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  • 1.
    Abdelaziz, Amr Abdelaziz Badrawy
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Troeller, Kenan Craig
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Cost-Effectiveness Analysis of Endovascular versus Open Repair of Ruptured Abdominal Aortic Aneurysm in Sweden2018Självständigt arbete på avancerad nivå (masterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background: Approximately 600 people die from ruptured abdominal aortic aneurism annually in Sweden. Abdominal aortic aneurysm (AAA) is a widening of the abdominal aorta. If a ruptured aortic aneurysm occurs (RAAA), it is a medical emergency and it is a life-threatening condition. The two interventions used to treat RAAA patients are known as the endovascular strategy (EVAR) and the open repair method (OR). Given the life-threatening nature of RAAA, mortality rates are quite high especially considering that this medical condition affects predominantly the elderly. Determining whether a patient is more suitable for EVAR or OR depends on —among other clinical factors— whether technical expertise and resources are available to perform EVAR. The Swedish Agency for Health and Technology Assessment (SBU) explain that it is currently unclear as to which of the two intervention is the cost-effective alternative in treating RAAA in Sweden. 

    Objective: The aim of this study is to evaluate whether the non-invasive EVAR (endovascular) or traditional surgery known as OR (open repair) is more cost-effective in treating RAAA in Sweden.

    Methods: A Cost-effectiveness analysis with healthcare provider perspective using secondary data from relevant peer-reviewed literature from Sweden, other European countries, Swedvascs' and Socialstyrelsens' registries. The model of choice for this evaluation is a decision tree. The target population is males and females who suffer from RAAA in Sweden ranging from ages 50 – 90+, the majority of which were >65. Two subgroups were analyzed; RAAA patients treated with EVAR  and RAAA patients treated with OR. Total RAAA patients n=178. EVAR n= 73. OR n= 105. The time horizon in the base-case is 90 days. The outcome measures are incremental cost-effectiveness ratio (ICER), QALYs and cost/QALY. A one-way deterministic sensitivity analyses, in addition to a probabilistic sensitivity analysis were performed in order to assess the level of confidence that may be associated with the conclusion of this economic evaluation

    Results: Results from the base-case analysis shows that EVAR's cost per QALY gained is SEK 715,823.82 with an ICER of SEK 1,113,499.44 per QALY gained. Results of the base-case analysis shows that EVAR is not cost-effective when considering the commonly accepted threshold of SEK 500,000 per QALY gained. Results of the deterministic sensitivity analyses show that under all suggested scenarios EVAR was not cost-effective. However, results of the probabilistic sensitivity analysis result shows that there is a considerable uncertainty around the cost-effectiveness of EVAR.

    Conclusion: EVAR is not cost-effective with marginal clinical benefits compared to OR. Since it is a high cost intervention which lacks national guidelines from "Socialstyrelsen", individual county councils in Sweden will likely have to make the decision individually if they want to adopt EVAR as a treatment method for RAAA. While RAAA is a very severe health condition it also has a low prevalence in Sweden meaning county councils with larger population centers, budgets and availability of technical expertise/equipment can still introduce EVAR to treat RAAA even if the cost-effectiveness analysis results exceed the commonly accepted threshold value of SEK 500,000 per QALY gained. Due to uncertainties vis-à-vis a lack of more conclusive data in a Swedish context, further investigation is required before recommending EVAR for subsidization. It would however be worth pursuing this end given the promise of EVAR as a non-invasive and more benign treatment method for patients. 

  • 2.
    Abraha, Atakelti
    et al.
    Tigray Health Bureau, Tigray, Ethiopia;Ethiopian Health Insurance Agency, Addis Ababa, Ethiopia.
    Myléus, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
    Kahsay, Asmelash
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
    The effects of maternal and child HIV infection on health equity in Tigray Region, Ethiopia, and the implications for the health system: a case-control study2019Ingår i: AIDS Care, ISSN 0954-0121, E-ISSN 1360-0451, Vol. 31, nr 10, s. 1271-1281Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Services that aim to prevent mother-to-child HIV transmission (PMTCT) can simultaneously reduce the overall impact of HIV infection in a population while also improving maternal and child health outcomes. By taking a health equity perspective, this retrospective case control study aimed to compare the health status of under-5 children born to HIV-positive and HIV-negative mothers in Tigray Region, Ethiopia. Two hundred and thirteen HIV-positive women (cases), and 214 HIV-negative women (controls) participated through interviews regarding their oldest children. Of the children born to HIV-positive mothers, 24% had not been tested, and 17% of those who had been tested were HIV-positive themselves. Only 29% of the HIV-positive children were linked to an ART programme. Unexpectedly, exposed HIV-negative children had fewer reports of perceived poor health as compared to unexposed children. Over 90% of all the children, regardless of maternal HIV status, were breastfed and up-to-date with the recommended immunizations. The high rate of HIV infection among the babies of HIV-positive women along with their low rates of antiretroviral treatment raises serious concerns about the quality of outreach to pregnant women in Tigray Region, and of the follow-up for children who have been exposed to HIV via their mothers.

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  • 3.
    Ajiko, Mary Margaret
    et al.
    Surgery, Soroti Regional Referral Hospital, Kampala, Uganda; Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Kressner, Julia
    Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Matovu, Alphonsus
    Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Surgery, Mubende Regional Referral Hospital, Kampala, Uganda.
    Nordin, Pär
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Department of Surgery, Östersunds Sjukhus, Östersund, Sweden.
    Wladis, Andreas
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Löfgren, Jenny
    Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Surgical procedures for children in the public healthcare sector: A nationwide, facility-based study in Uganda2021Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 11, nr 7, artikel-id e048540Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: This study investigated the surgical services for children at the highest levels of the public healthcare sector in Uganda. The aim was to determine volumes and types of procedure performed and the patients and the human resource involved.

    Design: The study was a facility-based, record review.

    Setting: The study was carried out at the National Referral Hospital, all 14 regional referral hospitals and 14 general hospitals in Uganda, representing the highest levels of hospital in the public healthcare sector.

    Participants: The subjects were children <18 years who underwent major surgery in the study hospitals during 2013 and 2014.

    Results: The study hospitals contribute with an average annual rate of paediatric surgery at 22.0 per 100 000 paediatric population. This is a fraction of the estimated need. Most of the procedures were performed for congenital anomalies (n=3111, 39.4%), inflammation and infection (n=2264, 28.7%) and trauma (n=1210, 15.3%). Specialist surgeons performed 60.3% (n=4758) of the procedures, and anaesthesia was administered by specialist physician anaesthetists in 11.6% (n=917) of the cases.

    Conclusions: A variety of paediatric surgical procedures are performed in a relatively decentralised system throughout Uganda. Task shifting and task sharing of surgery and anaesthesia are widespread: a large proportion of surgical procedures was carried out by non-specialist physicians, with anaesthesia mostly delivered by non-physician anaesthetists. Reinforcing the capacity and promoting the expansion of the health facilities studied, in particular the general hospitals and regional referral hospitals, could help reduce the immense unmet need for surgical services for children in Uganda.

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  • 4. Ajroud-Driss, Senda
    et al.
    Adams, David
    Coelho, Teresa
    Polydefkis, Michael
    Gonzalez-Duarte, Alejandra
    Quan, Dianna
    Kristen, Arnt
    Berk, John L.
    Partisano, Angela M.
    Gollob, Jared
    Sweetser, Marianne T.
    Chen, Jihong
    Agarwal, Sonalee
    Suhr, Ole B.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Impact of Patisiran on Overall Health Status in hATTR Amyloidosis: Results from the APOLLO Trial2019Ingår i: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 92, nr 15Artikel i tidskrift (Övrigt vetenskapligt)
  • 5.
    Al-Alawi, Kamila
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Training and Studies, Royal Hospital, Ministry of Health, Muscat, Oman.
    Al Mandhari, Ahmed
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Care providers' perceptions towards challenges and opportunities for service improvement at diabetes management clinics in public primary health care in Muscat, Oman: a qualitative study2019Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 19, artikel-id 18Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundThe literature has described several challenges related to the quality of diabetes management clinics in public primary health care centres in Oman. These clinics continue to face challenges due to the continuous growth of individuals diagnosed with type 2 diabetes. We sought to explore the challenges faced in these clinics and discuss opportunities for improvement in Oman.MethodsThis qualitative study was designed to include non-participant observations of diabetic patients and care providers during service provision at diabetes management clinics, as well as semi-structured interviews with care providers, at five purposively selected public primary health care centres. Care providers included physicians, nurses, dieticians, health educators, pharmacists, an assistant pharmacist, a psychologist, and a medical orderly. The data were analysed using qualitative content analysis.ResultsThe study disclosed three different models of service delivery at diabetes management clinics, which, to varying degrees, face challenges related to health centre infrastructure, technical and pharmaceutical support, and care providers' interests, knowledge, and skills. Challenges related to the community were also found in terms of cultural beliefs, traditions, health awareness, and public transportation.ConclusionThe challenges encountered in diabetes management clinics fall within two contexts: health care centres and community. Although many challenges exist, opportunities for improvement are available. However, improvements in the quality of diabetic clinics in primary health care centres might take time and require extensive involvement, shared responsibilities, and implications from the government, health care centres, and community.

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  • 6.
    Al-Alawi, Kamila
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Perceptions of type-two diabetes patients towards diabetes management visits at public primary health care centres with diverse opinions towards nurse-led clinics in Muscat, Oman: a pilot qualitative studyManuskript (preprint) (Övrigt vetenskapligt)
  • 7.
    Al-Alawi, Kamila
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    The question is not what we want; the question is, are we ready?: a qualitative study exploring primary health care providers`perceptions towards different human resources for health management mechanisms at diabetes management clinics in primary health care centres in Muscat, OmanManuskript (preprint) (Övrigt vetenskapligt)
  • 8.
    Al-Alawi, Kamila
    et al.
    Department of Training and Studies, Royal Hospital, Ministry of Health, Muscat, Oman.
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    “Yes to discuss different models of care between primary care physicians and diabetes-practice nurses, but not to complete implementation yet”: Explorative qualitative study at diabetes clinics in primary health care centres in Muscat, Oman2020Ingår i: International Journal of Healthcare, ISSN 2377-7338, Vol. 6, nr 1, s. 72-80Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Globally, many models of care through which the way health services are delivered have been adopted withinteam-based primary health care. Although these models have aimed to solve some of the health care challenges related tophysician’s shortages in clinics and further acceptance of non-physician-led clinics, their application is usually determined by arange of factors, such as preparedness of the health care providers, preparedness of patients and support from higher authorities.

