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  • 1.
    Abdullahi, Mohamed Farah
    et al.
    Department of Research and Development, Puntland University of Science and Technology , Galkayo City, Somalia..
    Stewart Williams, Jennifer
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle , Callaghan, Australia.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Bile, Khalif
    enior National Advisor Health Systems and Policy and Board Member Somali and Swedish Researchers' Association (SSRA) , Vällingby, Sweden.
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet , Stockholm, Sweden.
    Factors contributing to the uptake of childhood vaccination in Galkayo District, Puntland, Somalia2020Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 13, nr 1, artikel-id 1803543Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: As in many Sub-Saharan African countries, the health system in Somalia is not operating at the capacity needed to lift childhood vaccination coverage to ninety percent or above, as recommended by United Nations Children's Fund. Current national estimates of coverage for the six major vaccine preventable childhood diseases range from thirty to sixty percent. Infectious disease outbreaks continue to pose significant challenges for the country's health authorities.

    OBJECTIVE: This important qualitative study, conducted in Galkayo District, Somalia, investigates limiting factors associated with childhood vaccination uptake from the perspective of both communities and health care workers.

    METHODS: Qualitative information was collected through six focus group discussions with parents (n = 48) and five one-to-one interviews with health workers (n = 15) between March and May 2017, in three settings in the Galkayo District - Galkayo city, Bayra and Bacadwayn.

    RESULTS: From a health system perspective, the factors are: awareness raising, hard to reach areas, negative attitudes and perceived knowledge of health workers, inadequate supplies and infrastructure, and missed vaccination opportunities. From the perspective of individuals and communities the factors are: low trust in vaccines, misinterpretation of religious beliefs, vaccine refusals, Somalia's patriarchal system and rumours and misinformation. Parents mostly received immunization information from social mobilizers and health facilities. Fathers, who are typically family decision-makers, were poorly informed. The findings highlight the need for in-service training to enable health workers to improve communication with parents, particularly fathers, peripheral communities and local religious leaders.

    CONCLUSIONS: Enhancing knowledge and awareness of vaccination among parents is crucial. Fathers' involvement is lacking. This may be boosted by highlighting fathers' obligation to protect their children's health through vaccination. It is also important that men engage with the wider community in decision-making and advance towards the global vaccination targets.

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  • 2.
    Bile, Khalif
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Emmelin, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Freij, Lennart
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Gustafsson, Lars L.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Warsame Yusuf, Marian
    Who published what on Somali health issues?2022Ingår i: Somali Health Action Journal, E-ISSN 2004-1985, Vol. 2, nr 1Artikel i tidskrift (Övrigt vetenskapligt)
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  • 3.
    Blomstedt, Yulia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sahlén, Klas Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nilsson, Ingeborg
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Arbetsterapi.
    Sundström, Anna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Brändström, Anders
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Elderly care in Swedish welfare state: implications of the population ageing2013Ingår i: Global aging issues and policies: understanding the importance of comprehending and studying the aging process / [ed] Yushi Li, Springfield: Charles C. Thomas Publisher Ltd., 2013, s. 226-244Kapitel i bok, del av antologi (Refereegranskat)
  • 4.
    Daerga, Laila
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Edin-Liljegren, A.
    Dahlgren, L.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lack of trust in health and social services among reindeer herding Sami in SwedenManuskript (preprint) (Övrigt vetenskapligt)
  • 5.
    Dahlgren, Lars
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Emmelin, Maria
    Lund University.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. University West.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Winkvist, Anna
    Department of Clinical Nutrition, Sahlgrenska Academy.
    Qualitative methodology for international public health2019 (uppl. 3)Bok (Övrigt vetenskapligt)
  • 6. Dalmar, Abdirisak Ahmed
    et al.
    Hussein, Abdullahi Sheik
    Walhad, Said Ahmed
    Ibrahim, Abdirashid Omer
    Abdi, Abshir Ali
    Ali, Mohamed Khalid
    Ereg, Derie Ismail
    Egal, Khadra Ali
    Shirwa, Abdulkadir Mohamed
    Aden, Mohamed Hussain
    Yusuf, Marian Warsame
    Abdi, Yakoub Aden
    Freij, Lennart
    Johansson, Annika
    Mohamud, Khalif Bile
    Abdulkadir, Yusuf
    Emmelin, Maria
    Eriksen, Jaran
    Erlandsson, Kerstin
    Gustafsson, Lars L.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Klingberg-Allvin, Marie
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Källestål, Carina
    Målqvist, Mats
    Osman, Fatumo
    Persson, Lars-Åke
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Rebuilding research capacity in fragile states: the case of a Somali-Swedish global health initiative2017Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, nr 1, artikel-id 1348693Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper presents an initiative to revive the previous Somali-Swedish Research Cooperation, which started in 1981 and was cut short by the civil war in Somalia. A programme focusing on research capacity building in the health sector is currently underway through the work of an alliance of three partner groups: six new Somali universities, five Swedish universities, and Somali diaspora professionals. Somali ownership is key to the sustainability of the programme, as is close collaboration with Somali health ministries. The programme aims to develop a model for working collaboratively across regions and cultural barriers within fragile states, with the goal of creating hope and energy. It is based on the conviction that health research has a key role in rebuilding national health services and trusted institutions.

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  • 7.
    Edin-Liljegren, Anette
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Centre for Rural Medicine, Primary Health Care, County Council of Västerbotten, Storuman, Sweden.
    Daerga, Laila
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Centre for Rural Medicine, Primary Health Care, County Council of Västerbotten, Storuman, Sweden.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jacobsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Psychosocial perspectives on working conditions among men and women in reindeer breeding in Sweden2017Ingår i: Journal of Northern Studies, ISSN 1654-5915, E-ISSN 2004-4658, Vol. 11, nr 2, s. 31-47Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The aim of this project was to describe the work organisation in the Sami communities and in reindeer-herding work and to explore the range of female duties and compare how men and women experience their psychosocial working conditions.

    Design: A kind of intervention study was performed by means of a questionnaire sent out to 200 individuals from seven Sami communities. Questions were asked about work organisation, communication, personal relations, solitary work, support, participation and appreciation from colleagues and women's tasks. Meetings and discussions were held about what was perceived as being important in the life of the Sami communities. Notes from 16 group discussions were written down and analysed according to themes of topics relating to how men and women in the Sami communities experience their lives.

    Results: Communication and relations were described as being inadequate and some respondents experienced a heavy workload. The women reported more troubled relations, less participation in decision-making and less appreciation from colleagues. Positive issues reported were the Sami identity and a strong connection to the reindeer and to nature.

