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  • 401.
    Lundström, K
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Holmberg, H
    Topic: INGUINAL HERNIA - Post op chronic pain: incidence, evaluation, legal consequences, therapy, follow up: Choice of anesthesia and chronic pain after groin hernia repair2015In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 19, p. S270-S270, article id PO:152Article in journal (Refereed)
    Abstract [en]

    Chronic pain is common after groin hernia surgery, affecting approximately 10% of patients. The type of anesthesia has been shown to affect short term pain (within 30 days) where Local Anesthesia (LA) has advantages over Regional- and General Anesthesia (RA and GA) The aim of this study was to compare the impact of anesthesia on chronic pain one year after open anterior mesh repair

  • 402.
    Lundström, Karl-Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Montgomery, A.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Patient-reported rates of chronic pain and recurrence after groin hernia repair2018In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 105, no 1, p. 106-112Article in journal (Refereed)
    Abstract [en]

    Background: The effectiveness of different procedures in routine surgical practice for hernia repair with respect to chronic postoperative pain and reoperation rates is not clear.

    Methods: This was prospective cohort study based on a unique combination of patient-reported outcomes and national registry data. Virtually all patients with a groin hernia repair in Sweden between September 2012 and April 2015 were sent a questionnaire 1 year after surgery. Persistent pain, defined as at least "pain present, cannot be ignored, and interferes with concentration on everyday activities' in the past week was the primary outcome. Reoperation for recurrence recorded in the register was the secondary outcome.

    Results: In total, 22 917 patients (response rate 75.5 per cent) who had an elective unilateral groin hernia repair were analysed. Persistent pain present 1 year after hernia repair was reported by 15.2 per cent of patients. The risk was least for endoscopic total extraperitoneal (TEP) repair (adjusted odds ratio (OR) 0.84, 95 per cent c.i. 0.74 to 0.96), compared with open anterior mesh repair. TEP repair had an increased risk of reoperation for recurrence (adjusted OR 2.14, 1.52 to 2.98), as did open preperitoneal mesh repair (adjusted OR 2.34, 1.42 to 3.71) at 2.5-year follow-up. No other methods of repair differed significantly from open anterior mesh repair.

    Conclusion: The risk of significant pain 1year after groin hernia repair in routine surgical practice was 15.2 per cent. This figure was lower in patients who had surgery by an endoscopic technique, but at the price of a significantly higher risk of reoperation for recurrence.

  • 403. Lundström, Karl-Johan
    et al.
    Holmberg, Henrik
    Montgomery, Agneta
    Nordin, Pär
    Chronic pain and recurrence after groin hernia repair: a register basedpatient reported outcome measure studyManuscript (preprint) (Other academic)
  • 404. Lundström, Karl-Johan
    et al.
    Nordin, Pär
    Lord´s operation versus sclerotheraphy for testicular hydrocele, arandomised controlled studyManuscript (preprint) (Other academic)
  • 405.
    Lundström, Karl-Johan
    et al.
    Östersunds Hosp, Dept Surg, S-83183 Östersund, Sweden.
    Sandblom, Gabriel
    Karolinska Inst, Huddinge Univ Hosp, Dept Surg, Stockholm, Sweden.
    Smedberg, Sam
    Helsingborg Hosp, Dept Surg, Helsingborg, Sweden.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Risk factors for complications in Groin Hernia surgery: A National register study2012In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 255, no 4, p. 784-788Article in journal (Refereed)
    Abstract [en]

    Objective: This study aims to analyze and identify risk factors for postoperative complications and analyze the relative risk of reoperation for recurrence for respective complication. Background: The outcome of groin hernia surgery is evaluated mostly by comparing recurrence rates and long-term pain. The aim of this observational population-based registry study was to identify risk factors for postoperative complications and analyze the relative risk of reoperation for recurrence for respective complication. Methods: Using data from the nationwide Swedish Hernia Register between 1998 and 2009, 150,514 herniorrhaphies were analyzed with respect to postoperative complications occurring within 30 days of surgery. Results: Risk factors significantly affecting the rate of postoperative complications were laparoscopic repair (odds ratio [OR] 1.35, 95% confidence interval [CI] 1.24-1.47) and open preperitoneal techniques (OR: 1.31, 95% CI: 1.15-1.49), with open anterior mesh as reference category. Other significant risk factors were general (OR: 1.30, 95% CI: 1.23-1.37) and regional anesthesia (OR: 1.53, 95% CI: 1.43-1.63), with local anesthesia as reference category, emergency procedures (OR: 1.53, 95% CI: 1.43-1.63); recurrent hernia repair (OR: 1.39, 95% CI: 1.27-1.52); femoral hernia (OR: 1.30, 95% CI: 1.14-1.48); aged older than 65 years (OR: 1.26, 95% CI: 1.21-1.31); and duration of surgery exceeding 50 minutes (OR: 1.27, 95% CI: 1.22-1.33). Conclusions: Open anterior approach and surgery under local anesthesia are associated with less risk of postoperative complications.