    Objective: The study was designed to explore health care providers’ perceptions for changes in models of care in diabetes clinicsat primary health care in Muscat, Oman.

    Methods: A total of 27 semi-structured interviews were conducted with health care providers involved in diabetes clinics atfive purposively selected primary health care centres in Muscat. The interviewees included the core members of the diabetesmanagement team and other supportive members available at the centres, and were of mixed genders, nationalities and professions.Qualitative thematic analysis was applied.

    Results: The analysis resulted in one main theme, which captured positive responses towards task-sharing model, but revealedworries and requirements for complete implementation. Nurses’ competences and diabetic patients’ acceptance were among themain concerns. Health care providers revealed that for complete implementation of the model, nurses’ involvement in the teamcould be improved through updating their knowledge and through the provision of support from higher authorities, while diabeticpatients’ acceptance could be improved through understanding of their perceived knowledge towards the model which couldpromote nurse-led clinics.

    Conclusion: Task-sharing within the discussed possibilities could provide many positive outcomes and a rewarding future fordiabetes clinics at primary health care centres. Omani culture could play a role in its implementation; therefore, if successfulimplementation is desired, carefully considered steps must be applied by the government and the community

  • 9. Alghadir, Ahmad H.
    et al.
    Zafar, Hamayun
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi. Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia.
    Iqbal, Zaheen A.
    Experiences of Overseas Trained Physical Therapists Working in Saudi Arabia: An Observational Study2020Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, nr 10, artikel-id 3406Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Health professionals, including physical therapists (PTs), are known to migrate for better jobs, as well as for personal and professional development. However, this involves risks of maladjustment, discrimination, and exploitation. We conducted this study to investigate the experiences of overseas trained PTs in Saudi Arabia (SA) and their perceptions about physical therapy practice and problems regarding the profession in the country.

    Methods: A questionnaire and accompanying explanation of the study was sent to 175 members of the Saudi Physical Therapy Association (SPTA) working in SA who had been trained outside SA and had a minimum of one year of work experience before moving to SA.

    Results: One hundred and fifty (86%) respondents completed the questionnaire. Among the respondents, the majority had more than five years of work experience after moving to SA. While 54% of the respondents reported that they were satisfied with their work experiences in SA, the remaining respondents reported their dissatisfaction for various reasons.

    Conclusions: With the increase in aged population and rise in disability, the need for PTs has simultaneously increased in the health care sector around the world, including in SA. Until PTs of local origin are ready to fill the requirements, the services of PTs from other countries will be required in SA. Although the majority of respondents reported having positive work experiences in SA, the negative aspects and challenges faced by PTs in SA have also been highlighted in this study. These problems need to be addressed in order to promote the development of a better and more holistic approach to patient care.

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  • 10. Aljuaid, Mohammed
    et al.
    Elmontsri, Mustafa
    Edvardsson, David
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
    Rawaf, Salman
    Majeed, Azeem
    Psychometric evaluation of the Arabic language person-centred climate questionnairestaff version2018Ingår i: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 26, nr 4, s. 449-456Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AimTo evaluate the psychometric properties of the Arabic language person-centred climate questionnairestaff version. BackgroundThere have been increasing calls for a person-centred rather than a disease-centred approach to health care. A limited number of tools measure the extent to which care is delivered in a person-centred manner, and none of these tools have been validated for us in Arab settings. MethodThe validated form of the person-centred climate questionnairestaff version was translated into Arabic and distributed to 152 health care staff in teaching and non-teaching hospitals in Saudi Arabia. Statistical estimates of validity and reliability were used for psychometric evaluation. ResultsItems on the Arabic form of the person-centred climate questionnairestaff version had high reliability (Cronbach's alpha .98). Cronbach's alpha values for the three sub-scales (safety, everydayness and community), were .96, .97 and .95 respectively. Internal consistency was also high and measures of validity were very good. ConclusionArabic form of the person-centred climate questionnairestaff version provides a valid and reliable way to measure the degree of perceived person-centredness. Implications for nursing managementThe tool can be used for comparing levels of person-centredness between wards, units, and public and private hospitals. The tool can also be used to measure the extent of person-centredness in health care settings in other Arab countries.

  • 11.
    AlShurman, Bara’ Abdallah
    et al.
    School of Public Health Sciences, Faculty of Health, University of Waterloo, ON, Waterloo, Canada.
    Tetui, Moses
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. School of Public Health Sciences, Faculty of Health, University of Waterloo, ON, Waterloo, Canada; School of Pharmacy, University of Waterloo, ON, Kitchener, Canada.
    Nanyonjo, Agnes
    Lincoln International Institute for Rural Health, University of Lincoln, Brayford Way, Brayford, Pool, Lincoln, United Kingdom.
    Butt, Zahid Ahmad
    School of Public Health Sciences, Faculty of Health, University of Waterloo, ON, Waterloo, Canada.
    Waite, Nancy M.
    School of Pharmacy, University of Waterloo, ON, Kitchener, Canada.
    Vernon-Wilson, Elizabeth
    School of Pharmacy, University of Waterloo, ON, Kitchener, Canada.
    Wong, Ginny
    School of Pharmacy, University of Waterloo, ON, Kitchener, Canada.
    Grindrod, Kelly
    School of Pharmacy, University of Waterloo, ON, Kitchener, Canada.
    Understanding the COVID-19 vaccine policy terrain in Ontario Canada: a policy analysis of the actors, content, processes, and context2023Ingår i: Vaccines, E-ISSN 2076-393X, Vol. 11, nr 4, artikel-id 782Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    (1) Background: Canada had a unique approach to COVID-19 vaccine policy making. The objective of this study was to understand the evolution of COVID-19 vaccination policies in Ontario, Canada, using the policy triangle framework.

    (2) Methods: We searched government websites and social media to identify COVID-19 vaccination policies in Ontario, Canada, which were posted between 1 October 2020, and 1 December 2021. We used the policy triangle framework to explore the policy actors, content, processes, and context.

    (3) Results: We reviewed 117 Canadian COVID-19 vaccine policy documents. Our review found that federal actors provided guidance, provincial actors made actionable policy, and community actors adapted policy to local contexts. The policy processes aimed to approve and distribute vaccines while continuously updating policies. The policy content focused on group prioritization and vaccine scarcity issues such as the delayed second dose and the mixed vaccine schedules. Finally, the policies were made in the context of changing vaccine science, global and national vaccine scarcity, and a growing awareness of the inequitable impacts of pandemics on specific communities.

    (4) Conclusions: We found that the triad of vaccine scarcity, evolving efficacy and safety data, and social inequities all contributed to the creation of vaccine policies that were difficult to efficiently communicate to the public. A lesson learned is that the need for dynamic policies must be balanced with the complexity of effective communication and on-the-ground delivery of care.

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  • 12. Amaku, Marcos
    et al.
    Covas, Dimas Tadeu
    Bezerra Coutinho, Francisco Antonio
    Azevedo Neto, Raymundo Soares
    Struchiner, Claudio
    Wilder-Smith, Annelies
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department Public Health and Clinical, Heidelberg Institute of Global Health, University of Heidelberg, Germany; Department of Disease Control, London School of Hygiene and Tropical, Medicine, U.
    Massad, Eduardo
    Modelling the test, trace and quarantine strategy to control the COVID-19 epidemic in the state of Sao Paulo, Brazil2021Ingår i: Infectious Disease Modelling, ISSN 2468-0427, Vol. 6, s. 46-55Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Testing for detecting the infection by SARS-CoV-2 is the bridge between the lockdown and the opening of society. In this paper we modelled and simulated a test-trace-and-quarantine strategy to control the COVID-19 outbreak in the State of Sao Paulo, Brasil. The State of Sao Paulo failed to adopt an effective social distancing strategy, reaching at most 59% in late March and started to relax the measures in late June, dropping to 41% in 08 August. Therefore, Sao Paulo relies heavily on a massive testing strategy in the attempt to control the epidemic.

    Two alternative strategies combined with economic evaluations were simulated. One strategy included indiscriminately testing the entire population of the State, reaching more than 40 million people at a maximum cost of 2.25 billion USD, that would reduce the total number of cases by the end of 2020 by 90%. The second strategy investigated testing only symptomatic cases and their immediate contacts - this strategy reached a maximum cost of 150 million USD but also reduced the number of cases by 90%. The conclusion is that if the State of Sao Paulo had decided to adopt the simulated strategy on April the 1st, it would have been possible to reduce the total number of cases by 90% at a cost of 2.25 billion US dollars for the indiscriminate strategy but at a much smaller cost of 125 million US dollars for the selective testing of symptomatic cases and their contacts. 

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  • 13.
    Amani, Paul Joseph
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Health Systems Management, School of Public Administration and Management, Mzumbe University, Morogoro, Tanzania.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Kiwara, Angwara Denis
    Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
    Goicolea, Isabel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Healthcare workers´ experiences and perceptions of the provision of health insurance benefits to the elderly in rural Tanzania: an explorative qualitative study2023Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 23, nr 1, artikel-id 459Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Healthcare workers play an important part in the delivery of health insurance benefits, and their role in ensuring service quality and availability, access, and good management practice for insured clients is crucial. Tanzania started a government-based health insurance scheme in the 1990s. However, no studies have specifically looked at the experience of healthcare professionals in the delivery of health insurance services in the country. This study aimed to explore healthcare workers' experiences and perceptions of the provision of health insurance benefits for the elderly in rural Tanzania.