    Conclusions: This study indicates a need for a more systematic study of the psychosocial work conditions in the Sami communities in Sweden. Measures should be taken to develop the organisation of work, e.g. through developing communication strategies and conflict management, which has been requested by several Sami communities.

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  • 8.
    Edin-Liljegren, Anette
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jacobsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Daerga, Laila
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Reindeer-herding Sami experiences of seeking care in the mainstream society2016Ingår i: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 75, nr 33200Artikel i tidskrift (Refereegranskat)
  • 9.
    Eklund, Katarina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Stenberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Enthoven, Paul
    Gerdle, Björn
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    A cost-utility analysis of multimodal pain rehabilitation in primary healthcare2021Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 1, s. 48-58Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Multimodal rehabilitation programs (MMRPs) have been shown to be both cost-effective and an effective method for managing chronic pain in specialist care. However, while the vast majority of patients are treated in primary healthcare, MMRPs are rarely practiced in these settings. Limited time and resources for everyday activities alongside the complexity of chronic pain makes the management of chronic pain challenging in primary healthcare and the focus is on unimodal treatment. In order to increase the use of MMRPs incentives such as cost savings and improved health status in the patient group are needed. The aim of this study was to evaluate the cost-effectiveness of MMRPs for patients with chronic pain in primary healthcare in two Swedish regions. The aim of this study was to evaluate the cost-effectiveness of MMRPs at one-year follow-up in comparison with care as usual for patients with chronic pain in primary healthcare in two Swedish regions.

    Methods: A cost-utility analysis was performed alongside a prospective cohort study comparing the MMRP with the alternative of continuing with care as usual. The health-related quality of life (HRQoL), using EQ5D, and working situation of 234 participants were assessed at baseline and one-year follow-up. The primary outcome was cost per quality-adjusted life year (QALY) gained while the secondary outcome was sickness absence. An extrapolation of costs was performed based on previous long-term studies in order to evaluate the effects of the MMRP over a five-year time period.

    Results: The mean (SD) EQ5D index, which measures HRQoL, increased significantly (p<0.001) from 0.34 (0.32) to 0.44 (0.32) at one-year follow-up. Sickness absence decreased by 15%. The cost-utility analysis showed a cost per QALY gained of 18 704 € at one-year follow-up.

    Conclusions: The results indicate that the MMRP significantly improves the HRQoL of the participants and is a cost-effective treatment for patients with chronic pain in primary healthcare when a newly suggested cost-effectiveness threshold of 19 734 € is implemented. The extrapolation indicates that considerable cost savings in terms of reduced loss of production and gained QALYs may be generated if the effects of the MMRP are maintained beyond one-year follow-up. The study demonstrates potential benefits of MMRPs in primary healthcare for both the patient with chronic pain and the society as a whole. The cost-effectiveness of MMRPs in primary healthcare has scarcely been studied and further long-term studies are needed in these settings.

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  • 10. Ekstrand, Joakim
    et al.
    Petersson, Pia
    Westergren, Albert
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Preventiva hembesök till seniorer: har vi råd att inte satsa?2019Ingår i: Svensk geriatrik, ISSN 2001-2047, nr 1, s. 24-27Artikel i tidskrift (Övrigt vetenskapligt)
  • 11.
    Hambraeus, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Hambraeus, Kjerstin S.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Patient perspectives on interventional pain management: thematic analysis of a qualitative interview study2020Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 20, nr 1, artikel-id 604Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Chronic pain is a widespread problem that is usually approached by focusing on its psychological aspects or on trying to reduce the pain from the pain generator. Patients report that they feel responsible for their pain and that they are disempowered and stigmatized because of it. Here, we explored interventional pain management from the patient’s perspective to understand the process better.

    Methods: A purposive sample of 19 subjects was interviewed by an independent interviewer. The interviews were transcribed into text and thematic analysis was performed.

    Results: The subjects’ perceptions covered three key themes: themselves as objects; the caregivers, including the process of tests and retests, the encounters and interactions with professionals, and the availability of the caregivers; and finally the outcomes, including the results of the tests and treatments and how these inspired them to think of other people with pain. Linking these themes, the subjects reported something best described as “gained empowerment” during interventional pain management; they were feeling heard and seen, they gained knowledge that helped them understand their problem better, they could ask questions and receive answers, and they felt safe and listened to.

    Conclusions: Many of the themes evolved in relation to the subjects’ contact with the healthcare services they received, but when the themes were merged and structured into the model, a cohesive pattern of empowerment appeared. If empowerment is a major factor in the positive effects of interventional pain management, it is important to facilitate and not hinder empowerment.

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  • 12.
    Hoi, Le Van
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Tien, Nguyen Thi Kim
    Tien, Nguyen Van
    Dung, Dao Van
    Chuc, Nguyen Thi Kim
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sahlen, Klas Göran
    Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS). Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Willingness to use and pay for options of care for community dwelling older people in rural Vietnam2012Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 12, s. 36-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The proportion of people in Vietnam who are 60 years and over has increased rapidly. The emigration of young people and impact of other socioeconomic changes leave more elderly on their own and with less family support. This study assesses the willingness to use and pay for different models of care for community-dwelling elderly in rural Vietnam.

    Methods: In 2007, people aged 60 and older and their family representatives, living in 2,240 households, were randomly selected from the FilaBavi Demographic Surveillance Site. They were interviewed using structured questionnaires to assess dependence in activities of daily living (ADLs), willingness to use and to pay for day care centres, mobile care teams, and nursing centres. Respondent socioeconomic characteristics were extracted from the FilaBavi repeated census. Percentages of those willing to use models and the average amount (with 95% confidence intervals) they are willing to pay were estimated. Multivariate analyses were performed to measure the relationship of willingness to use services with ADL index and socioeconomic factors. Four focus group discussions were conducted to explore people's perspectives on the use of services. The first discussion group was with the elderly. The second discussion group was with their household members. Two other discussion groups included community association representatives, one at the communal level and another at the village level.

    Results: Use of mobile team care is the most requested service. The fewest respondents intend to use a nursing centre. Households expect to use services for their elderly to a greater extent than do the elderly themselves. Willingness to use services decreases when potential fees increase. The proportion of respondents who require that services be free-of-charge is two to three times higher than the proportion willing to pay full cost. Households are willing to pay more than the elderly for day care and nursing centres. The elderly are more willing to pay for mobile teams than are their households. Age group, sex, literacy, marital status, living arrangement, living area, working status, poverty, household wealth and dependence in ADLs are factors related to willingness to use services.