  • 406. Lundström, Karl-Johan
    et al.
    Söderstrom, Lars
    Jernow, Henning
    Stattin, Pär
    Nordin, Pär
    Hydrocele and spermatocele; Incidence, treatment and complicationsManuscript (preprint) (Other academic)
  • 407. Lundälv, Jörgen
    Ambulansbränder – unik händelse eller ledningsuppgift?2009In: Scandinavian Update – Skandinavisk Akutmedicinsk tidskrift, ISSN 1890-9493, Vol. 2, no 2, p. 18-21Article in journal (Refereed)
  • 408.
    Lundälv, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Göteborgs universitet.
    Ambulansföraren. Efterfrågad förarkompetens och trafiksäkerhet vid anställning av sommarvikarierande förare inom ambulanssjukvården2017Report (Other academic)
  • 409.
    Lundälv, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Ambulanskörning och riskmedvetenhet2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud och Lars Lundberg, Stockholm: Liber, 2016, 2, p. 128-133Chapter in book (Refereed)
  • 410.
    Lundälv, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Institutionen för socialt arbete, Göteborgs universitet.
    Användande av klassifikationen av ICF – en genomgång av förekomst av ICF i högre utbildning2017In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 94, no 5, p. 583-592Article in journal (Refereed)
    Abstract [en]

    This article is about the International Classification of Functioning, Disability and Health (ICF) and the diffusion of educational experiences. The article also describe the educational challenges including the classification in higher education. There will also be significant challenges in a social exchange between researchers and practitioners and sharing experiences with each other.

  • 411.
    Lundälv, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Autonoma fordon – ett hot eller en möjlighet. Debattartikel i tidningen Norra Västerbotten den 18 januari.2017In: Norran, ISSN 1103-9752Article in journal (Other (popular science, discussion, etc.))
  • 412.
    Lundälv, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Göteborgs universitet.
    Biljakter och dödliga skador i Sverige: en retrospektiv studie av konsekvenser av biljaktsrelaterade krascher2016In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 93, no 2, p. 166-176Article in journal (Refereed)
    Abstract [en]

    One person dies every year as a result of a police pursuit in Sweden. During the period 1997-2011 16 persons died in pursuit-related crashes. Previous article described and discussed causes and outcomes from pursuit-related crashes in Sweden. The purpose of the present study was to focus and analyse police pursuit and fatal injuries in Sweden during the period 1997-2011 within the framework of traffic safety policies in terms of educational level and risk situations in the traffic environment. Data were collected by two national media archieve in Sweden; Mediaarkivet and PressText database. Present study shows that during the period 1997-2011 has 16 persons died (fatal injuries) as a result of police pursuits in Sweden. One police officer was killed in this police pursuits in Sweden. A majority av the pursuit-related crashes occur in the nights. The scientific research concerning the phenomenon of police pursuit and pursuit-related crashes has been limited. International research, knowledge and information about the importance of edcuation of advanced driving and police driver attitudes will be very important in the future. To reduce traffic injuries and suffering required work with injury prevention.

  • 413. Lundälv, Jörgen
    Blogga tryggt – sociala medier och vården. Goda råd om tid, utrymme och ansvar.2015Conference paper (Other (popular science, discussion, etc.))
  • 414. Lundälv, Jörgen
    Busskrascher i media, Rasbo - Uppsala2008In: Scandinavian Update - Skandinavisk Akutmedicinsk tidskrift, ISSN 1890-9493, no 1, p. 7-11Article in journal (Refereed)
  • 415.
    Lundälv, Jörgen
    Göteborg University.
    Community-based psychological disaster management groups and psychosocial support to trauma victims: knowledge and awareness2016In: Nordisk Försäkringstidskrift, ISSN 0348-6516, E-ISSN 2001-1741, no 2, p. 1-10Article in journal (Refereed)
    Abstract [en]

    This article describes the role that media coverage plays in creating awareness of the psychosocial support available to people in Sweden who are affected by crises, accidents, and trauma. The connection between media coverage, psychosocial support and traffic accidents has not been made clear in the literature or previous research. Trauma and fatal injuries in road accidents in Sweden has decreased in recent decades. Developments in China and the European countries shows that many people are killed on the roads and the resulting trauma would be significant for relatives and families who are affected. Therefore, it is important that those affected can get the support needed and requested.  The importance of insurance and insurance companies in China has been desribed by Dellien (Dellien, 2011). In Sweden the municipal authorities operate POSOM-groups that provide psychological and social care in the event of major community crisis. However, knowledge and awareness of social support for trauma victims is also very important for insurance companies in Sweden. The economic and social costs of long-term consequences is very important to prevent in society. A Swedish study show that a system called “pay-as-you-speed” (PAYS) could save lives and create at safer road transport system (Stigson et al, 2014). This article describes how team leaders in the POSOM-groups experience accessibility, communication and interactions with the media. The article focuses on how to increase awareness of emergency crisis support for one of today's major public health problems - traffic accidents in the community.