    METHODS: An exploratory qualitative study was conducted in the rural districts of Igunga and Nzega, western-central Tanzania. Eight interviews were carried out with healthcare workers who had at least three years of working experience and were involved in the provision of healthcare services to the elderly or had a certain responsibility with the administration of health insurance. The interviews were guided by a set of questions related to their experiences and perceptions of health insurance and its usefulness, benefit packages, payment mechanisms, utilisation, and availability of services. Qualitative content analysis was used to analyse the data.

    RESULTS: Three categories were developed that describe healthcare workers´ experiences and perceptions of delivering the benefits of health insurance for the elderly living in rural Tanzania. Healthcare workers perceived health insurance as an important mechanism to increase healthcare access for elderly people. However, alongside the provision of insurance benefits, several challenges coexisted, such as a shortage of human resources and medical supplies as well as operational issues related to delays in funding reimbursement.

    CONCLUSION: While health insurance was considered an important mechanism to facilitate access to care among rural elderly, several challenges that impede its purpose were mentioned by the participants. Based on these, an increase in the healthcare workforce and availability of medical supplies at the health-centre level together with expansion of services coverage of the Community Health Fund and improvement of reimbursement procedures are recommended to achieve a well-functioning health insurance scheme.

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  • 14.
    Amani, Paul Joseph
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Health Systems Management, School of Public Administration and Management, Mzumbe University, Morogoro, Tanzania.
    Tungu, Malale
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Kiwara, Angwara Denis
    Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Frumence, Gasto
    Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Responsiveness of health care services towards the elderly in Tanzania: does health insurance make a difference? A cross-sectional study2020Ingår i: International Journal for Equity in Health, E-ISSN 1475-9276, Vol. 19, nr 1, artikel-id 179Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Responsiveness has become an important health system performance indicator in evaluating the ability of health care systems to meet patients' expectations. However, its measurement in sub-Saharan Africa remains scarce. This study aimed to assess the responsiveness of the health care services among the insured and non-insured elderly in Tanzania and to explore the association of health insurance (HI) with responsiveness in this population.

    Methods: A community-based cross-sectional study was conducted in 2017 where a pre-tested household survey, administered to the elderly (60 + years) living in Igunga and Nzega districts, was applied. Participants with and without health insurance who attended outpatient and inpatient health care services in the past three and 12 months were selected. Responsiveness was measured based on the short version of the World Health Organization (WHO) multi-country responsiveness survey study, which included the dimensions of quality of basic amenities, choice, confidentiality, autonomy, communication and prompt attention. Quantile regression was used to assess the specific association of the responsiveness index with health insurance adjusted for sociodemographic factors.

    Results: A total of 1453 and 744 elderly, of whom 50.1 and 63% had health insurance, used outpatient and inpatient health services, respectively. All domains were rated relatively highly but the uninsured elderly reported better responsiveness in all domains of outpatient and inpatient care. Waiting time was the dimension that performed worst. Possession of health insurance was negatively associated with responsiveness in outpatient (− 1; 95% CI: − 1.45, − 0.45) and inpatient (− 2; 95% CI: − 2.69, − 1.30) care.

    Conclusion: The uninsured elderly reported better responsiveness than the insured elderly in both outpatient and inpatient care. Special attention should be paid to those dimensions, like waiting time, which ranked poorly. Further research is necessary to reveal the reasons for the lower responsiveness noted among insured elderly. A continuous monitoring of health care system responsiveness is recommended.

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  • 15. Ameh, Soter
    et al.
    D'Ambruoso, Lucia
    Gomez-Olive, Francesc Xavier
    Kahn, Kathleen
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Tollman, Stephen M.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Klipstein-Grobusch, Kerstin
    Paradox of HIV stigma in an integrated chronic disease care in rural South Africa: Viewpoints of service users and providers2020Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 15, nr 7, artikel-id e0236270Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    An integrated chronic disease management (ICDM) model was introduced by the National Department of Health in South Africa to tackle the dual burden of HIV/AIDS and non-communicable diseases. One of the aims of the ICDM model is to reduce HIV-related stigma. This paper describes the viewpoints of service users and providers on HIV stigma in an ICDM model in rural South Africa.

    Materials and methods

    A content analysis of HIV stigmatisation in seven primary health care (PHC) facilities and their catchment communities was conducted in 2013 in the rural Agincourt sub-district, South Africa. Eight Focus Group Discussions were used to obtain data from 61 purposively selected participants who were 18 years and above. Seven In-Depth Interviews were conducted with the nurses-in-charge of the facilities. The transcripts were inductively analysed using MAXQDA 2018 qualitative software.

    Results

    The emerging themes were HIV stigma, HIV testing and reproductive health-related concerns. Both service providers and users perceived implementation of the ICDM model may have led to reduced HIV stigma in the facilities. On the other hand, service users and providers thought HIV stigma increased in the communities because community members thought that home-based carers visited the homes of People living with HIV. Service users thought that routine HIV testing, intended for pregnant women, was linked with unwanted pregnancies among adolescents who wanted to use contraceptives but refused to take an HIV test as a precondition for receiving contraceptives.

    Conclusions

    Although the ICDM model was perceived to have contributed to reducing HIV stigma in the health facilities, it was linked with stigma in the communities. This has implications for practice in the community component of the ICDM model in the study setting and elsewhere in South Africa.

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  • 16. Ameh, Soter
    et al.
    Klipstein-Grobusch, Kerstin
    D'ambruoso, Lucia
    Kahn, Kathleen
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; The International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH) Accra, Ghana.
    Tollman, Stephen M.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; The International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH) Accra, Ghana.
    Gomez-Olive, Francesc Xavier
    Quality of integrated chronic disease care in rural South Africa: user and provider perspectives2017Ingår i: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 32, nr 2, s. 257-266Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The integrated chronic disease management (ICDM) model was introduced as a response to the dual burden of HIV/AIDS and non-communicable diseases (NCDs) in South Africa, one of the first of such efforts by an African Ministry of Health. The aim of the ICDM model is to leverage HIV programme innovations to improve the quality of chronic disease care. There is a dearth of literature on the perspectives of healthcare providers and users on the quality of care in the novel ICDM model. This paper describes the viewpoints of operational managers and patients regarding quality of care in the ICDM model. In 2013, we conducted a case study of the seven PHC facilities in the rural Agincourt sub-district in northeast South Africa. Focus group discussions (n = 8) were used to obtain data from 56 purposively selected patients >= 18 years. In-depth interviews were conducted with operational managers of each facility and the sub-district health manager. Donabedian's structure, process and outcome theory for service quality evaluation underpinned the conceptual framework in this study. Qualitative data were analysed, with MAXQDA 2 software, to identify 17 a priori dimensions of care and unanticipated themes that emerged during the analysis. The manager and patient narratives showed the inadequacies in structure (malfunctioning blood pressure machines and staff shortage); process (irregular prepacking of drugs); and outcome (long waiting times). There was discordance between managers and patients regarding reasons for long patient waiting time which managers attributed to staff shortage and missed appointments, while patients ascribed it to late arrival of managers to the clinics. Patients reported anti-hypertension drug stock-outs (structure); sub-optimal defaulter-tracing (process); rigid clinic appointment system (process). Emerging themes showed that patients reported HIV stigmatisation in the community due to defaulter-tracing activities of home-based carers, while managers reported treatment of chronic diseases by traditional healers and reduced facility-related HIV stigma because HIV and NCD patients attended the same clinic. Leveraging elements of HIV programmes for NCDs, specifically hypertension management, is yet to be achieved in the study setting in part because of malfunctioning blood pressure machines and anti-hypertension drug stock-outs. This has implications for the nationwide scale up of the ICDM model in South Africa and planning of an integrated chronic disease care in other low-and middle-income countries.

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  • 17.
    Aminoff, Hedvig
    et al.
    Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden.
    Meijer, Sebastiaan
    Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden.
    Arnelo, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Groth, Kristina
    Innovation Center, Karolinska University Hospital, Stockholm, Sweden.
    Modeling the implementation context of a telemedicine service: Work domain analysis in a surgical setting2021Ingår i: JMIR Formative Research, E-ISSN 2561-326X, Vol. 5, nr 6, artikel-id e26505Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: A telemedicine service enabling remote surgical consultation had shown promising results. When the service was to be scaled up, it was unclear how contextual variations among different clinical sites could affect the clinical outcomes and implementation of the service. It is generally recognized that contextual factors and work system complexities affect the implementation and outcomes of telemedicine. However, it is methodologically challenging to account for context in complex health care settings. We conducted a work domain analysis (WDA), an engineering method for modeling and analyzing complex work environments, to investigate and represent contextual influences when a telemedicine service was to be scaled up to multiple hospitals.

    Objective: We wanted to systematically characterize the implementation contexts at the clinics participating in the scale-up process. Conducting a WDA would allow us to identify, in a systematic manner, the functional constraints that shape clinical work at the implementation sites and set the sites apart. The findings could then be valuable for informed implementation and assessment of the telemedicine service.

    Methods: We conducted observations and semistructured interviews with a variety of stakeholders. Thematic analysis was guided by concepts derived from the WDA framework. We identified objects, functions, priorities, and values that shape clinical procedures. An iterative “discovery and modeling” approach allowed us to first focus on one clinic and then readjust the scope as our understanding of the work systems deepened.

    Results: We characterized three sets of constraints (ie, facets) in the domain: the treatment facet, administrative facet (providing resources for procedures), and development facet (training, quality improvement, and research). The constraints included medical equipment affecting treatment options; administrative processes affecting access to staff and facilities; values and priorities affecting assessments during endoscopic retrograde cholangiopancreatography; and resources for conducting the procedure.

    Conclusions: The surgical work system is embedded in multiple sets of constraints that can be modeled as facets of the system. We found variations between the implementation sites that might interact negatively with the telemedicine service. However, there may be enough motivation and resources to overcome these initial disruptions given that values and priorities are shared across the sites. Contrasting the development facets at different sites highlighted the differences in resources for training and research. In some cases, this could indicate a risk that organizational demands for efficiency and effectiveness might be prioritized over the long-term outcomes provided by the telemedicine service, or a reduced willingness or ability to accept a service that is not yet fully developed or adapted. WDA proved effective in representing and analyzing these complex clinical contexts in the face of technological change. The models serve as examples of how to analyze and represent a complex sociotechnical context during telemedicine design, implementation, and assessment.

