. Cigarette tax is 70% of factory price which is equal to less than 45% of retail price and much lower than the recommendation of WHO. However, Vietnam is one of the very few countries that require manufacturers and importers to make "compulsory contributions" at 1-2% of the factory price of cigarettes sold in Vietnam for the establishment of a Tobacco Control Fund (TCF). The TCF is being operated well. In 2015, 67 units of 63 provinces/cities, 22 ministries and political-social organizations and 6 hospitals received funding from TCF to implement a wide range of tobacco control activities. Cessation services have been starting with a a toll-free quit-line but need to be further strengthened. In conclusion, Vietnam has constantly put efforts into the tobacco control field with high commitment from the government, scientists and activists. Though several remarkable achievements have been gained, many challenges remain. To overcome those challenges, implementation strategies that take into account the contextual factors and social determinants of tobacco use in Vietnam are needed.

  • 132.
    Monica, Nyström
    et al.
    Institutionen för lärande, informatik, management och etik, Karolinska institutet, Stockholm.
    Strehlenert, Helena
    Institutionen för lärande, informatik, management och etik, Karolinska institutet, Stockholm.
    Höög, Elisabet
    Institutionen för lärande, informatik, management och etik, Karolinska institutet, Stockholm.
    Bättre liv för sjuka och äldre: Lärdomar från en nationell satsnings upplägg och arbetssätt för att stödja förändring2014Report (Other academic)
  • 133. Moons, Philip
    et al.
    Kovacs, Adrienne H.
    Luyckx, Koen
    Thomet, Corina
    Budts, Werner
    Enomoto, Junko
    Sluman, Maayke A.
    Yang, Hsiao-Ling
    Jackson, Jamie L.
    Khairy, Paul
    Cook, Stephen C.
    Subramanyan, Raghavan
    Alday, Luis
    Eriksen, Katrine
    Dellborg, Mikael
    Berghammer, Malin
    Johansson, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Mackie, Andrew S.
    Menahem, Samuel
    Caruana, Maryanne
    Veldtman, Gruschen
    Soufi, Alexandra
    Fernandes, Susan M.
    White, Kamila
    Callus, Edward
    Kutty, Shelby
    Van Bulck, Liesbet
    Apers, Silke
    Patient-reported outcomes in adults with congenital heart disease: Inter-country variation, standard of living and healthcare system factors2018In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 251, p. 34-41Article in journal (Refereed)
    Abstract [en]

    Aims: Geographical differences in patient-reported outcomes (PROs) of adults with congenital heart disease (ConHD) have been observed, but are poorly understood. We aimed to: (1) investigate inter-country variation in PROs in adults with ConHD; (2) identify patient-related predictors of PROs; and (3) explore standard of living and healthcare system characteristics as predictors of PROs. Methods and results: Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study (APPROACH-IS) was a cross-sectional, observational study, in which 4028 patients from 15 countries in 5 continents were enrolled. Self-report questionnaires were administered: patient-reported health (12-item Short Form Health Survey; EuroQOL-5D Visual Analog Scale); psychological functioning (Hospital Anxiety and Depression Scale); health behaviors (Health Behavior Scale-Congenital Heart Disease) and quality of life (Linear Analog Scale for quality of life; Satisfaction With Life Scale). A composite PRO score was calculated. Standard of living was expressed as Gross Domestic Product per capita and Human Development Index. Healthcare systems were operationalized as the total health expenditure per capita and the overall health system performance. Substantial inter-country variation in PROs was observed, with Switzerland having the highest composite PRO score (81.0) and India the lowest (71.3). Functional class, age, and unemployment status were patient-related factors that independently and consistently predicted PROs. Standard of living and healthcare system characteristics predicted PROs above and beyond patient characteristics. Conclusions: This international collaboration allowed us to determine that PROs in ConHD vary as a function of patient-related factors as well as the countries in which patients live. 