    Conclusions: Community-centric elderly care will be used and partly paid for by individuals if it is provided by the government or associations. Capacity building for health professional networks and informal caregivers is essential for developing formal care models. Additional support is needed for the most vulnerable elderly to access services.

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  • 13.
    Ivarsson, Anneli
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Johansson, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Mohamud, Khalif Bile
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Freij, Lennart
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Dalmar, Abdirisak Ahmed
    Ibrahim, Abdirashid Omer
    Hagi, Abdisamad Abikar
    Abdi, Abshir Ali
    Hussein, Abdullahi Sheik
    Shirwa, Abdulkadir Mohamed
    Warsame, Amina
    Ereg, Derie Ismail
    Aden, Mohamed Hussain
    Qasim, Maryan
    Ali, Mohamed Khalid
    Elmi, Abdullahi
    Afrah, Abdullahi Warsame
    Sabtiye, Faduma Omar
    Guled, Fatuma Ege
    Ahmed, Hinda Jama
    Mohamed, Halima
    Tinay, Halima Ali
    Mohamud, Kadigia Ali
    Yusuf, Mariam Warsame
    Omar, Mayeh
    Abdi, Yakoub Aden
    Abdulkadir, Yusuf
    Johansson, Annika
    Kulane, Asli Ali
    Schumann, Barbara
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Essen, Birgitta
    Kalengayi, Faustine Nkulu
    Elgh, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Virologi.
    Norström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lönnberg, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Norder, Helene
    Schröders, Julia
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Erlandsson, Kerstin
    Edin, Kerstin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Gustafsson, Lars L.
    Persson, Lars-Ake
    Eriksson, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Emmelin, Maria
    Hasselberg, Marie
    Klingberg, Marie
    Preet, Raman
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hogberg, Ulf
    Sjostrom, Urban
    Omar, Saif
    Healing the health system after civil unrest2015Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, s. 1-4Artikel i tidskrift (Övrigt vetenskapligt)
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  • 14. Kobayashi, H.
    et al.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Distributed resources and care choice: formulation through the capability approach2016Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, nr Suppl 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Facing the problem of healthcare resource distribution under a severe healthcare budget constraint, care providers or healthcare authorities are strongly required to cut costs, which could deter individuals from applying for certain types of care services. The study aims to clarify the differences in resources distributed to individuals by formulating empirical data on patients through the capability approach, with a special focus on the opportunity and process aspects of freedom while utilising care services.

    Methods: A process aspect of freedom is captured by patients’ decision making for care services (DM), while an opportunity aspect of freedom is by accessing social services (SS). Distributed resources, nursing services offered to patients, are assumed to be converted to DM and SS through each individual’s utilisation ability of resources for DM and SS. A patient chooses an achievement point (a combination of DM and SS) within her budget set under her evaluation function of ‘well recuperation’. Achievement in DM and SS and ‘well recuperation’ were studied through a questionnaire survey on 116 patients hospitalised at general acute wards in Sweden. Individuals were asked about their physical and mental constraints toward daily living activities through an EQ-5D-3L questionnaire (specifically to examine the dimensions of ‘pain’ and ‘anxiety’).

    Results: The formulated choice set suggested that patients with constraints are less likely to achieve DM than those without any constraints. When individual evaluation is accounted for, the largest amount of resources is distributed to patients with physical and mental constraints, followed by those with physical constraints and those with no constraints.

    Conclusions: The formulation through a capability approach, supported by empirical data, shows that physical and mental constraints of patients’ can restrict their choice set with respect to the process aspect of freedom of care service utilisation.

    Key messages:

    • Capability approach can provide a theoretical background and empirical evidence to justify resource distribution in healthcare, accounting for individual differences in physical or mental conditions
    • Patients with physical or mental constraints have a restricted choice set with respect to the process aspect of freedom of care service utilisation despite additional resource distribution
  • 15.
    Kyaw, Tun Lin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. School of Public Health and Community Medicine, Institution of Medicine, University of Gothenburg, Göteborg, Sweden.
    Theocharaki, Margarita
    School of Public Health and Community Medicine, Institution of Medicine, University of Gothenburg, Göteborg, Sweden.
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Cost-effectiveness of digital tools for behavior change interventions among people with chronic diseases: systematic review2023Ingår i: Interactive Journal of Medical Research, E-ISSN 1929-073X, Vol. 12, artikel-id e42396Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    BACKGROUND: Chronic diseases, including cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, and cerebrovascular diseases, contribute to the most significant disease burden worldwide, negatively impacting patients and their family members. People with chronic diseases have common modifiable behavioral risk factors, including smoking, alcohol overconsumption, and unhealthy diets. Digital-based interventions for promoting and sustaining behavioral changes have flourished in recent years, although evidence of the cost-effectiveness of such interventions remains inconclusive.

    OBJECTIVE: In this study, we aimed to investigate the cost-effectiveness of digital health interventions for behavioral changes among people with chronic diseases.

    METHODS: This systematic review evaluated published studies focused on the economic evaluation of digital tools for behavioral change among adults with chronic diseases. We followed the Population, Intervention, Comparator, and Outcomes framework to retrieve relevant publications from 4 databases: PubMed, CINAHL, Scopus, and Web of Science. We used the Joanna Briggs Institute's criteria for economic evaluation and randomized controlled trials to assess the risk of bias in the studies. Two researchers independently screened, assessed the quality, and extracted data from the studies selected for the review.

    RESULTS: In total, 20 studies published between 2003 and 2021 fulfilled our inclusion criteria. All the studies were conducted in high-income countries. These studies used telephones, SMS text messaging, mobile health apps, and websites as digital tools for behavior change communication. Most digital tools for interventions focused on diet and nutrition (17/20, 85%) and physical activity (16/20, 80%), and a few focused on smoking and tobacco control (8/20, 40%), alcohol reduction (6/20, 30%), and reduction of salt intake (3/20, 15%). Most studies (17/20, 85%) used the health care payer perspective for economic analysis, and only 15% (3/20) used the societal perspective. Only 45% (9/20) of studies conducted a full economic evaluation. Most studies (7/20, 35%) based on full economic evaluation and 30% (6/20) of studies based on partial economic evaluation found digital health interventions to be cost-effective and cost-saving. Most studies had short follow-ups and failed to include proper indicators for economic evaluation, such as quality-adjusted life-years, disability-adjusted life-years, lack of discounting, and sensitivity analysis.