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  • 18.
    An, Qingfan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Agnello, Danielle
    School of Health and Life Sciences, Glasgow Caledonian University, UK.
    McCaffrey, Lauren
    School of Health and Life Sciences, Glasgow Caledonian University, UK.
    Chastin, Sebastien
    School of Health and Life Sciences, Glasgow Caledonian University, UK; Department of Movement and Sports Sciences, Ghent University, 9000, Ghent, Belgium.
    Helleday, Ragnberth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    A scoping review of co-creation practice in the development of non-pharmacological interventions for people with chronic obstructive pulmonary disease: a health CASCADE study2023Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 211, artikel-id 107193Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Incorporating co-creation processes may improve the quality of outcome interventions. However, there is a lack of synthesis of co-creation practices in the development of Non-Pharmacological Interventions (NPIs) for people with Chronic Obstructive Pulmonary Disease (COPD), that could inform future co-creation practice and research for rigorously improving the quality of care.

    Objective: This scoping review aimed to examine the co-creation practice used when developing NPIs for people with COPD.

    Methods: This review followed Arksey and O'Malley scoping review framework and was reported according to the PRISMA-ScR framework. The search included PubMed, Scopus, CINAHL, and Web of Science Core Collection. Studies reporting on the process and/or analysis of applying co-creation practice in developing NPIs for people with COPD were included.

    Results: 13 articles complied with the inclusion criteria. Limited creative methods were reported in the studies. Facilitators described in the co-creation practices included administrative preparations, diversity of stakeholders, cultural considerations, employment of creative methods, creation of an appreciative environment, and digital assistance. Challenges around the physical limitations of patients, the absence of key stakeholder opinions, a prolonged process, recruitment, and digital illiteracy of co-creators were listed. Most of the studies did not report including implementation considerations as a discussion point in their co-creation workshops.

    Conclusion: Evidence-based co-creation in COPD care is critical for guiding future practice and improving the quality of care delivered by NPIs. This review provides evidence for improving systematic and reproducible co-creation. Future research should focus on systematically planning, conducting, evaluating, and reporting co-creation practices in COPD care.

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  • 19.
    Andersson, Elin M.
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Nordin, Steven
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Lindvall, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Cognitive and emotional reactions to pictorial-based risk communication on subclinical atherosclerosis: a qualitative study within the VIPVIZA trial2023Ingår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 41, nr 1, s. 69-80Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives, setting and subjects: Atherosclerosis screening with ultrasound is non-invasive and can be used as part of risk communication. The potential of personalised and pictorial-based risk communication is assessed in VIPVIZA, a population-based randomised controlled trial that aims at optimising cardiovascular disease (CVD) prevention by investigating the impact of visualisation of subclinical atherosclerosis. The present aim was to explore cognitive and emotional reactions evoked by the intervention as well as attitudes to any implemented life style changes in VIPVIZA participants in the intervention group with improved health status and furthermore to study possible interactions between these factors. Understanding mechanisms of action was central since non-adherence to preventive guidelines are often faced in clinical practice. Design: In-depth interviews with 14 individuals were analysed with qualitative content analysis. Results: Cognitive and emotional processes were highly interlinked and described by the main theme Cognitive and emotional reactions in strong interplay for orchestration of health oriented behavioural change. The informants’ descriptions revealed two distinctly different psychological processes which constituted the two subthemes, Problem-focused coping and Encouragement-driven process. Conclusions: The results highlight that an interaction between emotional reactions and efficacy beliefs is important in facilitating behavioural change. Furthermore, the results underscore the importance of the risk message being perceived as clear, accurate, reliable and also emotionally engaging and thereby show why atherosclerosis screening and pictorial-based risk communication have the potential to contribute to effective CVD prevention strategies and shared decision making in primary care.

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  • 20.
    Andersén, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Bäckström, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Dahlquist, Gisela
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Damber, Jan-Erik
    Engström-Laurent, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Hjemdahl, Paul
    Korsgren, Olle
    Olsson, Håkan
    Wiberg, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Handkirurgi.
    Widmark, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Svensk medicinsk forskning behöver inte mer styrning2014Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, nr 22-23, s. 980-981Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 21.
    Andreen, Johan
    et al.
    Nationellt centrum för suicidforskning och prevention av psykisk ohälsa, Karolinska institutet, Sweden.
    Herlofson, Jörgen
    [NO CONNECTION TO ANY AFFILIATION IN XML].
    Einhorn, Stefan
    Karolinska institutet, Centrum för social hållbarhet, Sweden.
    Holm, Herman
    Malmö psykiatri, Sweden.
    Jacobsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap.
    Nyberg, Ullakarin
    Norra Stockholms psykiatri, Svenska psykiatriska föreningen, Sweden.
    Rosengren, Ludmilla
    Rosengrens läkartjänst, Sweden.
    Åsberg, Marie
    Karolinska institutet, Danderyds sjukhus, Sweden.
    Gör »mötet« till obligatoriskt kompetensområde: För att vårdarbetet ska kunna nå sin fulla potential bör mötesdimensionen införas som nytt kompetensområde i all utbildning och vård2016Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, nr 41, artikel-id D9YCArtikel i tidskrift (Övrigt vetenskapligt)
  • 22.
    Anh Huyen, Nguyen
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Provider Payment Methods of healthcare service in Vietnam: a literature review2015Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background

     Achieving access to basic health care for the entire population without risk of catastrophic expenditure and impoverishment is an important goal for Vietnam’s health system. Provider payment methods (PPM), which is an important component of purchasing and health financing, are powerful tools to promote the health system and achieve health policy objectives. However, the current PPM in Vietnam appears have drawbacks in both framework and arrangement. Reforms  of PPM and the health financing system are required.

    Objective

     The objective of this study is to identify the PPM mechanism in the health financing system of Vietnam, in order to provide scientific evidences for the reform process.

    Methods

     A literature review using the search terms “Vietnam “, “provider payment method”, “purchasing” and “health financing” is carried out in different databases:  Pubmed, Google Scholar, Science Direct, World Health Organization (WHO) and Word Bank (WB) library. The reference lists of included studies are also screeedn in the selecting process. Studies are included following criteria 1. Published from 1995 to March of 2015 2. Written in English and 3. Report, analyze PPM evolved in health financing system. Not only articles and papers, reports and books are also included to be reviewed.

    Results

      Among 78 papers, reports and books primarily, only 10 studies are eligible with 4 studies conducting assessment and 6 studies being reviews. About the structure of PPM, Vietnam operates a mixed system which consists of global budget, line item, fee-for-services (FFS)  and capitation.  FFS play the biggest role in the system but also receive the most critical assessments. Capitation, which has evolved since 2005, is far from the success found in other coountries. There are 2 purchaser contributed in system, Vietnam social security (VSS) and Ministry of health (MOH).  The suggestion for developing the mix of system of capitation and fee for services or transforming FFS to the capitation and case-based payment system are discussed.

    Conclusion

      There is a limited number of PPM in Vietnam and it is necessary to implement more empirical studies such as pilot study for different new scenarios of mixing PPM  as well as evaluation studies to find the best reform process in the future. 

  • 23.
    Antoniou, Stavros A.
    et al.
    Surgical Department, Mediterranean Hospital of Cyprus, Limassol, Cyprus; Medical School, European University Cyprus, Nicosia, Cyprus.
    Mavridis, Dimitris
    Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece; Faculté de Médecine, Université Paris Descartes, Paris, France.
    Kontouli, Katerina Maria
    Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.
    Drakopoulos, Vasileios
    1st Department of Surgery & Organ Transplant Unit, Evangelismos General Hospital of Athens, Athens, Greece.
    Gorter-Stam, Marguerite
    Department of Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands.
    Eriksson, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Leone, Marc
    Department of Anesthesiology and Critical Care Medicine, Nord Hospital, Marseille, France.
    Pérez-Bocanegra, Maria Carmen
    Geriatrics Department, Hospital Universitari Vall D’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
    Smart, Neil J.
    Department of Surgery, Department of Surgery, Royal Devon & Exeter Hospital, Exeter, United Kingdom.
    Milone, Marco
    Department of Clinical Medicine and Surgery, University “Federico II” of Naples, Naples, Italy.
    Carrano, Francesco Maria
    PhD Program in Applied Medical-Surgical Sciences, University of Rome “Tor Vergata”, Rome, Italy; Department of Surgical Sciences, University of Rome “Tor Vergata”, Rome, Italy.
    Antoniou, George A.
    Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Northern Care Alliance NHS Group, Manchester, United Kingdom; Division of Cardiovascular Sciences, School of Medical Sciences, The University of Manchester, Manchester, United Kingdom.
    Vandvik, Per Olav
    Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
    EAES rapid guideline: appendicitis in the elderly2021Ingår i: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 35, nr 7, s. 3233-3243Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There is a lack of trustworthy evidence-informed guidelines on the diagnosis and management of acute appendicitis in elderly patients.

    Methods: We developed a rapid guideline in accordance with GRADE and AGREE II standards. The steering group consisted of general surgeons, members of the EAES Research Committee/Guidelines Subcommittee with expertise and experience in guideline development, advanced medical statistics and evidence synthesis, biostatisticians, and a guideline methodologist. The guideline panel consisted of three general surgeons, an intensive care physician, a geriatrician and a patient advocate. We conducted systematic reviews and the results of evidence synthesis were summarized in evidence tables. Recommendations were authored and published through an online authoring and publication platform (MAGICapp), with the guideline panel making use of an evidence-to-decision framework and a Delphi process to arrive at consensus.