  • 134. Mosquera Mendez, Paola
    et al.
    Hernández Torres, Jineth
    Pontificia Universidad Javeriana.
    Vega, Roman
    Pontificia Universidad Javeriana.
    Junca, Cesar
    Pontificia Universidad Javeriana.
    Experience of implementing the strategy of primary health care in the locality of Bosa2011In: Revista Gerencia y Políticas de Salud, ISSN 1657-7027, Vol. 10, no 21, p. 124-152Article in journal (Refereed)
    Abstract [en]

    In order to describe the way in which a strategy APS was implemented at Hospital Pablo VI Bosa (HPVI) and to describe predisposing factors and limitations of such an implementation, a qualitative analysis of documentary material, in-depth interviewing with institutional actors and officials and community workshops was performed. From the triangulation of structured information was drafted a narrative synthesis that describes the experience in the area. Among the main findings is an interesting bet management model that views the APS as a central strategy and complements other strategies proposed by the District for the implementation of its public policy emphasizes the strengthening of community dynamics that although, mainly limited to institutional issues, have been significant in terms of sustainability. Favoring and limiting factors identified are diverse, but all related to how to implement public policy and institutional dynamics.

  • 135. Mosquera Mendez, Paola
    et al.
    Reveiz, Ludovic
    National University of Colombia.
    Cattivera, Claudia
    Pacientes online Argentina.
    Guevara, Oscar Alexander
    National University of Colombia.
    The process of incorporating a user perspective to the development of clinical practice guidelines: literature reviewing2011In: Revista Gerencia y Políticas de Salud, ISSN 1657-7027, Vol. 10, no 21, p. 176-195Article in journal (Refereed)
    Abstract [en]

    In order to identify methodologies for effective identification and incorporation of the user considerations and perspective to the development of clinical practice guidelines, a systematic review of the literature was conducted. A total of 729 articles were identified from the initial search of these, 18 met the criteria and were included in the review. The items were valued according to methodological quality and extracted relevant information from them. No methodological items were found that described or evaluated a specific methodology that incorporates considerations of the patients in the development of GPC. The techniques used for these processes were the formal ones such as Delphi, focus groups, stakeholder analysis, surveys, workshops and preference scales. The reported experiences agree on the need to link patients during the stages of prioritization and approval of the recommendations.

  • 136.
    Mosquera Mendéz, Paola A
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hernandez, Jinneth
    Vega, Roman
    Martinez, Jorge
    Sebastian, Miguel San
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Performance evaluation of the essential dimensions of the primary health care services in six localities of Bogota-Colombia: a cross-sectional study2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, p. 315-Article in journal (Refereed)
    Abstract [en]

    Background: The high segmentation and fragmentation in the provision of services are some of the main problems of the Colombian health system. In 2004 the district government of Bogota decided to implement a Primary Health Care (PHC) strategy through the Home Health program. PHC was conceived as a model for transforming health care delivery within the network of the first-level public health care facilities. This study aims to evaluate the performance of the essential dimensions of the PHC strategy in six localities geographically distributed throughout Bogota city.

    Methods: The rapid assessment tool to measure PHC performance, validated in Brazil, was applied. The perception of participants (users, professionals, health managers) in public health facilities where the Home Health program was implemented was compared with the perception of participants in private health facilities not implementing the program. A global performance index and specific indices for each primary care dimension were calculated. A multivariate logistic regression analysis was conducted to determine possible associations between the performance of the PHC dimensions and the self-perceived health status of users.

    Results: The global performance index was rated as good for all participants interviewed. In general, with the exception of professionals, the differences in most of the essential dimensions seemed to favor public health care facilities where the Home Health program was implemented. The weakest dimensions were the family focus and community orientation-rated as critical by users; the distribution of financial resources-rated as critical by health managers; and, accessibility-rated as intermediate by users.

    Conclusions: The overall findings suggest that the Home Health program could be improving the performance of the network of the first-level public health care facilities in some PHC essential dimensions, but significant efforts to achieve its objectives and raise its visibility in the community are required.