    In China, there is a growing demand for knowledge and skills in providing psychosocial support in the context of crisis and trauma (Cuiling, 2010). Traffic injuries in China has been highlighted in several studies in recent years (Wu and Cheung, 2006; Hu et al., 2008; Wu et al., 2008; Zhao, 2009, Alcorn, 2011; Yuan et al., 2012). Both China and Sweden have a great deal of experience and knowledge about treatment for victims of major disasters and accidents (Kulling, 1994; Hagström, 1995; Kulling and Riddez, 2001; Broberg et al., 2005; Lundin and Jansson, 2007; Berg Johannesson et al., 2009; Arnberg et al., 2012). In China several studies have provided insights on major disasters such as earthquakes and their consequences for the inhabitants (Cuiling, 2010; Fan et al., 2011; Ma et al., 2011; Ya-Hong et al., 2012).

    The consequences of traffic accidents can create to significant social and economic burdens in China and Europe (Berg et al., 2005; Tierens et al., 2012). In light of the long-term social, psychological and economic consequences of crises, trauma, and accidents in the community, there are several good reasons to try to reduce the damage and costs for individuals, insurance company and society.

    China is one of the countries most affected by fatal and serious injuries as a result of road accidents. In Europe more than 1.3 million traffic accidents occur annually, resulting in approximately 43,000 deaths 1.7 million people receiving injuries (European Commission, 2013).  In China, 200,619,351 people were killed in traffic accidents during the period 2000–2005 while 2,972,229 people were injured. In the same period, 3183 people were killed in traffic accidents in Sweden, while 150,000 people were injured in traffic accidents. During the period 2000–2010, 1,434,194 people were killed in road traffic accidents in China and Europe. The death rates has declined in recent years but still remains at a high level. In Sweden, the death rate of is the same as it was in 1940 (Central Statistical Office, 2011).  In Table 1 a total of 17 randomly selected accidents and disasters in both countries are presented. In these accidents and disasters a total of 3761 people have been killed and 996 injured.

  • 416. Lundälv, Jörgen
    Emergency medical vehicle crashes and injury events in Northern Finland2007In: Journal of Chinese Clinical Medicine, ISSN 1562-9023, Vol. 2, no 4, p. 181-187Article in journal (Refereed)
  • 417.
    Lundälv, Jörgen
    Akut- och katastrofmedicinskt centrum, Olycksanalysgruppen, Norrlands Universitetssjukhus.
    Försäkringsbranschen och trafikskadade i Sverige och Finland: en studie om skadades upplevelser av bemötande, kompensation och informationstillgång1999In: Nordisk Försäkringstidskrift, ISSN 0348-6516, E-ISSN 2001-1741, Vol. 80, no 3, p. 301-304Article in journal (Refereed)
    Abstract [sv]

    En majoritet av totalt 836 trafikskadade i Sverige och Finland har upplevt ett mindre bra bemötande av försäkringsbolagen. I Sverige visade sig kvinnorna vara mer otillfredsställda än männen, medan förhållandet i Finland var det omvända. I båda länderna har de skadade rapporterat att de känt en otillfredsställelse med den ekonomiska kompensationen för skadan. Jörgen Lundälv har belyst sociala konsekvenser av skadefall i sin doktorsavhandling. Studien har genomförts vid Socialpolitiska institutionen, Helsingfors universitet.

  • 418.
    Lundälv, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    How to increase patient involvement in clinical trials2017Conference paper (Other academic)
  • 419.
    Lundälv, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Intensiv medierapportering efter busskraschen vid Rasbo-Uppsala2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 36, p. 2418-2420Article in journal (Refereed)
  • 420.
    Lundälv, Jörgen
    Akut- och katastrofmedicinskt centrum, Olycksanalysgruppen, Norrlands universitetssjukhus i Umeå..
    Läkarens sensitivitet högt värderad hos trafikskadade. En retrospektiv studie av trafikskadades upplevelser av hälso- och sjukvård i Finland1999In: Suomen Lääkerilehti, Vol. 54, no 29, p. 2897-2900Article in journal (Refereed)
    Abstract [sv]

    Traumavården upplevs som välutvecklad av en majoritet av de tillfrågade trafikskadade som ingått i en nationell studie år 1996 av levnadsvillkor för trafikskadade i Finland. Hela 70 procent ansåg att de blivit positivt bemötta av läkare såväl under det akuta omhändertagandet efter olyckan som under rehabiliteringsprocessen. Studien visar att läkarens vilja att lyssna och sensitivitet i rehabiliteringsprocessen är något som värderats högt. Kvinnor som erfarit traumatiska olyckor är mer tillfredsställda med läkarkontakten än männen.

  • 421.
    Lundälv, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Macchiariniaffären och primum non nocere. En mediestudie om reflekterande forskare och läkare i tre medicinska tidskrifter.2016In: Svensk Kirurgi, ISSN 0346-847X, Vol. 74, no 3, p. 124-127Article in journal (Refereed)
    Abstract [sv]

    Denna artikel fokuserar på hur läkare och forskare inom den medicinska världen reflekterar över och diskuterar etik, förhållningssätt och forskningspolitik i anslutning till att Macchiariniaffären blivit offentliggjord i medierna genom en svensk TV-dokumentärserie som sändes i januari 2016. Affären beskriver kirurgen Paolo Macchiarini och hans aktivitet som forskare och läkare vid Karolinska Institutet och Karolinska Sjukhuset i Stockholm. Handlingen i den mediala berättelsen beskrivs i TV-dokumentären genom en berättarlinje där betraktaren får följa operationer av patienter som fått en luftstrupe i plast inopererad och vilka konsekvenser detta fått17.