    Results: This rapid guideline provides a weak recommendation against the use of clinical scoring systems to replace cross-sectional imaging in the diagnostic approach of suspected appendicitis in elderly patients. It provides a weak recommendation against the use of antibiotics alone over surgical treatment in patients who are deemed fit for surgery, and a weak recommendation for laparoscopic over open surgery. Furthermore, it provides a summary of surgery-associated risks in elderly patients. The guidelines, with recommendations, evidence summaries and decision aids in user-friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/4494.

    Conclusions: This rapid guideline provides evidence-informed trustworthy recommendations on the diagnosis and management of acute appendicitis in elderly patients.

  • 24.
    Anyango, Cartrine
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Nkulu Kalengayi, Faustine
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Goicolea, Isabel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Linander, Ida
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    "A One-size-fit-all model is not good"?: Ambivalent perceptions and experiences of African immigrant parents towards Swedsih sexual and reproductive health services for young people2020Ingår i: BMC Research Notes, E-ISSN 1756-0500, Vol. 13, artikel-id 449Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Parents have a key role regarding young people’s access to sexual and reproductive health services, thus their perceptions go a long way towards promoting or discouraging young people from using such services. Research has revealed that immigrant young people in Sweden access these essential services to a lesser extent than their native peers, and that they perceive their parents as unsupportive of such visits. This pilot study’s objective was to explore immigrant parents’ perceptions and experiences of the sexual and reproductive health services provided by Swedish youth clinics.

    Results: Two categories were developed from the data analysis: (i) Youth clinics are well-known (to some) and appreciated (to a certain extent), and (ii) Parents feel left out from youth clinics and that the clinics have taken over parental responsibility. This study presents an ambivalent scenario connected to immigrant parents’ experiences and perceptions of having neither a space nor a voice within the existing youth clinic model. Parents expressed the desire for the youth clinics to recognise their cultural backgrounds, norms, and beliefs while providing sexual and reproductive health services to their children.

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  • 25. Appelros, Peter
    et al.
    Stegmayr, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Terént, Andreas
    Riks-Stroke och hur fallgropar vid tolkning av resultaten undviks2008Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, nr 8, s. 529-533Artikel i tidskrift (Övrigt vetenskapligt)
  • 26. Arne, Mats
    et al.
    Emtner, Margareta
    Lisspers, Karin
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Stallberg, Bjorn
    Availability of pulmonary rehabilitation in primary care for patients with COPD: a cross-sectional study in Sweden2016Ingår i: EUROPEAN CLINICAL RESPIRATORY JOURNAL, ISSN 2001-8525, Vol. 3, artikel-id 31601Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Pulmonary rehabilitation (PR) is an important, evidence-based component for the management of individuals with chronic obstructive pulmonary disease (COPD). In daily practice, the majority of COPD patients are treated in primary care. However, information about the availability of PR in primary care in Sweden is lacking. The aim was to investigate the availability of rehabilitation resources in primary care settings for patients with COPD in Sweden. Methods: A cross-sectional descriptive design was applied, using web-based questionnaires sent to all primary care centres in four regions, comprising more than half of the 9.6 million inhabitants of Sweden. The main questionnaire included questions about the content and availability of rehabilitation resources for COPD patients. PR was defined as exercise training and one or more of the following activities: education, nutritional intervention, energy conservation techniques or psychosocial support. Results: A total of 381 (55.9%) of the 682 primary care centres answered the main questionnaire. In addition to physicians and nurses, availability of healthcare professionals for rehabilitation in primary care settings was physiotherapists 92.0%, occupational therapists 91.9%, dieticians 83.9% and social workers or psychologists 98.4%. At 23.7% of all centres, PRwas not available toCOPD patients - neither in primary care nor at hospitals. Conclusion: Despite high availability of professionals for rehabilitation in primary care settings, about one-quarter of managers at primary care centres stated that their COPD patients had no access to PR. This indicates a need to structure resources for rehabilitation and to present and communicate the available resources within the healthcare system.

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  • 27.
    Asplund, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Vi kan ha något att lära av komplementär och alternativ vård: ger insikter om vårdmiljön, kontinuitet, patientmötet och ospecifika effekter2019Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, artikel-id FTEZArtikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Den komplementära och alternativa vården satsar ofta på att den fysiska miljön ska vara samstämmig med vårdens innehåll, något som är mindre vanligt i hälso- och sjukvården. Bristande kontinuitet har negativa konsekvenser för vårdens resultat. Kontinuiteten mellan vårdpersonal och vårdsökande är klart bättre i komplementär och alternativ vård än i hälso- och sjukvården. Generös tid i mötet mellan vårdsökande och behandlare bidrar till den komplementära och alternativa vårdens attraktionskraft. Inom komplementär och alternativ vård utnyttjas ospecifika effekter, t ex förväntanseffekter, mer konsekvent för att nå gynnsamma behandlingsresultat. 

  • 28.
    Asplund, Kjell
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Bertholds, Eric
    Skaraborgs sjukhus, Sverige.
    Etiska dilemman i strokevården: [Frequent ethical issues encountered in stroke care]2023Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 120, artikel-id 23040Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    We review some of the most frequent ethical issues encountered in stroke care. Priorities in stroke care should be based on the principles of the Swedish prioritization platform: human dignity, needs/solidarity, and cost-effectiveness. The prognosis is often uncertain very early after stroke. We therefore advocate time for careful assessment before taking decisions on treatment restrictions such as do-not-resuscitate orders. Swedish law permits acute treatment for patients unable to consent because of severe stroke. For selected patients already living in home-based medical care or institutional care when afflicted by stroke, it may be appropriate not to transfer them to an acute care hospital, provided that sufficient skills in acute evaluation and stroke care are available. Likewise, if a stroke patient is discharged from hospital with a percutaneous endoscopic gastrostomy, adequate competence is needed in home-based or institutional care. It is not ethically appropriate to continue advanced medical treatment that is without benefit for the patient during the last days of life.

  • 29.
    Asplund, Kjell
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Hermerén, Göran
    The need to revise the Helsinki Declaration2017Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 389, nr 10075, s. 1190-1191Artikel i tidskrift (Refereegranskat)
  • 30.
    Aweesha, Huzeifa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. World Health Organization Sudan Country Office, Sudan.
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Pulkki-Brännström, Anni-Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sudan's health sector partnership: from confined progression to openness and hope to uncertain demise2023Ingår i: Development Policy Review, ISSN 0950-6764, E-ISSN 1467-7679, artikel-id e12757Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Motivation: Despite signature of the 2005 Paris Declaration on Aid Effectiveness and subsequent adoption of the effective development cooperation (EDC) principles for better health cooperation, there is a gap in documenting the challenges to implement these commitments at country level. Sudan represents an interesting case study: the country adopted a local health compact in 2014, but for much of the time since the regime was under sanction. Sudan witnessed a revolution in 2018, followed by a counter-coup in 2021.

    Purpose: We aim to explore the evolution of Sudan health sector partners’ relationships, perspectives, and adherence to EDC principles of ownership, alignment, and harmonization, while accounting for underlying processes and context changes between 2015 and 2022.

    Methods and approach: We collected data through two rounds of interviews, in 2015 (16) and 2022 (8), with stakeholders within the Sudan Health Sector Partnership. We used the framework method for data analysis where responses are coded then sorted into themes.

    Findings: Prior to the 2019 revolution cooperation was progressive but restricted, with civil society marginalized and a dominating government. The principles, especially ownership, were misused and misaligned with national priorities driven by donors’ interests and conditions.

    The transitional (post-revolution) period witnessed partners’ openness and influx, but unstable leadership and subsequent changes in priorities led to wasted opportunities.

    Following the coup, donors adopted a no-contact policy towards the de facto government. Instead, the expectation was that civil society organizations would replace the government as the main implementers. Overall, limited coordination capacity and no sustainability measures were present throughout.

    Policy implications: Much of what was observed was down to the often complicated and difficult context of the governance of Sudan. That said, general issues arose including the government's ability to coordinate policy and implementation; the need for stable, legitimate arrangements; and the need to define the role of civil society and to empower civil society organizations. Within a complex and volatile context, revisiting partners’ commitments through joint compact reviews and transparent EDC progress monitoring is crucial.

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  • 31. Axen, Iben
    et al.
    Bergström, Cecilia
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bronson, Marc
    Cote, Pierre
    Nim, Casper Glissmann
    Goncalves, Guillaume
    Hebert, Jeffrey J.
    Hertel, Joakim Axel
    Innes, Stanley
    Larsen, Ole Kristoffer
    Meyer, Anne-Laure
    O'Neill, Soren
    Perle, Stephen M.
    Weber, Kenneth A., II
    Young, Kenneth J.
    Leboeuf-Yde, Charlotte
    Misinformation, chiropractic, and the COVID-19 pandemic2020Ingår i: Chiropractic and Manual Therapies, E-ISSN 2045-709X, Vol. 28, nr 1, artikel-id 65Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: In March 2020, the World Health Organization elevated the coronavirus disease (COVID-19) epidemic to a pandemic and called for urgent and aggressive action worldwide. Public health experts have communicated clear and emphatic strategies to prevent the spread of COVID-19. Hygiene rules and social distancing practices have been implemented by entire populations, including 'stay-at-home' orders in many countries. The long-term health and economic consequences of the COVID-19 pandemic are not yet known.

    Main text: During this time of crisis, some chiropractors made claims on social media that chiropractic treatment can prevent or impact COVID-19. The rationale for these claims is that spinal manipulation can impact the nervous system and thus improve immunity. These beliefs often stem from nineteenth-century chiropractic concepts. We are aware of no clinically relevant scientific evidence to support such statements. We explored the internet and social media to collect examples of misinformation from Europe, North America, Australia and New Zealand regarding the impact of chiropractic treatment on immune function. We discuss the potential harm resulting from these claims and explore the role of chiropractors, teaching institutions, accrediting agencies, and legislative bodies.

    Conclusions: Members of the chiropractic profession share a collective responsibility to act in the best interests of patients and public health. We hope that all chiropractic stakeholders will view the COVID-19 pandemic as a call to action to eliminate the unethical and potentially dangerous claims made by chiropractors who practise outside the boundaries of scientific evidence.