  • 137. Mosson, Rebecca
    et al.
    von Thiele Schwarz, Ulrica
    Hasson, Henna
    Lundmark, Robert
    Department of Learning, Informatics, Management and Ethics, Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Richter, Anne
    How do iLead? Validation of a scale measuring active and passive implementation leadership in Swedish healthcare2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 6, article id e021992Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This study aims to describe the creation of a scale-the iLead scale-through adaptations of existing domain-specific scales that measure active and passive implementation leadership, and to describe the psychometric properties of this scale.

    METHODS: Data collected from a leadership intervention were used in this validation study. Respondents were 336 healthcare professionals (90% female and 10% male; mean age 47 years) whose first-line and second-line managers participated in the intervention. The data were collected in the Stockholm regional healthcare organisation that offer primary, psychiatric, rehabilitation and acute hospital care, among other areas. The items for measuring implementation leadership were based on existent research and the full-range leadership model. Confirmatory factor analysis was performed to evaluate the dimensionality of the scale, followed by tests for reliability and convergent, discriminant and criterion-related validity using correlations and multilevel regression analyses.

    RESULTS: The final scale consists of 16 items clustered into four subscales representing active implementation leadership, and one scale signifying passive implementation leadership. Findings showed that the hypothesised model had an acceptable model fit (χ2(99)=382.864**, Comparative Fit Index=0.935, Tucker-Lewis Index=0.911, root mean square error of approximation=0.059). The internal consistency and convergent, discriminant and criterion-related validity were all satisfactory.

    CONCLUSIONS: The iLead scale is a valid measure of implementation leadership and is a tool for understanding how active and passive leader behaviours influence an implementation process. This brief scale may be particularly valuable to apply in training focusing on facilitating implementation, and in evaluating leader training. Moreover, the scale can be useful in evaluating various leader behaviours associated with implementation success or failure.

  • 138.
    Munck, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Centrala etikprövningsnämnden.
    Dahlquist, Gisela
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Centrala etikprövningsnämnden.
    Johansson, Gunn
    Petersson, Bo
    Ringborg, Ulrik
    Etikprövningsnämnderna bör bli en enda myndighet2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 15, p. 773-774Article in journal (Other (popular science, discussion, etc.))
  • 139. Mutebi, Aloysius
    et al.
    Kananura, Rornald Muhumuza
    Ekirapa-Kiracho, Elizabeth
    Bua, John
    Kiwanuka, Suzanne Namusoke
    Nammazi, Gertrude
    Paina, Ligia
    Tetui, Moses
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Makerere University School of Public Health, Department of Health Policy Planning and Management, Makerere University, Kampala, Uganda.
    Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1347363Article in journal (Refereed)
    Abstract [en]

    Background: Rural populations in Uganda have limited access to formal financial Institutions, but a growing majority belong to saving groups. These saving groups could have the potential to improve household income and access to health services.

    Objective: To understand organizational characteristics, benefits and challenges, of savings groups in rural Uganda.

    Methods: This was a cross-sectional descriptive study that employed both quantitative and qualitative data collection techniques. Data on the characteristics of community-based savings groups (CBSGs) were collected from 247 CBSG leaders in the districts of Kamuli, Kibukuand Pallisa using self-administered open-ended questionnaires. To triangulate the findings, we conducted in-depth interviews with seven CBSG leaders. Descriptive quantitative and content analysis for qualitative data was undertaken respectively.

    Results: Almost a quarter of the savings groups had 5-14 members and slightly more than half of the saving groups had 15-30 members. Ninety-three percent of the CBSGs indicated electing their management committees democratically to select the group leaders and held meetings at least once a week. Eighty-nine percent of the CBSGs had used metallic boxes to keep their money, while 10% of the CBSGs kept their money using mobile money and banks, respectively. The main reasons for the formation of CBSGs were to increase household income, developing the community and saving for emergencies. The most common challenges associated with CBSG management included high illiteracy (35%) among the leaders, irregular attendance of meetings (22%), and lack of training on management and leadership (19%). The qualitative findings agreed with the quantitative findings and served to triangulate the main results.