    Syftet med föreliggande mediestudie var att särskilt studera läkares och forskares reflektioner och diskussioner i så kallade diskussionstrådar i öppna forum i sociala medier. De sociala medier som artikeln behandlar är elektroniska versioner av tre medicinska tidskrifter i Sverige; Läkartidningen, Sjukhusläkaren och Dagens Medicin. De frågor som undersökts har varit följande: Vilka medicinska företrädare reflekterar över att affären avslöjats? Hur aktiva är läkare och forskare i tråddiskussionerna i de tre tidskrifterna? Vilka medicinska specialiteter företräds i diskussionerna? Vilket fokus har diskussionerna utifrån Macchiariniaffären? Hur aktiva är juniora respektive seniora medicinska företrädare i de öppna forum som erbjuds av tidskrifterna? Ett bakomliggande syfte med studien var att få en ökad kunskap om läkares och forskares reflektioner i sociala medier när en affär offentliggjorts inom den medicinska världen. En ökad medvetenhet om reflektionens betydelse och vad som uttalas är också betydelsefullt för att ett ökat lärande ska kunna uppnås.

  • 422.
    Lundälv, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Media Coverage of mobility and injury events involving people with visual impairment in Sweden2007In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 15, p. 210-214Article in journal (Refereed)
  • 423. Lundälv, Jörgen
    National and Potential Preventive Strategies for Ambulance Safety in Sweden - The Importance of Adverse Events2016Conference paper (Other academic)
  • 424.
    Lundälv, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Institutionen för socialt arbete, Göteborgs universitet.
    Ord och bild för brukarmedverkan i forskning: perspektiv och berättelser om patienter och närstående i patienttidningen Mun&Hals2017Report (Other academic)
  • 425.
    Lundälv, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Polisaspiranten och utbildningsansvaret: polisbilskörningens dilemman och värdegrund2012In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 89, no 6, p. 490-499Article in journal (Refereed)
    Abstract [en]

    The Swedish police authorities must respond to the national ”vision zero” for road safety policy, an the Swedish police Internal Road Safety Policy and their own values. Every police car drivers have the total driver responsibility. In re-cent decade, the tragic trend of police car crashes and incidents could be de-tected. This paradox is problematized in this article on the assumption that all trained police officers in Sweden have to drive police vehicles on duty without having adequate and sufficient training

  • 426.
    Lundälv, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Polisasprianten som ville träna: aspiranters förarattityder till polisbilskörning och risktagande inom polisens förareutbildning – en attitydundersökning 2008-20102010Report (Other academic)
  • 427.
    Lundälv, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Polisbilen som aldrig kom fram. 11-års nationell personskadestudie med skadeatlas: skadehändelser med polisfordon i svensk vägtrafik2009Report (Other academic)
  • 428. Lundälv, Jörgen
    Risker och krav på körkompetens hos den som kör utryckningsfordon2017Conference paper (Other (popular science, discussion, etc.))
  • 429.
    Lundälv, Jörgen
    Göteborgs universitet.
    Ställ hårdare krav på ambulansförare2017In: Dagens ArenaArticle in journal (Other (popular science, discussion, etc.))
  • 430.
    Lundälv, Jörgen
    Institutionen för socialt arbete, Göteborgs universitet.
    "Svarta lådor" i vägtrafiken och bättre skadeinformation2006In: Nordisk Försäkringstidskrift, ISSN 0348-6516, E-ISSN 2001-1741, no 2, p. 161-166Article in journal (Refereed)
  • 431.
    Lundälv, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Institutionen för socialt arbete, Göteborgs universitet.
    Trafikdöden 2.0 – Stödinsatser krävs för trafikoffer och trafikskadade2017In: Hjärnkraft, ISSN 1654-7446, no 2Article in journal (Other (popular science, discussion, etc.))
  • 432. Lundälv, Jörgen
    Trafikmedicinskt språkbruk i svensk kontext - Från ett trafikskadeperspektiv2009In: Nordisk forsikringstidsskrift : Nordisk försäkringstidskrift, ISSN 0348-6516, no 3, p. 1-10Article in journal (Refereed)
    Abstract [sv]

    Under flera år har begreppet olycka (accident) beskrivits som föråldrat, snävt och som ett icke-entydigt begrepp. Ändå så fortsätter begreppet att spridas och användas i vårt moderna risksamhälle där andra nyord och moderniteter ter sig som självklara. Trafikolyckor är inget folkhälsoproblem men det är däremot trafikskador. Vi vet nämligen att människan skadas i en skadehändelse, vilket är ett mer adekvat ordval än begreppet olycka. Denna artikel diskuterar begreppets relevans och spridning inom det trafikmedicinska forskningsfältet med exempel på tillämpning på internet och en trafikmedicinsk världskongress.