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  • 32. Backhans, Mona Christina
    et al.
    Burström, Bo
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Månsdotter, Anna
    Pioneers and laggards: Is the effect of gender equality on health dependent on context?2009Ingår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 68, s. 1388-1395Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study combines data at individual and area level to examine interactions between equality within couples and gender equality in the municipality in which individuals live. The research question is whether the context impacts on the association between gender equality and health. The material consists of data on 37,423 men and 37,616 women in 279 Swedish municipalities, who had their first child in 1978. The couples were classified according to indicators of their level of gender equality in 1980 in the public sphere (occupation and income) and private sphere (child care leave and parental leave) compared to that of their municipality. The health outcome is compensated days from sickness insurance during 1986-1999 with a cut-off at the 85% percentile. Data were analysed using logistic regression with the overall odds as reference. The results concerning gender equality in the private sphere show that among fathers, those who are equal in an equal municipality have lower levels of sick leave than the average while laggards (less equal than their municipality) and modest laggards have higher levels. In the public sphere, pioneers (more equal t han their municipality) fare better than the average while laggards fare worse. For mothers, those who are traditional in their roles in the public sphere are protected from high levels of sick leave, while the reverse is true for those who are equal. Traditional mothers in a traditional municipality have the lowest level of sick leave and pioneers the highest. These results show that there are distinct benefits as well as disadvantages to being a gender pioneer and/or a laggard in comparison to your municipality. The associations are markedly different for men and women.

  • 33.
    Backman, Annica
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandman, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. NVS, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.
    Sköldunger, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. NVS, Division of Neurogeriatrics, Department of Nursing, Karolinska Institutet, Huddinge, Sweden.
    Characteristics of nursing home units with high versus low levels of person-centred care in relation to leadership, staff- resident- and facility factors: findings from SWENIS, a cross-sectional study in Sweden2021Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 21, nr 1, artikel-id 498Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The context of care consists of factors that determines the extent to which staff can offer person-centred care. However, few studies have investigated factors that can explain variation in levels of person-centred care among nursing home units. The aim of this study was to explore factors characterizing nursing home units with high and low degree of person-centred care, with focus on leadership, staff, resident and facility factors.

    Methods: Cross-sectional data from residents, staff, and managers in 172 randomly selected nursing homes in Sweden were collected in 2014. Activities of Daily Living Index, Gottfries' cognitive scale, Person-centred Care Assessment Tool together with demographic information and estimations of leadership engagement was used. Independent samples t-test and Chi2 test were conducted.

    Results: Highly person-centred units were characterised by leaders engaging in staff knowledge, professional development, team support and care quality. In highly person-centred units' staff also received supervision of a nurse to a larger extent. Highly person-centred units were also characterised as dementia specific units, units with fewer beds and with a larger proportion of enrolled nurses. No differences in degree of person-centred care were seen between public or private providers.

    Conclusions: This study provides guidance for practitioners when designing, developing and adapting person-centred units in aged care contexts. Managers and leaders have an important role to promote the movement towards a person-centred practice of care, by supporting their staff in daily care, and engaging in staff knowledge and professional development. Targeting and adjusting environmental factors, such as provide small and dementia adapted environments to match the residents' personal preferences and capacity are also important when striving towards person-centredness.

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  • 34.
    Backman, Annica
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sjögren, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindkvist, Marie
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lövheim, Hugo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Edvardsson, David
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. School of Nursing and Midwifer y, La Trobe University, Melbourne, VIC, Australia.
    Towards person-centredness in aged-care: exploring the impact of leadership2016Ingår i: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 24, nr 6, s. 766-774Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To explore the association between leadership behaviours among managers in aged care, and person‐centredness of care and the psychosocial climate.

    Background: Theory suggests that leadership is important for improving person‐centredness in aged care, however, empirical evidence is lacking.

    Methods: A cross‐sectional design was used to collect data from Swedish aged care staff (= 3661). Valid and reliable questionnaires assessing leadership behaviours, person‐centeredness of care and the psychosocial climate were used. Data were analysed using multiple linear regression including interaction terms.

    Results: Leadership behaviours were significantly related to the person‐centredness of care and the psychosocial climate. The level of person‐centredness of care moderated the impact of leadership on the psychosocial climate.

    Conclusions and implications for nursing management: The leadership behaviour of managers significantly impacts person‐centred care practice and contributes to the psychosocial climate for both staff and residents in aged care. This study is the first empirically to confirm that middle managers have a central leadership role in developing and supporting person‐centred care practice, thereby creating a positive psychosocial climate and high quality care.

  • 35.
    Backman Lönn, Beatrice
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Research & Development, Region Västernorrland, Sundsvall Hospital, Sundsvall, Sweden.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Styrke, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Hajdarevic, Senada
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Transitioning to the clinical research nurse role: a qualitative descriptive study2022Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 78, nr 11, s. 3817-3829Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Studies have reported on the important role of the clinical research nurse in clinical studies. Yet, there is no international consensus about the role's competencies and tasks. Furthermore, the literature offers a little description of the career pathway from a ward-based registered nurse to a clinical research nurse. More knowledge about this specific role could benefit the nursing profession as well as increase the quality of clinical research.

    Aim: The aim of the study was to explore Swedish registered nurses' experiences transitioning into the clinical research nurse role.

    Design: The study had a qualitative design. Data were collected via semi-structured interviews. Inductive qualitative content analysis was employed.

    Methods: Ten participants (i.e., clinical research nurses) were interviewed in the spring of 2017. A semi-structured interview guide was used to address the transition into the clinical research nurse role, experience working in a new role, experience of ethical dilemmas and experience of organizational and professional issues related to the role. The interviews were analysed inductively using qualitative content analysis.

    Results: The registered nurses described experiencing reality shock when they became clinical research nurses; that is, it was a challenging and transforming experience. The main theme, a challenging transition, was developed from the four subthemes highlighting that it defied their previous nursing role. They experienced an unclear professional identity, extended professional mandate, increased professional status and growing ethical consciousness in their new role.

    Conclusion: The results highlight that registered nurses who became clinical research nurses had needs that were both distinct from and overlapped with those of their former professional role as registered nurses. To avoid reality shocks, the development of clear competence pathways for nurses to become clinical research nurses, including introduction, mentorship and continued support, is necessary. Making their professional title more homogeneous, nationally and internationally, would facilitate role identification and comparisons in research.

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  • 36. Baldeh, Tejan
    et al.
    Saz-Parkinson, Zuleika
    Muti, Paola
    Santesso, Nancy
    Morgano, Gian Paolo
    Wiercioch, Wojtek
    Nieuwlaat, Robby
    Gräwingholt, Axel
    Broeders, Mireille
    Duffy, Stephen
    Hofvind, Solveig
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy.
    Ioannidou-Mouzaka, Lydia
    Warman, Sue
    McGarrigle, Helen
    Knox, Susan
    Fitzpatrick, Patricia
    Rossi, Paolo Giorgi
    Quinn, Cecily
    Borisch, Bettina
    Lebeau, Annette
    de Wolf, Chris
    Langendam, Miranda
    Piggott, Thomas
    Giordano, Livia
    Van Landsveld-Verhoeven, Cary
    Bernier, Jacques
    Rabe, Peter
    Schunemann, Holger J.
    Development and use of health outcome descriptors: a guideline development case study2020Ingår i: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 18, nr 1, artikel-id 167Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: During healthcare guideline development, panel members often have implicit, different definitions of health outcomes that can lead to misunderstandings about how important these outcomes are and how to balance benefits and harms. McMaster GRADE Centre researchers developed ‘health outcome descriptors’ for standardizing descriptions of health outcomes and overcoming these problems to support the European Commission Initiative on Breast Cancer (ECIBC) Guideline Development Group (GDG). We aimed to determine which aspects of the development, content, and use of health outcome descriptors were valuable to guideline developers.

    Methods: We developed 24 health outcome descriptors related to breast cancer screening and diagnosis for the European Commission Breast Guideline Development Group (GDG). Eighteen GDG members provided feedback in written format or in interviews. We then evaluated the process and conducted two health utility rating surveys.

    Results: Feedback from GDG members revealed that health outcome descriptors are probably useful for developing recommendations and improving transparency of guideline methods. Time commitment, methodology training, and need for multidisciplinary expertise throughout development were considered important determinants of the process. Comparison of the two health utility surveys showed a decrease in standard deviation in the second survey across 21 (88%) of the outcomes.

    Conclusions: Health outcome descriptors are feasible and should be developed prior to the outcome prioritization step in the guideline development process. Guideline developers should involve a subgroup of multidisciplinary experts in all stages of development and ensure all guideline panel members are trained in guideline methodology that includes understanding the importance of defining and understanding the outcomes of interest.

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  • 37.
    Bangdiwala, Shrikant I.
    et al.
    Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States; University of South Africa, Johannesburg, South Africa.
    Fonn, Sharon
    School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
    Okoye, Osegbeaghe
    2B Degema Close, Rumuibekwe Housing Estate, Port Harcourt, Nigeria.
    Tollman, Stephen M.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
    Workforce resources for health in developing countries2010Ingår i: Public Health Reviews, ISSN 0301-0422, E-ISSN 2107-6952, Vol. 32, nr 1, s. 296-318Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    With increased globalization and interdependence among countries, sustained health worker migration and the complex threats of rapidly spreading infectious diseases, as well as changing lifestyles, a strong health workforce is essential. Building the human resources for health should not only include healthcare professionals like physicians and nurses, but must take into consideration community health workers, mid-level workers and strengthened primary healthcare systems to increase coverage and address the basic health needs of societies. This is especially true in low and middle-income countries where healthcare access is a critical challenge. There is a global crisis in the health workforce, expressed in acute shortages and maldistribution of health workers, geographically and professionally. This massive global shortage, though imprecise quantitatively, is estimated at more than 4 million workers. To respond to this crisis, policies and actions are needed to address the dynamics of the health labour market and the production and management of the health workforce, and to strengthen the performance of existing health systems. Schools of public health need to develop the range of capacity and leadership in addition to the traditional training of healthcare managers and researchers. Countries should first identify their health problems in order to properly address their health worker needs, retention, recruitment and training, if they are to come close to reaching the Millennium Development Goals (MDGs) for health.