    Conclusions: Saving groups in Uganda have the basic required structures; however, challenges exist in relation to training and management of the groups and their assets. The government and development partners should work together to provide technical support to the groups.

  • 140.
    Mutiganda, Jean C.
    et al.
    Åbo Akademi University.
    Grossi, Giuseppe
    Kristianstad University.
    Hassel, Lars G
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Business Administration.
    Modernising management Processes in elderly care2017In: Statsvetenskaplig Tidskrift, ISSN 0039-0747, Vol. 119, no 1, p. 1-19Article in journal (Refereed)
  • 141. Månsdotter, Anna
    et al.
    Ekman, Björn
    Feldman, Inna
    Hagberg, Lars
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    We Propose a Novel Measure for Social Welfare and Public Health: Capability-Adjusted Life-Years, CALYs2017In: Applied Health Economics and Health Policy, ISSN 1175-5652, E-ISSN 1179-1896, Vol. 15, no 4, p. 437-440Article in journal (Refereed)
  • 142. Månsdotter, Anna
    et al.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Lundberg, Michael
    Winkvist, Anna
    Öhman, Ann
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Parental share in public and domestic spheres: a population study on gender equality, death, and sickness.2006In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 60, no 7, p. 616-620Article in journal (Refereed)
  • 143. Månsdotter, Anna M
    et al.
    Rydberg, Malin K
    Wallin, Eva
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Andréasson, Sven
    A cost-effectiveness analysis of alcohol prevention targeting licensed premises.2007In: Eur J Public Health, ISSN 1101-1262Article in journal (Refereed)
  • 144. Namazzi, Gertrude
    et al.
    Okuga, Monica
    Tetui, Moses
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Makerere University, School of Public Health (MakSPH), Kampala, Uganda.
    Kananura, Rornald Muhumuza
    Kakaire, Ayub
    Namutamba, Sarah
    Mutebi, Aloysius
    Kiwanuka, Suzanne Namusoke
    Ekirapa-Kiracho, Elizabeth
    Waiswa, Peter
    Working with community health workers to improve maternal and newborn health outcomes: implementation and scale-up lessons from eastern Uganda2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1345495Article in journal (Refereed)
    Abstract [en]

    Background: Preventable maternal and newborn deaths can be averted through simple evidence-based interventions, such as the use of community health workers (CHWs), also known in Uganda as village health teams. However, the CHW strategy faces implementation challenges regarding training packages, supervision, and motivation.

    Objectives: This paper explores knowledge levels of CHWs, describes the coverage of home visits, and shares lessons learnt from setting up and implementing the CHW strategy.

    Methods: The CHWs were trained to conduct four home visits: two during pregnancy and two after delivery. The aim of the visits was to promote birth preparedness and utilization of maternal and newborn health (MNH) services. Mixed methods of data collection were employed. Quantitative data were analyzed using Stata version 13.0 to determine the level and predictors of CHW knowledge of MNH. Qualitative data from 10 key informants and 15 CHW interviews were thematically analyzed to assess the implementation experiences.

    Results: CHWs' knowledge of MNH improved from 41.3% to 77.4% after training, and to 79.9% 1 year post-training. However, knowledge of newborn danger signs declined from 85.5% after training to 58.9% 1 year later. The main predictors of CHW knowledge were age (>= 35 years) and post-primary level of education. The level of coverage of at least one CHW visit to pregnant and newly delivered mothers was 57.3%. Notably, CHW reports complemented the facility-based health information. CHWs formed associations, which improved teamwork, reporting, and general performance, and thus maintained low dropout rates at 3.6%. Challenges included dissatisfaction with the quarterly transport refund of 6 USD and lack of means of transportation such as bicycles.

    Conclusions: CHWs are an important resource in community-based health information and improving demand for MNH services. However, the CHW training and supervision models require strengthening for improved performance. Local solutions regarding CHW motivation are necessary for sustainability.