    CONCLUSIONS: Digital health interventions for behavioral change among people with chronic diseases are cost-effective in high-income settings and can therefore be scaled up. Similar evidence from low- and middle-income countries based on properly designed studies for cost-effectiveness evaluation is urgently required. A full economic evaluation is needed to provide robust evidence for the cost-effectiveness of digital health interventions and their potential for scaling up in a wider population. Future studies should follow the National Institute for Health and Clinical Excellence recommendations to take a societal perspective, apply discounting, address parameter uncertainty, and apply a lifelong time horizon.

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  • 16.
    Lindholm, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Löfgren, Curt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Meili, Kaspar
    Nygren, Lennart
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Pulkki-Brännström, Anni-Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nytt sätt att mäta livskvalitet öppnar för effektivare insatser2018Ingår i: Dagens samhälle, ISSN 1652-6511, nr 31, s. 26-26Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 17.
    Löfgren, Curt
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ming, HV
    Thanh, NX
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Catastrophic Health Expenditure and Impoverishment among the Elderly Households in VietnamManuskript (preprint) (Övrigt vetenskapligt)
  • 18.
    Martinsson, Lisa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Translation and cultural adaptation of the Integrated Palliative care Outcome Scale for Dementia (IPOS-Dem) to Swedish2022Ingår i: BMC Nursing, E-ISSN 1472-6955, Vol. 21, nr 1, artikel-id 78Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Systematic assessment tools are helpful for improving and maintaining quality of care. The Integrated Palliative care Outcome Scale (IPOS) was developed for systematic assessment of persons receiving palliative care in a patient-centred way. A version of this tool, the Integrated Palliative care Outcome Scale for Dementia (IPOS-Dem), has been developed for patients with dementia. The aim of this study was to develop a version of the IPOS-Dem translated into Swedish and culturally adapted to a Swedish care setting.

    Methods: Forward and backward translations from English into Swedish were performed to develop a first Swedish version. This version was modified for clarity and cultural adaptation based on 13 interviews with nurses and assistant nurses working in geriatrics and dementia care homes.

    Results: The interview process revealed several issues with the first version that emerged from the translation process. This was changed and further tested to work well, resulting in the final version of the Swedish IPOS-Dem. The tool was perceived as clinically useful but somewhat overlapping with already implemented tools for assessing behavioural and psychological symptoms in dementia.

    Conclusion: The Swedish version of the IPOS-Dem can now be used as a tool for assessing palliative care related problems and concerns for persons with advanced dementia. Future studies can focus on implementation as well as examining validity and reliability of this tool in a Swedish context.

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  • 19.
    Mkoba, Egfrid Michael
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi. Physiotherapy Department, Faculty of Rehabilitation Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
    Sundelin, Gunnevi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sörlin, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    The characteristics of stroke and its rehabilitation in Northern Tanzania2021Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 14, nr 1, artikel-id 1927507Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Stroke causes great suffering and severe disability worldwide, and rehabilitation following a stroke seeks to restore lost functions. The extent to which stroke patients get access to rehabilitation in Tanzania is not well estimated, and drawing a current picture of the rehabilitation services for these persons is the first step in developing a more effective rehabilitation model in the country. Objective: The objective of this study was to establish the characteristics of stroke and its rehabilitation at the Kilimanjaro Christian Medical Centre (KCMC), a consultant referral hospital in northern Tanzania.

    Methods: This was a records-based descriptive study in which demographic, clinical, and rehabilitation information of stroke patients admitted to the KCMC between January 2012 and December 2015 was collected and audited. The means, percentages, and proportions were used to summarise the demographic, clinical, and rehabilitation patterns using SPSS version 24.0 software. The chi-squared statistic was used to examine the relationships between categorical variables, and a p-value<0.05 was considered statistically significant.

    Results: Of the 17,975 patients admitted to the KCMC during the period of the study, 753 (4.2%) had suffered a stroke, with a mean age of 68.8 ± 16.4 years. The predominant cause of stroke was hypertension, which accounted for 546 (72.5%) patients. A total of 357 (47.4%) patients had various forms of rehabilitation during the admission to hospital. Following a discharge home 240 (31.9%) patients did not return to the hospital for the continuation of rehabilitation.

    Conclusion: Stroke patients at the KCMC lack access to rehabilitation therapies. Insufficient access to rehabilitation therapies may warrant the need to explore alternative approaches such as tele-rehabilitation technologies in Tanzania.

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  • 20.
    Moshi, Haleluya I.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi. Physiotherapy Department, Faculty of Rehabilitation Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
    Sundelin, Gunnevi G.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sahlen, Klas-Göran G.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sörlin, Ann VM.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    A one-year prospective study on the occurrence of traumatic spinal cord injury and clinical complications during hospitalisation in north-east Tanzania2021Ingår i: African Health Sciences, ISSN 1680-6905, E-ISSN 1729-0503, Vol. 21, nr 2, s. 788-794Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Clinical complications following spinal cord injury are a big concern as they account for increased cost of rehabilitation, poor outcomes and mortality.

    Objective: To describe the occurrence of traumatic spinal cord injury and associated clinical complications during hospi- talisation in North-East Tanzania.

    Method: Prospective data were collected from all persons with traumatic spinal cord injury from North-East Tanzania from their admission to discharge from the hospital. Neurological progress and complications were assessed routinely. Data were captured using a form that incorporated the components of the core data set of the International Spinal Cord Society and were analysed descriptively.

    Results: A total of 87 persons with traumatic spinal cord injury were admitted at the hospital with a mean age of 40.2 ± 15.8 years. There were 69 (79.3%) males, and 58 (66.6%) of the injuries resulted from falls. Spasms (41 patients, 47.1%), neuropathic pain (40 patients, 46%), and constipation (35 patients, 40.2%) were the most commonly reported complications. The annual incidence rate in the Kilimanjaro region was at least 38 cases per million.

    Conclusion: The incidence of traumatic spinal cord injury in the Kilimanjaro region is relatively high. In-hospital compli- cations are prevalent and are worth addressing for successful rehabilitation.

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  • 21.
    Moshi, Haleluya
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Faculty of Rehabilitation Medicine, Physiotherapy Department, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
    Sundelin, Gunnevi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sörlin, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Traumatic spinal cord injury in the north-east Tanzania: describing incidence, etiology and clinical outcomes retrospectively2017Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, nr 1, artikel-id 1355604Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Causes, magnitude and consequences of traumatic spinal cord injury depend largely on geography, infrastructure, socioeconomic and cultural activities of a given region. There is a scarcity of literature on profile of traumatic spinal cord injury to inform prevention and rehabilitation of this health condition in African rural settings, particularly Tanzania. Objective: To describe the incidence, etiology and clinical outcomes of traumatic spinal cord injury and issues related to retrospective study in underdeveloped setting.