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  • 38.
    Baroudi, Mazen
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Goicolea, Isabel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Social factors associated with trust in the health system in northern Sweden: a cross-sectional study2022Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 22, nr 1, artikel-id 881Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Despite the importance of having trust in the health system, there is a paucity of research in this feldin Sweden. The aim of this study was to estimate the level of trust in the health system and to assess the factors asso‑ciated with it in northern Sweden.

    Methods: A cross-sectional survey was conducted in 2014 in the four northern regions of Sweden. A total of 24 795 participants (48% response rate) aged 18 to 84 years were involved in the study. A log-binomial regression was usedto measure the association between sociodemographic factors and trust in the health system.

    Results: Two thirds of the participants (68.5%) reported high trust in the health system i.e. had very much or quitea lot confdence in the health system. Women had lower prevalence of trust compared to men (PR=0.96; 95%CI=0.94–0.98) while older participants had a higher trust compared to youth (PR=1.11; 95% CI=1.06–1.16). Participants with lower level of education, those who experienced economic stress, those who were born outside Swedenand those living in small municipalities also had lower prevalence of trust in the health system. Conversely, lowerincome was associated with higher trust (PR=1.08; 95% CI=1.04–1.12). Finally, a strong relationship between highersocial capital (having emotional and instrumental support, horizontal trust, and higher social participation) and trustin the health system was also found.

    Conclusions: Trust in the health system was moderately high in northern Sweden and strongly associated withsociodemographic and social capital factors. Trust is a complex phenomenon and a deeper exploration of the relationbetween trust in the health system and sociodemographic factors is needed.

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  • 39.
    Baroudi, Mazen
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Waenerlund, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    San Sebastián, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Goicolea, Isabel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Assessing the dimensionality of YFHS-Swe: a questionnaire to assess youth-friendliness in differentiated health services2017Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, nr 1, artikel-id 1380399Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to assess the dimensionality of YFHS-Swe and identify possible unique factors in the evaluation of youth-friendliness. YFHS-Swe was answered by 1110 youths aged 16 to 25 years visiting youth clinics in Northern Sweden. Thirteen factors were identified by exploratory factor analysis and except for one factor they all proved to fit well and have good reliability when assessed by the confirmatory factor analysis. The YFHS-Swe proved to be credible and suitable for assessing youth-friendliness of differentiated health services in Sweden. With cultural and linguistic adaptations, it can be used in similar settings internationally.

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  • 40.
    Bejerholm, Ulrika
    et al.
    Lunds universitet, Institutionen för hälsovetenskaper.
    Bergmark, Magnus
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Svensson, Bengt
    Lunds universitet, Institutionen för hälsovetenskaper.
    From national incentives of implementing Individual Placement and Support to the impact on the service users' quality of life, and view on support2015Ingår i: ENMESH 2015 : Eleventh International Conference of the European Network For Mental Health Service Research; Closing the gap between research and policy in mental health: Book of Abstracts, ENMESH , 2015, s. 153-154, artikel-id OP/182Konferensbidrag (Refereegranskat)
    Abstract [en]

    Introduction: It is a challenge to translate evidence-based-research into practice in a way that meets the needs of the service users. The effectiveness of the IPS vocational rehabilitation approach in terms of gaining competitive employment is well known. During the last three years, IPS has been widely implemented in Community Mental Health Service in Sweden, with financial support from the government. Within this context, we aimed to investigate the benefits of IPS as experienced by some of the serviceusers in addition to them increasing their job opportunities.

    Methods: Based on a one group pre-test and post-test design (one year), we administered instruments targeting activity and community integration (POES-S) and quality of life (MANSA) among 117 service users from four sites. We also addressed their satisfactionwith the IPS service (MY VIEW) and therapeutic relationship with the IPS-employment specialist (STAR) after one year. Descriptive and comparative statistics were applied.

    Results: Significant differences and increase of scores were found between measurement points with regard to both activity and community integration and quality of life. Satisfaction with service and therapeutic relationships were scored well above the midpoint of the scales after one year.

    Conclusions: The results indicate that national incentives to implement IPSbenefits the way of life of the users and is a valued service.

  • 41.
    Bendtsen Kronkvist, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Forsberg, Karl Anton
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Rämgård, Margareta
    Department of Care Science, Malmö University, Malmö, Sweden.
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Janarv, Tove
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Dahlqvist Jönsson, Patrik
    Region Halland, Halmstad, Sweden.
    User participation in decision-making: a qualitative intervention study on mental health professionals’ experiences2022Ingår i: Journal of Public Mental Health, ISSN 1746-5729, E-ISSN 2042-8731, Vol. 21, nr 3, s. 250-261Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The purpose of this study was to describe mental health professionals’ experiences of changes in attitudes towards, and knowledge about, users of mental health-care recovery and decisional participation in clinical practice after an educational intervention.

    Design/methodology/approach: Users of mental health care want to participate in decisions regarding their own mental health care. Shared decision-making as a method is coherent with recovery orientation in mental health services and results in better-informed patients and fewer conflicts regarding decisions. A qualitative intervention study was designed to evaluate changes in attitudes and knowledge about mental health recovery in Sweden. Nine participants were interviewed, and the data were analysed by content analysis.

    Findings: Three categories were generated from the analysis: Increased theoretical knowledge, changing attitudes about practical approaches and the significance of social factors in recovery.

    Originality/value: When shared decision-making is to be implemented in mental health, professionals need to gain knowledge about recovery and need to adopt changed roles as health professionals. Educational interventions therefore seem necessary if such changes are to happen.

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  • 42.
    Bengtsson, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Tjärdalen, Cecilia
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ambulanssjuksköterskors erfarenheter av att säkerställa ofri luftväg i gles landsbygd: En kvalitativ intervjustudie2022Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Bakgrund: Ambulanssjuksköterskorna kan möta stora variationer av luftvägsproblem som kan försvåras i gles landsbygd på grund av långa transporter. Detta ställer höga krav på ambulanssjuksköterskan.

    Syfte: Att beskriva ambulanssjuksköterskors erfarenheter av att säkerställa fri luftväg i gles landsbygd.

    Metod: Studien är en kvalitativ intervjustudie baserad på semistrukturerade intervjuer. Sju ambulanssjuksköterskor intervjuades och data analyserades inspirerades av kvalitativ innehållsanalys.

    Resultat: Analysen resulterade i två huvudkategorier, första kategorien Att uppleva påfrestningar vid larm om ofri luftväg denna resulterade i två underkategorier Att uppleva stress och förbereda sig mentalt vid larm om ofri luftväg. Och Att uppleva hur långa avstånd och otillräcklig bemanning försvårar arbetet. Andra kategorin var Att uppleva bristande organisatoriskt stöd denna kategori resulterade i sex underkategorier Att uppleva bristande tillgång på läkarstöd, Att uppleva det som viktigt med stöd från räddningstjänsten utifrån IVPA, Att uppleva bristande möjlighet på att öva, att uppleva arbetsrutiner och riktlinjer som otydliga, Att uppleva stödet från ambulanshelikopter som otillräcklig, Att uppleva hur otillräcklig utbildning försvårar arbetet.

    Slutsats: Resultatet och resultat från tidigare forskning pekar mot att det är viktigt att organisera vården på ett sådant sätt så att ambulanssjuksköterskorna får tillräckligt med utbildning och möjligheter att öva för att säkerhetsställa en ofri luftväg. För att lösa det problem som ambulanssjuksköterskorna kan ställas inför önskar ambulanssjuksköterskorna att få tillgång till extra resurser för att ge patienterna optimala förutsättningar.

  • 43. Bennett, Sara
    et al.
    Mahmood, Shehrin Shaila
    Edward, Anbrasi
    Tetui, Moses
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
    Ekirapa-Kiracho, Elizabeth
    Strengthening scaling up through learning from implementation: comparing experiences from Afghanistan, Bangladesh and Uganda2017Ingår i: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 15, artikel-id 108Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Many effective innovations and interventions are never effectively scaled up. Implementation research (IR) has the promise of supporting scale-up through enabling rapid learning about the intervention and its fit with the context in which it is implemented. We integrate conceptual frameworks addressing different dimensions of scaling up (specifically, the attributes of the service or innovation being scaled, the actors involved, the context, and the scale-up strategy) and questions commonly addressed by IR (concerning acceptability, appropriateness, adoption, feasibility, fidelity to original design, implementation costs, coverage and sustainability) to explore how IR can support scale-up.

    Methods: We draw upon three IR studies conducted by Future Health Systems (FHS) in Afghanistan, Bangladesh and Uganda. We reviewed project documents from the period 2011-2016 to identify information related, to the dimensions of scaling up. Further, for each country, we developed rich descriptions of how the research teams approached scaling up, and how IR contributed to scale-up. The rich descriptions were checked by FHS research teams. We identified common patterns and. differences across the three cases.

    Results: The three cases planned quite different innovations/interventions and had very different types of scale-up strategies. In all three cases, the research teams had extensive prior experience within the study communities, and. little explicit attention was paid, to contextual factors. All three cases involved complex interactions between the research teams and other stakeholders, among stakeholders, and between stakeholders and the intervention. The IR planned by the research teams focussed primarily on feasibility and effectiveness, but in practice, the research teams also had critical insights into other factors such as sustainability, acceptability, cost-effectiveness and appropriateness. Stakeholder analyses and other project management tools further complemented IR.

    Conclusions: IR can provide significant insights into how best to scale-up a particular intervention. To take advantage of insights from IR, scale-up strategies require flexibility and IR must also be sufficiently flexible to respond to new emerging questions. While commonly used conceptual frameworks for scale-up clearly delineate actors, such as implementers, target communities and the support team, in our experience, IR blurred the links between these groups.