  • 433. Lundälv, Jörgen
    Trafiksäkerhetsarbete och trafikskador: Ett aktuellt multidisciplinärt kunskapsläge och framtidsutsikter om att förebygga skador hos vägtrafikanter.2012In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 89, no 6, p. 459-461Article in journal (Refereed)
  • 434.
    Lundälv, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Vilda biljakter, hälsoförluster och Nollvisionen: Skador och våldsanvändning i vägtrafiken: Populärvetenskapligt föredrag vid Vetenskapskaféet Café-å-lär. Science Café, Chalmers Tekniska Högskola den 1 december 2016, Göteborg.2016Conference paper (Other (popular science, discussion, etc.))
  • 435.
    Lundälv, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Department of Social Work, University of Gothenburg.
    Voices of public involvement – the coverage of patient involvement in a Swedish patient cancer magazine2017Conference paper (Other academic)
  • 436.
    Lundälv, Jörgen
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Gårder, Per
    University of Maine.
    Risser, Ralf
    Leden, Lars
    Luleå Tekniska Universitet.
    Police Cycle-Patrols in Finland: A Qualitative Study Applying the Diamond Model2008In: The Police Journal, ISSN 0032-258X, E-ISSN 1740-5599, Vol. 81, p. 323-335Article in journal (Refereed)
    Abstract [en]

    This article describes a study in Finland of self-assessed risks and safety of policemen and women patrolling on bicycles. The study included focus-group interviews with police officers about their activities and ways of improving their situation. The interviews were structured into five different solution areas according to the Diamond Model: cycle-patrol officer, police bicycle, infrastructure, society/structure and communication. The study also included a questionnaire about police cycling activities in Helsinki, and active cycle-patrol officers' responses were analysed. The purpose of this study was to look at how police activities in Helsinki can be advanced and, in particular, how cycle-patrol members perceive their own safety, visibility and calming effect on other road users. It was also intended to study demands on the bicycle and other equipment used.

  • 437.
    Lundälv, Jörgen
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Göteborgs universitet.
    Philipson, Christer
    Stoppa polisens utbildning i prejning2018In: Norran, ISSN 1103-9752Article in journal (Other (popular science, discussion, etc.))
  • 438.
    Lundälv, Jörgen
    et al.
    Department Of Social Work, Gothenburg University, Gothenburg .
    Thodelius, Charlotta
    Chalmers Tekniska Högskola.
    Extending the concept of interdisciplinary research – what can we learn from inclusive research?: Reflections from two research circles2017Conference paper (Other academic)
  • 439.
    Lundälv, Jörgen
    et al.
    Göteborgs universitet.
    Thodelius, Charlotta
    Chalmers Tekniska Högskola.
    Ekbrand, Hans
    Göteborgs universitet.
    Injury events in residential environment for individuals with disabilities, multiple disabilities and long ­term illness in the County of Värmland, Sweden – a 2­year study2015Conference paper (Refereed)
  • 440.
    Lysholm, Jack
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Yelverton, Tegner
    Department of Health Sciences, University of Technology, Luleå.
    Knee injury rating scales2008In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 78, no 4, p. 445-453Article in journal (Refereed)
  • 441. Lyth, J.
    et al.
    Hansson, J.
    Ingvar, C.
    Mansson-Brahme, E.
    Naredi, Peter
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Stierner, U.
    Wagenius, G.
    Lindholm, C.
    Prognostic subclassifications of T1 cutaneous melanomas based on ulceration, tumour thickness and Clark's level of invasion: results of a population-based study from the Swedish Melanoma Register2013In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 168, no 4, p. 779-786Article in journal (Refereed)
    Abstract [en]

    Background Survival and prognostic factors for thin melanomas have been studied relatively little in population-based settings. This patient group accounts for the majority of melanomas diagnosed in western countries today, and better prognostic information is needed. Objectives The aim of this study was to use established prognostic factors such as ulceration, tumour thickness and Clark's level of invasion for risk stratification of T1 cutaneous melanoma. Methods From 1990 to 2008, the Swedish Melanoma Register included 97% of all melanomas diagnosed in Sweden. Altogether, 13 026 patients with T1 melanomas in clinical stage I were used for estimating melanoma-specific 10- and 15-year mortality rates. The Cox regression model was used for further survival analysis on 11 165 patients with complete data. Results Ulceration, tumour thickness and Clark's level of invasion all showed significant, independent, long-term prognostic information. By combining these factors the patients could be subdivided into three risk groups: a low-risk group (67.9% of T1 cases) with a 10-year melanoma-specific mortality rate of 1.5% (1.2-1.9%); an intermediate-risk group (28.6% of T1 cases) with a 10-year mortality rate of 6.1% (5.0-7.3%); and a high-risk group (3.5% of T1 cases) with a 10-year mortality rate of 15.6% (11.2-21.4%). The high-and intermediate-risk groups accounted for 66% of melanoma deaths within T1. Conclusions Using a population-based melanoma register, and combining ulceration, tumour thickness and Clark's level of invasion, three distinct prognostic subgroups were identified.