    Methods: Records for patients with traumatic spinal cord injury for five consecutive years (2010–2014) were obtained retrospectively from the admission wards and health records archives of the Kilimanjaro Christian Medical Center. Sociodemographic, cause, complications and patients’ condition on discharge were recorded and analyzed descriptively.

    Results: The admission books in the wards registered 288 new traumatic spinal cord injury cases from January 2010 to December 2014. Of the 288 cases registered in the books, 224 were males and 64 females with mean age 39.1(39.1 ± 16.3) years and the majority of individuals 196(68.1%) were aged between 16 and 45 years. A search of the hospital archives provided 213 full patient records in which the leading cause of injury was falls 104(48.8%) followed by road traffic accidents 73(34.3%). Cervical 81(39.9%) and lumbar 71(34.74%) spinal levels were the most affected. The annual incidence for the Kilimanjaro region (population 1,640,087) was estimated at more than 26 persons per million population. The most docu- mented complications were pressure ulcers 42(19.7%), respiratory complications 32(15.0%) and multiple complications 28(13.1%). The mean length of hospital stay was 64.2 ± 54.3 days and the mortality rate was 24.4%.

    Conclusion: Prevention of traumatic spinal cord injury in North-east Tanzania should consider falls (particularly from height) as the leading cause, targeting male teenagers and young adults. Pressure ulcers, respiratory complications, in-hospital mortality and availability of wheelchairs should be addressed. 

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  • 22.
    Moshi, Haleluya
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Kilimanjaro Cristian Medical University College, Moshi, Tanzania.
    Sundelin, Gunnevi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Anthea, Rhoda
    Sörlin, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Coping Resources for Persons With Traumatic Spinal Cord Injury in A Tanzania Rural Area2018Ingår i: Global Journal of Health Science, ISSN 1916-9736, E-ISSN 1916-9744, Vol. 10, nr 5, s. 138-153Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Persons with traumatic spinal cord injury (TSCI) in Tanzanian rural settings face a variety of geographical and socioeconomic challenges that make life almost impossible for them. However, some have managed to live relatively long lives despite these difficult conditions. This study aimed at exploring secrets behind successful lives of persons with TSCI in typical resource-constrained rural Tanzanian settings.

    METHODS: A modified constructivist grounded theory was employed for the analysis of data from 10 individuals who have lived between 7 and 28 years with TSCI in typical Tanzanian rural area. The 10 were purposively selected from 15 interviews that were conducted in 2011. The analysis followed the constructivist approach in which data was first open and axial coded, prior to categories being constructed. The categories were frequently reviewed in light of the available literature to determine the over-arching core category that described or connected the rest.

    RESULTS: Nine categories (identified as internal and external coping resources) were constructed. The internal coping resources were: secured in God, increase in awareness on health risk, problem-solving skills and social skills. External coping resources were: having a reliable family, varying support from the community, a matter of possession and left without means for mobility. Acceptance was later identified as a core category that determines identification and utilization of the rest of the coping resources.

    CONCLUSION: Persons with traumatic spinal cord injury can survive for a relatively long time despite the hostile environment. Coping with these environments requires the employment of various coping resources, acceptance being the most important.

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  • 23.
    Moshi, Haleluya
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Sundelin, Gunnevi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sörlin, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Incidence of traumatic spinal cord injury and prevalence of medical complications among hospitalized patients at Kilimanjaro: a one year prospective studyManuskript (preprint) (Övrigt vetenskapligt)
  • 24.
    Moshi, Haleluya
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi. Physiotherapy Department, Faculty of Rehabilitation Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
    Sundelin, Gunnevi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Sörlin, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Quality of life of persons with traumatic spinal cord injury in rural Kilimanjaro, Tanzania: a community survey2021Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 43, nr 20, s. 2838-2845Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To describe the quality of life of persons with traumatic spinal cord injury (TSCI) in a rural area of a low-income country.

    Methods: This was a cross-sectional descriptive study in which snowballing was used to identify persons with TSCI in their homes. A Kiswahili version of the short version of the World Health Organization quality of life questionnaire was used for data collection. Data were analyzed descriptively and independent samples t-tests were used to calculate the difference in the mean scores between groups.

    Results: Eighty persons with TSCI with a mean age of 42.29 +/- 11.4 years were identified, 68.8% of whom were males. The highest scoring domains were psychological (12.76 +/- 2.55) and social relationships (12.62 +/- 2.95). The lowest scores were for physical (11.48 +/- 2.74) and environment (9.59 +/- 2.68) domains. Significantly higher scores were associated with younger age in: physical (0.05), social relationships (0.01), and environment (0.02) domains (p value < 0.05).

    Conclusions: Persons with TSCI in the Kilimanjaro rural area registered a relatively low quality of life in which the most affected domains are physical health and environment.

  • 25.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Eriksson, Malin
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Guerrero, Esteban
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Gustafsson, Carina
    Public Health Unit, Region Västerbotten, Umeå, Sweden.
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lindberg, Jens
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Lindgren, Helena
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Lindvall, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lundgren, Anna Sofia
    Umeå universitet, Humanistiska fakulteten, Institutionen för kultur- och medievetenskaper.
    Lönnberg, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Santosa, Ailiana
    School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Richter Sundberg, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Public Health Unit, Region Västerbotten, Umeå, Sweden.
    Sustainable Behavior Change for Health Supported by Person-Tailored, Adaptive, Risk-Aware Digital Coaching in a Social Context: Study Protocol for the STAR-C Research Programme2021Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 9, artikel-id 593453Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: The Västerbotten Intervention Programme (VIP) in the Region Västerbotten Sweden is one of the very few cardiovascular disease (CVD) prevention programmes globally that is integrated into routine primary health care. The VIP has been shown as a cost-effective intervention to significantly reduce CVD mortality. However, little is known about the effectiveness of a digital solution to tailor risk communication strategies for supporting behavioral change. STAR-C aims to develop and evaluate a technical platform for personalized digital coaching that will support behavioral change aimed at preventing CVD.