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  • 44.
    Bergman, Mats A.
    et al.
    Södertörns Högskola.
    Johansson, Per
    Uppsala University.
    Lundberg, Sofia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Spagnolo, Giancarlo
    Stockholm School of Economics.
    Privatization and quality: evidence from elderly care in Sweden2016Ingår i: Journal of Health Economics, ISSN 0167-6296, E-ISSN 1879-1646, Vol. 49, s. 109-119Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Non-contractible quality dimensions are at risk of degradation when the provision of public services is privatized. However, privatization may increase quality by fostering performance-improving innovation, particularly if combined with increased competition. We assemble a large data set on elderly care services in Sweden between 1990 and 2009 and estimate how opening to private provision affected mortality rates – an important and not easily contractible quality dimension – using a difference-in-difference-in-difference approach. The results indicate that privatization and the associated increase in competition significantly improved non-contractible quality as measured by mortality rates. 

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  • 45. Bergman, Mats
    et al.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Rudholm, Niklas
    Reforming the Swedish pharmaceuticals market: consequences for costs per defined daily dose2016Ingår i: International Journal of Health Economics and Management, ISSN 2199-9023, E-ISSN 2199-9031, Vol. 16, nr 3, s. 201-214Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In 2009 and 2010, the Swedish pharmaceuticals market was reformed. One of the stated policy goals was to achieve low costs for pharmaceutical products dispensed in Sweden. We use price and sales data for off-patent brand-name and generic pharmaceuticals to estimate a log-linear regression model, allowing us to assess how the policy changes affected the cost per defined daily dose. The estimated effect is an 18 % cost reduction per defined daily dose at the retail level and a 34 % reduction in the prices at the wholesale level (pharmacies’ purchase prices). The empirical results suggest that the cost reductions were caused by the introduction of a price cap, an obligation to dispense the lowest-cost generic substitute available in the whole Swedish market, and the introduction of well-defined exchange groups. The reforms thus reduced the cost per defined daily dose for consumers while being advantageous also for the pharmacies, who saw their retail margins increase. However, pharmaceutical firms supplying off-patent pharmaceuticals experienced a clear reduction in the price received for their products.

  • 46.
    Bergmark, Magnus
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Bejerholm, Ulrika
    Lunds universitet, Institutionen för hälsovetenskaper..
    Markström, Urban
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Policy Changes in Community Mental Health: Interventions and Strategies Used in Sweden over 20 Years2017Ingår i: Social Policy & Administration, ISSN 0144-5596, E-ISSN 1467-9515, Vol. 51, nr 1, s. 95-113Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The deinstitutionalization of mental health care has changed the responsibilities of involved authoritiesand has led to a continuous need for new treatment forms and interventions. This articledescribes this development in Europe, and in particular how these new conditions have been handledin Sweden over the past 20 years at the level of governmental policy-making. Three major policydocuments from 1994, 2009 and 2012 were included in this study. To increase our understandingof the policies’ contents, we have used theoretical concepts concerning governance,implementation and political risk management. Although our main interest was to find out howthe government handles interventions for users of the mental health care system, we found that thepolicy work is progressing stepwise. The first document, from the deinstitutionalization era, did notdiscuss interventions clearly. Instead, it was mainly concerned with both practical and economicalareas of responsibility. The second document, from the post-deinstitutionalization era, was morefocused on what services should be delivered to the users, while the most recently published documentto a greater extent addressed the question of how the support is supposed to be designed. The trendin European community mental health policy has been to advocate services in open forms that areintegrated into the society’s other care systems. This is also the case in Sweden, and continuous workis being done by the government to find strategies to support the development, and to meet the needs atboth political and local levels.

  • 47. Björk, Anna Bell
    et al.
    Hillborg, Helene
    Augutis, Marika
    Umefjord, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Evolving techniques in text-based medical consultation: Physicians' long-term experiences at an Ask the doctor service2017Ingår i: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 105, s. 83-88Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Both the demands and the options for patients to communicate with health care providers utilizing eHealth solutions are increasing. Some patients, or relatives to patients, want to consult another health care provider than the regular one, merely in text.

    Objective: To improve text-based medical consultation by learning from long-term experiences.

    Materials and methods: Physicians with comprehensive experience of answering free-text medical inquiries at an official health portal in Sweden were interviewed. The interviews were analyzed using a grounded theory approach.

    Results: Over time, the interviewed physicians developed strategies on how to formulate the answer to a medical inquiry from a previously unknown inquirer. The answering physicians experienced their primary role as providers of medical information and as mediators between an inquirer and the regular health care provider. Many of the answering physicians experienced a personal development with improved communication skills, also in face-to-face meetings with patients.

    Conclusion: Text-based medical consultation is part of an expanding area in eHealth. The development of strategies, guidelines, ethical considerations as well as educational efforts are needed to optimize the skills of asynchronous text-based health consultation.

  • 48.
    Björkman, Anders
    et al.
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Gisslén, Magnus
    Department of Infectious Diseases, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden; Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Gullberg, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för molekylärbiologi (Medicinska fakulteten).
    Ludvigsson, Johnny
    Division of Pediatrics, Department of Biomedical and Clinical Sciences, Crown Princess Victoria Children's Hospital, Linköping University, Linköping, Sweden.
    The Swedish COVID-19 approach: a scientific dialogue on mitigation policies2023Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, artikel-id 1206732Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    During the COVID-19 pandemic, Sweden was among the few countries that did not enforce strict lockdown measures but instead relied more on voluntary and sustainable mitigation recommendations. While supported by the majority of Swedes, this approach faced rapid and continuous criticism. Unfortunately, the respectful debate centered around scientific evidence often gave way to mudslinging. However, the available data on excess all-cause mortality rates indicate that Sweden experienced fewer deaths per population unit during the pandemic (2020–2022) than most high-income countries and was comparable to neighboring Nordic countries through the pandemic. An open, objective scientific dialogue is essential for learning and preparing for future outbreaks.

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  • 49.
    Blom, Lisa
    et al.
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Edenius, Anna
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Enebrink, Pia
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Hjern, Anders
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Åhlén, Johan
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Bergström, Malin
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Lindberg, Lene
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Little All Children in Focus (Little ACF), evaluation of a parental support program for parents of children aged 1–2 years: study protocol for a randomized controlled trial2023Ingår i: Trials, E-ISSN 1745-6215, Vol. 24, nr 1, artikel-id 184Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Child health and development can be promoted by strengthening and supporting parents. Research on parental support programs based on positive psychology and a health-promoting approach aimed at all parents, and in particular parents of infants is limited. All Children in Focus (ACF) is a parental support program that has been evaluated in a randomized trial in parents of children 3–12 years. The ACF is based on health promotion aiming to increase parents’ confidence and child’s well-being. In the current study, we will study the effects of a revised version of the ACF called Little ACF adapted to parents with children aged 1–2 years.

    Methods: The study includes a randomized controlled trial (RCT) taking place at several Child Health Centers (CHCs) in Sweden. The RCT will evaluate the efficacy of Little ACF (intervention) in comparison with four digital lectures about child development and parenting (active control). Parents are recruited at the 10-, 12-, or 18-month visits to CHC by CHC-nurses. Data to assess changes in parental competencies and child socio-emotional development are collected through online questionnaires completed by parents at five time points: baseline, post-intervention, after 6 and 12 months, and when the child is 3 years old.

    Discussion: The paper describes a study protocol of a randomized controlled trial evaluating the effects of a parental support program during infancy. Several issues related to the methodology and implementation are discussed.

    Trial registration: ClinicalTrials.gov NCT05445141. Registered on 6 July 2022.

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  • 50.
    Blomström Lundqvist, Carina
    et al.
    Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Själander, Sara
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Garcia Rodriguez, Luis A.
    Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain.
    Åkerborg, Örjan
    Wickenstones Ltd, Carlow, Ireland.
    Jin, Guanyi
    Wickenstones Ltd, Carlow, Ireland.
    Caleyachetty, Amrit
    Wickenstones Ltd, Carlow, Ireland.
    Huelsebeck, Maria
    Bayer AG, Berlin, Germany.
    Bowrin, Kevin
    Bayer Plc, Reading, United Kingdom.
    Schaefer, Bernhard
    Bayer AG, Berlin, Germany.
    Mahdessian, Hovsep
    Bayer AB, Stockholm, Sweden.
    Hofmeister, Lucas
    Bayer AG, Berlin, Germany.
    Levin, Lars-Åke
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Impact of non-adherence to direct oral anticoagulants amongst Swedish patients with non-valvular atrial fibrillation: results from a real-world cost-utility analysis2022Ingår i: Journal of Medical Economics, ISSN 1369-6998, E-ISSN 1941-837X, Vol. 25, nr 1, s. 1085-1091Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: A third of non-valvular atrial fibrillation (NVAF) patients are non-adherent to direct oral anticoagulants (DOACs). Estimates of the economic value of full adherence and the cost of two types of adherence improving interventions are important to healthcare planners and decision-makers.

    Methods: A cost-utility analysis estimated the impact of non-adherence over a 20-year horizon, for a patient cohort with a mean age of 77 years, based on data from the Stockholm Healthcare database of NVAF patients with incident stroke between 2011 and 2018. Adherence was defined using a medication possession ratio (MPR) cut-off of 90%; primary outcomes were the number of ischemic strokes and associated incremental cost–utility ratio.

    Results: Hypothetical comparisons between cohorts of 1,000 patients with varying non-adherence levels and full adherence (MPR >90%) predicted an additional number of strokes ranging from 117 (MPR = 81–90%) to 866 (MPR <60%), and years of life lost ranging from 177 (MPR = 81– 90%) to 1,318 (MPR < 60%; discounted at 3%). Chronic disease co-management intervention occurring during each DOAC prescription renewal and patient education intervention at DOAC initiation will be cost-saving to the health system if its cost is below SEK 143 and SEK 4,655, and cost-effective if below SEK 858 and SEK 28,665, respectively.

    Conclusion: Adherence improving interventions for NVAF patients on DOACs such as chronic disease co-management and patient education can be cost-saving and cost-effective, within a range of costs that appear reasonable to the Swedish healthcare system.

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