  • 442.
    Löfgren, Jenny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Groin hernias and unmet need for surgery in Uganda: Epidemiology, mosquito nets and cost-effectiveness2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background Surgery has traditionally been considered more expensive than many other health care interventions and with little impact on the burden of disease in a global perspective. One of the reasons behind this misconception is that the effects of surgical conditions and their treatment have not been factored into the equation. Cost-effectiveness analyses of surgical interventions have largely been missing.

    An estimated 20 million herniorrhaphies are carried out annually but over 200 million people suffer from groin hernias. Herniorrhaphy is one of the most commonly performed surgical procedures also in Low and Middle Income Countries (LMIC). However, the surgical repair method is not the same due to financial constraints. In high income countries a synthetic mesh is used and has reduced the risk of recurrence. This 125 USD mesh is too costly for the majority in LMIC. Mosquito mesh, which is cheaper but very similar to commercial meshes, is used in several settings but outcomes need to be investigated more extensively before this practice can be recommended in routine surgical service.

    The Aims of this thesis were to define the prevalence of groin hernia, to relate it to the surgical capacity, outcomes and costs of surgery in eastern Uganda and to investigate the feasibility and difference in cost and cost-effectiveness of replacing a commercial mesh with a mosquito mesh in groin hernia surgery.

    Methods Three studies (1-3) were carried out in eastern Uganda. 1: A cross sectional study investigating the prevalence of groin hernia in adult males in the Health and Demographic Surveillance Site (HDSS) in Iganga and Mayuge districts. 2: A facility based study with prospective data collection of all surgeries undertaken in the two hospitals providing surgery for the HDSS population. 3: A double blinded, randomised controlled trial comparing the outcomes of using a mosquito mesh relative using a commercial mesh in groin hernia surgery.

    Results 1: the prevalence of untreated groin hernia among the study participants was 6.6%. 2: the rate of groin hernia surgery was 17 per 100 000 population. Thus, less than 1% of the estimated number of cases of groin hernia in the catchment area of the two hospitals are operated per year. A herniorrhaphy costs around 60 USD to perform. This corresponds to a third of the cost of TB treatment and a 15th of the cost of HIV/AIDS treatment per year in Uganda. 3: No significant differences in terms of recurrence rates, post operative and chronic complications and patient satisfaction were demonstrated between the patients operated using the mosquito mesh and the commercial mesh. Cost-effectiveness was very high for both materials but total cost in the mosquito mesh group was 124 USD lower per surgery than in the commercial mesh group.

    Conclusion There is a vast unmet need for groin hernia surgery. Cost of surgery compares favourably with other health care interventions prioritised by the international organisations and funders. A superior technique can be used in groin hernia surgery at low cost, with high cost-effectiveness in a Low Income Country. 

  • 443.
    Löfgren, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Forsberg, Birger
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Wladis, Andreas
    Global kirurgi – ett forskningsområde med enorm potential för miljarder2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 9-10, p. 404-Article in journal (Other (popular science, discussion, etc.))
  • 444.
    Löfgren, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University Hospital, Umeå, Sweden.
    Kadobera, Daniel
    Forsberg, Birger C.
    Mulowooza, Jude
    Wladis, Andreas
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University Hospital, Umeå, Sweden.
    District-level surgery in Uganda: Indications, interventions and perioperative mortality2015In: Surgery, ISSN 0039-6060, E-ISSN 1532-7361, Vol. 158, no 1, p. 7-16Article in journal (Refereed)
    Abstract [en]

    Background: The world's poorest 2 billion people, benefit from no more than about 3.5% of the world's operative procedures. The burden of surgical disease is greatest in Africa, where operations could save many lives. Previous facility-based studies have described operative procedure caseloads, but prospective studies investigating interventions, indications and perioperative mortality rates (POMR), are rare.

    Methods: A prospective, questionnaire-based collection of data on all major and minor operative procedures was undertaken at 2 hospitals in rural Uganda covering 4 and 3 months in 2011, respectively. Data included patient characteristics, indications for the interventions performed, and outcome after surgery.

    Results: We recorded 2,790 operative procedures on 2,701 patients. The rate of major operative procedures per 100,000 population per year was 225. Patients undergoing major operative procedures (n = 1,051) were mostly women (n = 923; 88%) because most interventions were performed owing to pregnancy-related complications (n = 747; 67%) or gynecologic conditions (n = 114; 10%). General operative interventions registered included herniorrhaphy (n = 103; 9%), exploratory laparotomy (n = 60; 5%), and appendectomy (n = 31; 3%). The POMR for major operative procedures was 1 % (n = 14) and was greatest after exploratory laparotomy (13%; n = 8) and caesarean delivery (1%; n = 4). Most deaths = 16) were a result of sepsis (n = 10-11) or hemorrhage (n = 3-5).