    Methods: STAR-C employs a mixed-methods design in seven multidisciplinary projects, which runs in two phases during 2019–2024: (i) a formative intervention design and development phase, and (ii) an intervention implementation and evaluation phase. In the 1st phase, STAR-C will model the trajectories of health behaviors and their impact on CVDs (Project 1), evaluate the role of the social environment and social networks on behavioral change (Project 2) and assess whether and how social media facilitates the spread of health information beyond targeted individuals and stimulates public engagement in health promotion (Project 3). The findings will be utilized in carrying out the iterative, user-centered design, and development of a person-tailored digital coaching platform (Project 4). In the 2nd phase, STAR-C will evaluate the implementation of the coaching programme and its effectiveness for promoting behavioral change and the spreading of health information across social networks and via social media (Project 5). The cost-effectiveness (Project 6) and ethical issues (Project 7) related to the coaching programme intervention will be evaluated.

    Discussion: The STAR-C research programme will address the knowledge and practice research gaps in the use of information technologies in health promotion and non-communicable disease (NCD) prevention programmes in order to narrow the health inequality gaps.

    Ethics: STAR-C has received approval from the Swedish Ethical Review Authority (Dnr. 2019-02924;2020-02985).

    Dissemination: The collaboration between Umeå University and Region Västerbotten will ensure the feasibility of STAR-C in the service delivery context. Results will be communicated with decision-makers at different levels of society, stakeholders from other regions and healthcare professional organizations, and through NGOs, local and social media platforms.

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  • 26.
    Norström, Fredrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Waenerlund, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Nygren, Rebecka
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Brydsten, Anna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen. Stockholms universitet.
    Does unemployment contribute to poorer health-related quality of life among Swedish adults?2019Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 19, s. 1-12, artikel-id 457Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Previous studies have shown that unemployment has negative impacts on various aspects of health. However, little is known about the effect of unemployment on health-related quality of life. Our aim was to examine how unemployment impacts upon health-related quality of life among Swedish adults, and to investigate these effects on population subgroups defined by education level, marital status, previous health, and gender.

    METHODS: As part of a cross-sectional study, a questionnaire was sent to 2500 randomly selected individuals aged 20 to 64 years living in Sweden in 2016. The questionnaire included the EuroQol 5 dimensions (EQ-5D) instrument and was answered by 967 individuals (39%). Quality-adjusted life year (QALY) scores were derived from the EQ-5D responses. Of the respondents, 113 were unemployed and 724 were employed. We used inverse probability-weighted propensity scores in our analyses to estimate a risk difference. Gender, age, education level, marital status, and previous health were used as covariates in our analyses.

    RESULTS: There was a statistically significant lower QALY score by 0.096 points for the unemployed compared to the employed. There were also statistically significant more problems due to unemployment for usual activities (6.6% more), anxiety/depression (23.6% more), and EQ-5D's Visual Analogue Scale (7.5 point lower score). Grouped analyses indicated a larger negative health effect from becoming unemployed for men, those who are married, and young individuals.

    CONCLUSIONS: In our study, we show that the health deterioration from unemployment is likely to be large, as our estimated effect implies an almost 10% worse health (in absolute terms) from being unemployed compared to being employed. This further highlights that unemployment is a public health problem that needs more focus. Our study also raises further demands for determining for whom unemployment has the most negative effects and thus suggesting groups of individuals who are in greatest need for labor market measures.

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  • 27.
    Norström, Fredrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Zingmark, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden; Department of Health Sciences, Lund University, Lund, Sweden.
    Pettersson-Strömbäck, Anita
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Öhrling, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Bölenius, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    How does the distribution of work tasks among home care personnel relate to workload and health-related quality of life?2023Ingår i: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 96, nr 8, s. 1167-1181Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The work for Swedish home care workers is challenging with a variety of support and healthcare tasks for home care recipients. The aim of our study is to investigate how these tasks relate to workload and health-related quality of life among home care workers in Sweden. We also explore staff preferences concerning work distribution.

    Methods: A cross-sectional study was conducted in 16 municipalities in Northern Sweden. Questionnaires with validated instruments to measure workload (QPSNordic) and health-related quality of life (EQ-5D), were responded by 1154 (~ 58%) of approximately 2000 invited home care workers. EQ-5D responses were translated to a Quality-adjusted life-year (QALY) score. For 15 different work task areas, personnel provided their present and preferred allocation. Absolute risk differences were calculated with propensity score weighting.

    Results: Statistically significantly more or fewer problems differences were observed for: higher workloads were higher among those whose daily work included responding to personal alarms (8.4%), running errands outside the home (14%), rehabilitation (13%) and help with bathing (11%). Apart from rehabilitation, there were statistically significantly more (8–10%) problems with anxiety/depression for these tasks. QALY scores were lower among those whose daily work included food distribution (0.034) and higher for daily meal preparation (0.031), both explained by pain/discomfort dimension. Personnel preferred to, amongst other, spend less time responding to personal alarms, and more time providing social support.

    Conclusion: The redistribution of work tasks is likely to reduce workload and improve the health of personnel. Our study provides an understanding of how such redistribution could be undertaken.

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  • 28.
    Rocklöv, Joacim
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Bao Giang, Kim
    Van Minh, Hoang
    Ebi, Kristie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Univ Washington, Sch Publ Hlth, Seattle, WA 98195 USA.
    Nilsson, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Local research evidence for public health interventions against climate change in Vietnam2014Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, artikel-id 26552Artikel i tidskrift (Refereegranskat)
    Ladda ner fulltext (pdf)
    fulltext
  • 29.
    Sahlen, Klas Göran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Löfgren, Curt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hellner, Britt Mari
    IMS, Institutet för metodutveckling i socialt arbete, Socialstyrelsen.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Preventive home visits to older people are cost-effective2008Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 36, s. 265-271Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: There is ongoing debate over the effectiveness of preventive home visits (PHVs) for the elderly. A municipality in the north of Sweden carried out a controlled trial of such visits. Healthy seniors aged 75 years and over received two PHVs per year over 2 years. The aim of this study was to do a cost utility analysis of the intervention.

    Methods: The intervention group (n=196) was compared with a control group (n=346), and a cost utility analysis was performed. The analysis was carried out with three different time perspectives. Data were sourced from official documents and medical and social records.

    Results: From a societal perspective, using a time period of 4 years, the analysis of PHVs to healthy seniors showed net savings. When including estimated future costs for health and elderly care during gained life years, the result changed from a net saving to a cost of Euro 200,000. A lifetime perspective also resulted in net savings if the costs of future health and elderly care were not included in the analysis. In this case, the total costs rose to approximately Euro 900,000. The cost could also be expressed as Euro 14,200 per quality-adjusted life year gained if future costs for elderly care and healthcare were included.

    Conclusions: PHVs represent a cost-effective intervention in this setting. The costs are justified by the outcomes.