  • 145. Neikter, Susanna Allgurin
    et al.
    Rehnqvist, Nina
    Rosén, Måns
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Swedish Council on Technology Assessment in Health Care.
    Dahlgren, Helena
    Toward a new information infrastructure in health technology assessment: communication, design, process, and results2009In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 25, no Suppl 2, p. 92-98Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to facilitate effective internal and external communication of an international network and to explore how to support communication and work processes in health technology assessment (HTA).

    Structure and Methods: European network for Health Technology Assessment (EUnetHTA) connected sixty-four HTA Partner organizations from thirty-three countries. User needs in the different steps of the HTA process were the starting point for developing an information system. A step-wise, interdisciplinary, creative approach was used in developing practical tools.

    Results: An Information Platform facilitated the exchange of scientific information between Partners and with external target groups. More than 200 virtual meetings were set up during the project using an e-meeting tool. A Clearinghouse prototype was developed with the intent to offering a single point of access to HTA relevant information. This evolved into a next step not planned from the outset: Developing a running HTA Information System including several Web-based tools to support communication and daily HTA processes. A communication strategy guided the communication effort, focusing on practical tools, creating added value, involving stakeholders, and avoiding duplication of effort.

    Conclusions: Modern technology enables a new information infrastructure for HTA. The potential of information and communication technology was used as a strategic tool. Several target groups were represented among the Partners, which supported collaboration and made it easier to identify user needs. A distinctive visual identity made it easier to gain and maintain visibility on a limited budget.

  • 146.
    Nguyen Xuan, Thanh
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Löfgren, Curt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nguyen Thi Kim, Chuc
    Rudholm, Niklas
    Emmelin, Anders
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    People’s preferences for health care financing options: a choice experiment in rural VietnamManuscript (preprint) (Other academic)
  • 147.
    Nilsson, Ingeborg
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Blanchard, M
    Wicks, A
    Occupational engagement among community dwelling older people: a time-geographic perspective2015In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 30, no 3, p. 484-494Article in journal (Refereed)
    Abstract [en]

    How older people spend their time in different occupations could contribute to our understanding of everyday life in healthy ageing. This study adopted a time-geographic method and occupational perspective to explore the occupational engagement of community dwelling older people. The term occupational engagement encompasses what people do, where and with whom they spend their time and the perceived level of competence and meaningfulness of their time use. Nineteen volunteers born between 1932 and 1933, living alone in an urban area in northern Sweden and receiving no home care services, completed open time-geographic diaries for 5 days in May 2010. The diary data were analyzed using Daily Life software program. The study revealed the complexity and the diversity of the older people's occupational engagement and that most of their time was spent alone in their home. The older people reported they were very good at doing almost half of the occupations in which they engaged and that their occupations were primarily either very meaningful or meaningful. While some methodological limitations were identified, time-geographic studies of community dwelling older people living independently are considered to have potential to contribute to community and social planning for older people as they can provide interesting insights to older persons' time use and occupational needs.

  • 148.
    Nilsson, Ingeborg
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Luborsky, Mark
    Rosenberg, Lena
    Sandberg, Linda
    Bostrom, Anne-Marie
    Borell, Lena
    Perpetuating harms from isolation among older adults with cognitive impairment: observed discrepancies in homecare service documentation, assessment and approval practices2018In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, article id 800Article in journal (Refereed)
    Abstract [en]

    Background: Older persons with cognitive impairment (CI) risk social isolation. Strong evidence shows that perceived loneliness, or inadequate social networks, triggers and increases health problems. How homecare systems address social participation remains unknown; anecdotal data suggests there are significant gaps. This study's objective was to identify and describe how the assessors of homecare needs document social participation among persons with CI and how their documentation corresponds with the services actually provided to meet social needs. The research questions were: How and what kinds of social participation needs are documented on need assessment forms? What types of homecare services (with a social focus) are documented and approved? How are specified needs in social participation profiles addressed by a homecare service?