    Conclusion: The volume of surgery was low relative to the size of the catchment population. The POMR was high. Exploratory laparotomy and caesarean section were identified as high-risk procedures. Increased availability of blood, improved pen operative monitoring, and early intervention could be part of a solution to reduce the POMR

  • 445.
    Löfgren, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Kadobera, Daniel
    Forsberg, Birger C.
    Mulowooza, Jude
    Wladis, Andreas
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Surgery in district hospitals in rural Uganda-indications, interventions, and outcomes2015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 385, p. 18-18Article in journal (Other academic)
    Abstract [en]

    Background: There is a vast unmet need for surgical interventions in resource scarce settings. The poorest 2 billion people share 3·5% of the world's operations. The highest burden of surgical disease is seen in Africa where surgery could avert many deaths. Prospective studies investigating interventions, indications, and outcomes including perioperative mortality rates (POMR) after surgery are scant. The aim of the study was to describe the situation of surgery in a low-income setting in sub-Saharan Africa. Methods: In this descriptive, facility-based study, data were prospectively collected in questionnaires by 41 staff employed at two hospitals (Iganga General Hospital and Buluba Mission Hospital) in eastern Uganda during 4 months (major surgeries) and 3 months (minor surgeries) in 2011. Data included patient characteristics, interventions, indications for surgery, and in-hospital mortality after surgery. Descriptive statistical methods were used to analyse the data. Findings: 2701 patients underwent 2790 surgical interventions. Of these, 1051 patients underwent major surgery, which corresponds to a major surgery rate of 224·8 per 100 000 population. Most patients undergoing major surgery were women (n=923, 88%). Pregnancy related complications (n=747, 66%) leading to caesarean section (n=496, 47%) and evacuation (n=244, 22%) or gynaecological conditions (n=114, 10%) were common indications for surgery. General surgery interventions registered were herniorrhaphy (n=103, 9%), explorative laparotomy (n=60, 5%), and appendicectomy (n=31, 3%). Overall, the POMR was 0·6% (16 deaths); for major surgery it was 1·3% (14 deaths) and for minor surgeries it was 0·1% (two of 1650 patients). High POMR were seen following explorative laparotomy (13·3%, eight deaths) and caesarean section (0·8%, four deaths). Of the 510 babies delivered through caesarean section, 59 (12%) were still born or died before discharge. Interpretation: Rates of surgery are low in the study setting compared with in high-income settings where surgical rates exceed 11 000 per 100 000 population. POMR are high after exploratory laparotomy and caesarean section. Although very detailed, a larger study could be undertaken to investigate the situation in other settings. Underlying reasons leading to death and quality of surgical care should be investigated further so that POMR can be reduced in this setting.

  • 446.
    Löfgren, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Makumbi, F.
    Galiwango, E.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Ibingira, C.
    Forsberg, B. C.
    Wladis, A.
    Prevalence of treated and untreated groin hernia in eastern Uganda2014In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 101, no 6, p. 728-734Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hernia repair is the most commonly performed general surgical procedure worldwide. The prevalence is poorly described in many areas, and access to surgery may not be met in low- and middle-income countries. The objectives of this study were to investigate the prevalence of groin hernia and the surgical repair rate in a defined sub-Saharan region of Africa. METHODS: A two-part study on hernia prevalence was carried out in eastern Uganda. The first was a population-based prevalence study with 900 randomly selected men in a Health and Demographic Surveillance Site. The second was a prospective facility-based study of all surgical procedures performed in the two hospitals providing surgical care in the region. RESULTS: The overall prevalence of groin hernia (current hernia or scar after groin hernia surgery) in men was 9·4 per cent. Less than one-third of men with a hernia had been operated on. More than half had no pain symptoms. The youngest age group had an overall prevalence of 2·4 per cent, which increased to 7·9 per cent in the age range 35-54 years, and to 37 per cent among those aged 55 years and above. The groin hernia surgery rate at the hospitals investigated was 17 per 100 000 population per year, which corresponds to a surgical correction rate of less than 1 per cent per year. Based on hospital records, a considerable number of patients having surgery for groin hernia were women (20 of 84 patients, 24 per cent). CONCLUSION: Groin hernia is a common condition in men in this east Ugandan cohort and the annual surgical correction rate is low. Investment is needed to increase surgical capacity in this healthcare system.

  • 447.
    Löfgren, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Matovu, A.
    Wladis, A.
    Ibingira, C.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Galiwango, E.
    Forsberg, B. C.
    Cost-effectiveness of groin hernia repair from a randomized clinical trial comparing commercial versus low-cost mesh in a low-income country2017In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 104, no 6, p. 695-703Article in journal (Refereed)
    Abstract [en]