  • 30.
    Sahlen, Klas Göran Sahlen
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Dahlgren, Lars
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hellner, Britt Mari
    IMS, Institutet för metodutveckling i socialt arbete, Socialstyrelsen.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Preventive home visits postpone mortality: a controlled trial with time-limited results2006Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 6, nr 220Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There is a debate on whether preventive home visits to older people have any impact. This study was undertaken to investigate whether preventive home visits by professional health workers to older persons can postpone mortality in a Swedish context.

    Method: A controlled trial in a small community in the north of Sweden. Participants are healthy pensioners aged 75 years and over. 196 pensioners were selected as the intervention group and 346 as the control group. The intervention, two visits per year, lasted two years.

    Results: During the intervention, mortality was 27 per 1000 in the intervention group and 48 per 1000 in the control group. The incidence rate ratio for the control group IR2000–2001 was 1,79 (95%CI = 0,94–3,40). Analysing the data with an "on treatment approach" gave a significant result, 2,31 (95%CI = 1,07–5,02) After the trial the difference between the groups disappeared.

    Conclusion: Preventive home visits in a healthy older population can postpone mortality in a Swedish context if they are carried out by professional health-workers in a structured way. When the home visit programme ended the effect on mortality disappeared. These findings are dependent on contextual factors that make it difficult to form general policy recommendations.

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    FULLTEXT01
  • 31.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Implementering av verksamhet med förebyggande hembesök:: Nordmalings kommun - primärvården i Nordmaling2005Rapport (Övrig (populärvetenskap, debatt, mm))
  • 32.
    Sahlen, Klas-Göran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Boman, Kurt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Brännström, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    A cost-effectiveness study of person-centered integrated heart failure and palliative home care: based on a randomized controlled trial2016Ingår i: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 30, nr 3, s. 296-302Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Previous economic studies of person-centered palliative home care have been conducted mainly among patients with cancer. Studies on cost-effectiveness of advanced home care for patients with severe heart failure are lacking when a diagnosis of heart failure is the only main disease as the inclusion criterion.

    Aim: To assess the cost-effectiveness of a new concept of care called person-centered integrated heart failure and palliative home care.

    Design: A randomized controlled trial was conducted from January 2011 to 2013 at a center in Sweden. Data collection included cost estimates for health care and the patients’ responses to the EQ-5D quality of life instrument.

    Setting/participants: Patients with chronic and severe heart failure were randomly assigned to an intervention (n = 36) or control (n = 36) group. The intervention group received the Palliative Advanced Home Care and Heart Failure Care intervention over 6 months. The control group received the same care that is usually provided by a primary health care center or heart failure clinic at the hospital.

    Results: EQ-5D data indicated that the intervention resulted in a gain of 0.25 quality-adjusted life years, and cost analysis showed a significant cost reduction with the Palliative Advanced Home Care and Heart Failure Care intervention. Even if costs for staffing are higher than usual care, this is more than made up for by the reduced need for hospital-based care. This intervention made it possible for the county council to use €50,000 for other needs.

    Conclusion: The Palliative Advanced Home Care and Heart Failure Care working mode saves financial resources and should be regarded as very cost-effective.

  • 33.
    Sahlen, Klas-Göran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Health coaching to promote healthier lifestyle among older people at moderate risk for cardiovascular diseases, diabetes and depression: a study protocol for a randomized controlled trial in Sweden2013Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 13, nr 199Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The challenge of an aging population in the society makes it important to find strategies to promote health for all. The aim of this study is to evaluate if repeated health coaching in terms of motivational interviewing, and an offer of wide range of activities, will contribute to positive lifestyle modifications and health among persons aged 60-75 years, with moderately elevated risk for cardiovascular disease (CVD), diabetes, or mild depression.

    METHODS/DESIGN: Men and women between 60 and 75 are recruited in four regions in Sweden if they fulfill one or more of the four inclusion criteria.•Current reading of blood pressure (140-159/90-99) without medication.•Current reading of blood sugar (Hba1c 42-52 mmol/mol) without medication.•A current waist-circumference of ≥94 cm for men and ≥80 for women.•A minor/mild depression (12-20 points) according to Montgomery-Åsberg Depression Rating Scale without medication.Individuals with a worse result than inclusion criteria are treated according to regular guidelines at the PHCs and therefore not included. Exclusion criteria for the study are dementia, mental illness or other condition deemed unsuitable for participation.All participants fill out a questionnaire at baseline, and at the 6-, 12- and 18-month follow-ups containing questions on demographic characteristics, social life, HRQoL, lifestyle habits, general health/medication, self-rated mental health, and sense of coherence. At the 12-month follow-up, the health coach will give each participant a second questionnaire to capture attitudes and perceptions related to health coaching and venues/activities offered.Qualitative data will be collected twice to obtain a deeper understanding of perceptions and attitudes related to health and lifestyle/lifestyle modifications. A health economic assessment will be performed. Individual costs for health care utilisation will be collected and QALY-scores will be estimated.

    DISCUSSION: Several drawbacks can be identified when conducting research in real life. However, many of the identified problems can diminish the positive results of the intervention and if the intervention shows positive effects they might be underestimated.

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    Health coaching to promote healthier lifestyle among older people at moderate risk for cardiovascular diseases, diabetes and depression: a study protocol for a randomized controlled trial in Sweden
  • 34.
    Sahlen, Klas-Göran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Löfgren, Curt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Brodin, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. FHI, Folkhälsoinstitutet.
    Dahlgren, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Measuring the value of older people's production: a diary study2012Ingår i: BMC Health Services Research, E-ISSN 1472-6963, artikel-id 4Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The productive capacity of retired people is usually not valued. However, some retirees produce much more than we might expect. This diary-based study identifies the activities of older people, and suggests some value mechanisms. One question raised is whether it is possible to scale up this diary study into a larger representative study.

    Methods: Diaries kept for one week were collected among 23 older people in the north of Sweden. The texts were analysed with a grounded theory approach; an interplay between ideas and empirical data.

    Results: Some productive activities of older people must be valued as the opportunity cost of time or according to the market value, and others must be valued with the replacement cost. In order to make the choice between these methods, it is important to consider the societal entitlement. When there is no societal entitlement, the first or second method must be used; and when it exists, the third must be used.

    Conclusions: An explicit investigation of the content of the entitlement is needed to justify the choice of valuation method for each activity. In a questionnaire addressing older people's production, each question must be adjusted to the type of production. In order to fully understand this production, it is important to consider the degree of free choice to conduct an activity, as well as health-related quality of life.