    Methods: Descriptive data from need assessment forms and their attached care plans for all applicants aged 65+ were collected during a 2 month period from a large homecare agency serving a municipality in Sweden. Persons with documented CI (n = 43) in the group were identified. Qualitative data analysis was conducted to examine the research questions.

    Results: Social participation factors were not documented consistently. The relationship between recognition of limitations to social participation and approval of service eligibility was not consistent. Social participation was designated by references to social status, sometimes by social network size, and occasionally by limitations to social participation. The range of approved homecare services (with social focus) covered services such as day care center visits or companionship. Three profiles of social participation were identified: clients with, (a) no participation limitations; (b) potential limitations; and (c) marked limitations.

    Conclusion: Given the known health harms from social isolation and the high risk of isolation among older persons with CI, this novel study's documentation of inadequate and inconsistent information in homecare social need assessments and services is sobering. The findings suggest a pressing need for initiatives to formulate best practices and standards to ensure alignment of care service systems to the health needs of the growing group of aging individuals with CI.

  • 149.
    Nilsson, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Grankvist, Kjell
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Juthberg, Christina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Factors associated with nursing students' adherence to venous blood collection practice guidelines: A cross sectional study2017In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 23, p. 92-98Article in journal (Refereed)
    Abstract [en]

    Venous blood specimen collection is a common procedure that nursing students perform during pre-registration courses, and training for such collections takes place on campus as well as at clinical placements. However, levels of adherence to practice guidelines are still suboptimal among both nursing students and healthcare staff. We aimed to explore nursing students' adherence to the Swedish national venous blood specimen collection practice guidelines regarding patient identification and test request management and how this adherence is related to clinical experience, capability beliefs, research use,and the perceived social climate in clinical contexts. A survey with a cross-sectional design was conducted among 305 nursing students at a medium sized university in Sweden. Descriptive statistics and logistic regression were used for data analysis. The survey showed that 82% of the students adhered to patient identification guideline practices and 80% to test request management practices. Factors associated with correct patient identification procedures were semester and frequency of research use.Factors associated with correct test request management were previous healthcare work experience,semester, and capability beliefs regarding academic abilities and evidence-based practice. We conclude that there is a need to develop educational tools to train students in research use and evidence-based practice in order to enhance guideline practice adherence and improve patient safety.

  • 150.
    Nilsson, Stefan
    et al.
    Göteborgs universitet.
    Wallbing, Ulrika
    Karolinska institutet.
    Alfvén, Gösta
    Karolinska institutet.
    Dalenius, Kristina
    Lerums kommun.
    Fors, Andreas
    Göteborgs Universitet.
    Golsäter, Marie
    Jönköpings kommun.
    Rosvall, Per-Åke
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Wigert, Helena
    Göteborgs universitet.
    Lundberg, Mari
    Göteborgs universitet.
    Development of the Help Overcoming Pain Early (HOPE) Programme Built on a Person-Centred Approach to Support School Nurses in the Care of Adolescents with Chronic Pain: A Feasibility Study2019In: Children, ISSN 2227-9067, Vol. 6, no 9, article id 95Article in journal (Refereed)
    Abstract [en]

    Chronic pain and its consequences are major global health challenges, and the prevalence is increasing worldwide among adolescents. Adolescents spend most of their waking hours in school; however, there is limited research available on how school nurses can address chronic pain among adolescents in the Swedish school context. Therefore, we designed a person-centred intervention, known as Help Overcoming Pain Early (HOPE), to enable school nurses to offer adolescents strategies to manage their stress and pain. We used the Medical Research Council (MRC) framework for developing and designing this new complex intervention. For this study, we describe two of the four phases: (a) development and (b) feasibility and piloting. The final version of the HOPE programme consists of (i) an educational package for school nurses in the areas person-centred care, stress and pain education/management and gender perspective; and (ii) an intervention package for adolescents with chronic pain. The programme consists of four sessions during which adolescents with chronic pain have person-centred dialogues with a school nurse. The HOPE programme is based on the existing evidence of managing chronic pain and on the assumption that school nurses can support adolescents with chronic pain by using person-centred care.

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