    BackgroundOver 200 million people worldwide live with groin hernia and 20 million are operated on each year. In resource-scarce settings, the superior surgical technique using a synthetic mesh is not affordable. A low-cost alternative is needed. The objective of this study was to calculate and compare costs and cost-effectiveness of inguinal hernia mesh repair using a low-cost versus a commercial mesh in a rural setting in Uganda. MethodsThis is a cost-effectiveness analysis of a double-blinded RCT comparing outcomes from groin hernia mesh repair using a low-cost mesh and a commercially available mesh. Cost-effectiveness was expressed in US dollars (with euros in parentheses, exchange rate 30 December 2016) per disability-adjusted life-year (DALY) averted and quality-adjusted life-year (QALY) gained. ResultsThe cost difference resulting from the choice of mesh was $1247 (Euro1181). In the low-cost mesh group, the cost per DALY averted and QALY gained were $168 (Euro159) and $76 (Euro72) respectively. The corresponding costs were $582 (Euro551) and $333 (Euro315) in the commercial mesh group. A sensitivity analysis was undertaken including cost variations and different health outcome scenarios. The maximum costs per DALY averted and QALY gained were $1484 (Euro1405) and $847 (Euro802) respectively. ConclusionRepair using both meshes was highly cost-effective in the study setting. A potential cost reduction of over $120 (nearly Euro120) per operation with use of the low-cost mesh is important if the mesh technique is to be made available to the many millions of patients in countries with limited resources. Trial registration number: ISRCTN20596933 (). Mosquito mesh is cost-efficient

  • 448.
    Löfgren, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Matovu, Alphonsus
    Makerere University.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Galiwango, Edward
    Makerere University.
    Wladis, Andreas
    Karolinska Institutet.
    Ibingira, Charles
    Makerere University.
    Forsberg, Birger
    Karolinska Institutet.
    Cost-effectiveness of groin hernia surgery using a low-cost versus a commercial meshManuscript (preprint) (Other academic)
  • 449.
    Löfgren, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Mulowooza, Jude
    Iganga, Uganda.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Wladis, Andreas
    Stockholm, Sweden.
    Forsberg, Birger C.
    Solna, Sweden.
    Cost of surgery in a low-income setting in eastern Uganda2015In: Surgery, ISSN 0039-6060, E-ISSN 1532-7361, Vol. 157, no 6, p. 983-991Article in journal (Refereed)
    Abstract [en]

    Background. Operative interventions have traditionally been seen as expensive; therefore, surgery has been given low priority in global health care planning in low-income countries. A growing body of evidence indicates that surgery can also be highly cost effective in low-income settings, but our current knowledge of the actual cost of surgery in such settings is limited. This study was carried out to obtain data on the costs of commonly performed operative procedures in a rural/semiurban setting in eastern Uganda. Methods. A prospective, facility-based study carried out at a general district hospital (public) and a mission hospital (private, not-for-profit) in the Iganga and Mayuge districts in eastern Uganda. Items included in the cost calculations were staff time, materials and medicines, overhead costs, and capital costs. Results. The cost of surgery was higher at the mission hospital, with higher expenditure and lower productivity than the public hospital. The most commonly performed major procedures were caesarean section, uterine evacuation, and herniorrhaphy for groin hernia. The costs for these interventions varied between $68.4 and $74.4, $25.0 and $32.6, and $58.6 and $66.0, respectively. The most commonly performed minor procedures were circumcision, suture of cuts and lacerations, and incision and drainage of abscess. The costs for these interventions varied between $16.2 and $24.6, $15.8 and $24.3, and $10.1 and $18.6, respectively. Conclusion. The cost of surgery in the study setting compares favorably with other prioritized health care interventions, such as treatment for tuberculosis, human immunodeficiency virus/AIDS, and childhood immunization. Surgery in low-income settings can be made more cost effective, leading to increased quantity and improved quality of surgical services.

  • 450.
    Löfgren, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Ibingira, Charles
    Makerere University.
    Matovu, Alphonsus
    Makerere University.
    Galiwango, Edward
    Makerere University.
    Wladis, Andreas
    Karolinska Institutet.
    A Randomized Trial of Low-Cost Mesh in Groin Hernia Repair2016In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 374, no 2, p. 146-153Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The most effective method for repair of a groin hernia involves the use of a syn-thetic mesh, but this type of mesh is unaffordable for many patients in low- and middle-income countries. Sterilized mosquito meshes have been used as a lower-cost alternative but have not been rigorously studied.METHODS: We performed a double-blind, randomized, controlled trial comparing low-cost mesh with commercial mesh (both lightweight) for the repair of a groin hernia in adult men in eastern Uganda who had primary, unilateral, reducible groin hernias. Surgery was performed by four qualified surgeons. The primary outcomes were hernia recurrence at 1 year and postoperative complications.RESULTS: A total of 302 patients were included in the study. The follow-up rate was 97.3% after 2 weeks and 95.6% after 1 year. Hernia recurred in 1 patient (0.7%) assigned to the low-cost mesh and in no patients assigned to the commercial mesh (abso-lute risk difference, 0.7 percentage points; 95% confidence interval [CI], −1.2 to 2.6; P = 1.0). Postoperative complications occurred in 44 patients (30.8%) assigned to the low-cost mesh and in 44 patients (29.7%) assigned to the commercial mesh (absolute risk difference, 1.0 percentage point; 95% CI, −9.5 to 11.6; P = 1.0).CONCLUSIONS: Rates of hernia recurrence and postoperative complications did not differ signifi-cantly between men undergoing hernia repair with low-cost mesh and those un-dergoing hernia repair with commercial mesh.

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