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  • 35.
    Sahlén, Klas Göran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hellner, Britt Mari
    IMS, Institutet för Metodutveckling i Socialt arbete.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Dahlgren, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Preventive home visits improve Swedish seniors' coping strategies and healthManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Preventive home visits (PHVs) promote health in old age.  Research indicates that PHVs have a positive health effect on mortality, admissions to institutions, and falls.  To understand how seniors perceive PHVs and how they cope with everyday life when PHVs have ended, five individual research interviews were conducted with seniors aged 79 – 88 years. Seniors with a low degree of control over their daily life appeared to gain more from PHVs than other seniors. To help seniors to increase control seems essential if they are to lead an independent and healthy life. PHVs can contribute to positive health development by improving seniors’ sense of control over their everyday lives and processing the used coping strategies. It is important that home visitors understand how the different coping strategies used by seniors affect health.

  • 36.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    An ounce of prevention is worth a pound of cure: preventive home visits among healthy seniors2009Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The aim of this thesis is to contribute to existing knowledge. If the knowledge is not useful in building society it has limited value. In order to be a tool for decision-makers, Preventive Home Visits (PHVs) are described and discussed according to a realist synthesis approach. The premise of this approach is that a single trial cannot tell the whole story and that understanding theoutcome pattern is much more important than seeking regularities in results across different trials. In order to understand the o utcome pattern, the PHV strategy in Nordmaling is examined against other trials and scientific work, and also in grey literature such as reports and workingpapers.

    An increasing population of seniors means that resources for health and elderly care are being scrutinised in order to achieve the best possible health for the money invested. PHVs represent one strategy that attempts to promote health among independent seniors. This thesis is a multidisciplinary study aiming to gain knowledge about the effects of PHVs and to understand the mechanisms of importance when implementing this particular strategy. The point of departure is a study conducted in Nordmaling in the north of Sweden among healthy seniors aged 75 years and over.

    The study, conducted as a controlled trial during 2000 and 2001, showed a decrease in mortality as well as the utilisation of care, and an improvement in indicators of perceived health. Cost analyses showed significant savings for the municipality following a reduction in the use of home help. These and other savings combined with costs of the intervention were related to saved life years and used to conduct health economic analyses. Medical and social records from the primary health centre and the municipality, along with official registers provided information for modelling health economic analyses from a lifetime perspective. Results showed that the costs of PHVs were less than 10 000 Euros per gained life year, against an acceptable level of cost effectiveness of 50 000 Euros. Using a shorter time perspective, the result was even more favourable for PHVs. It was evident that the time window used in the analyses, the normative choice of including future healthcare costs or not, and how to handle the value of the seniors’ production were important factors in determining the results.

    Two years after the trial, in-depth interviews were conducted with 5 seniors who had experienced PHVs, in order to gain understanding of the outcome of the PHV trial in Nordmaling.

    Participants were selected with respect to their health and how they responded to advice given during the PHV trial. Grounded Theory was used to analyse the interviews. Seniors who used autonomous coping strategies in everyday life gained less from PHVs than other seniors. All participants could benefit from PHVs, but in order for these to be successful it was important for the home visitor to be professional and to understand how the different coping strategies of seniors worked.

    Taken together, the different aspects of this study raised normative questions that are discussed in this thesis. One, whether the production of seniors has any monetary value in health economic analyses conducted from a societal perspective, was addressed in a smaller diary study where 23 seniors were asked to keep a diary in order to identify everything they did over a oneweek period. It was evident that most of the respondents “produced” a lot, however the production of seniors is rarely taken into account in health economic analyses. The concept of “senior production” includes both the market value of what seniors do, as well as the value of what society can avoid doing if the seniors are independent and healthy.

    Ladda ner fulltext (pdf)
    FULLTEXT01
  • 37.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för regionalvetenskap (CERUM).
    Hälsa På-projektet: Effekter av förebyggande hembesök hos pigga pensionärer i Nordmaling2002Rapport (Övrigt vetenskapligt)
    Ladda ner fulltext (pdf)
    FULLTEXT01
  • 38.
    Sahlén, Klas-Göran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Östlund, Ulrika
    Lämås, Kristina
    Lindgren, Britt Marie
    Enarsson, Per
    Juthberg, Christina
    Isaksson, Rose Marie
    Hajdarevic, Senada
    Saveman, Brittinger
    Nursing research in Sweden II2014Ingår i: The Japanese Journal of Nursing Research, ISSN 0022-8370, Vol. 47, nr 3, s. 234-240Artikel i tidskrift (Refereegranskat)
  • 39.
    Sahlén, Klas-Göran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Isaksson, Ulf
    Östlund, Ulrika
    Lämås, Kristina
    Lindgren, Britt-Marie
    Enarsson, Per
    Juthberg, Christina
    Isaksson, Rose Marie
    Hajdarevic, Senada
    Saveman, Brittinger
    Nursing research in Sweden2014Ingår i: The Japanese Journal of Nursing Research, ISSN 0022-8370, Vol. 47, nr 2, s. 126-133Artikel i tidskrift (Refereegranskat)
  • 40.
    Sahlén, Klas-Göran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Löfgren, Curt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Är det lönsamt med prevention efter 65?: Ålders betydelse i hälsoekonomiska utvärderingsmetoder: förebyggande hembesök i Nordmaling2006Rapport (Övrig (populärvetenskap, debatt, mm))
  • 41.
    Sjöberg, André
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Pettersson-Strömbäck, Anita
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Norström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    The burden of high workload on the health-related quality of life among home care workers in Northern Sweden2020Ingår i: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 93, nr 6, s. 747-764Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Previous studies have shown that high workload affects health negatively. However, studies are lacking among home care workers. The aim of this study is to examine the burden of perceived workload on health-related quality of life (HRQoL) among home care workers and to determine whether psychosocial factors modify such a relationship.

    METHODS: A cross-sectional study was conducted in which 1162 (58% response rate) home care workers participated. The psychosocial factors were measured by QPSnordic. HRQoL was measured by EuroQol 5 dimensions, from which responses were translated into quality-adjusted life year scores (QALY). Propensity scores were used with absolute risk differences (RD). Stratified analysis was used to test the buffer hypothesis of the demand-control-support model.

    RESULTS: Personnel with a high workload had a statistically significant 0.035 lower QALY than personnel with a normal workload. This difference was also statistically significant for the Visual Analogue Scale (RD 5.0) and the mobility (RD 0.033) and anxiety/depression scales (RD 0.20) dimensions of EQ-5D. For QALY, the effect of a high workload compared to a normal workload was higher, with low (RD 0.045, significant) compared with high (RD 0.015, non-significant) social support; while it was similar, and non-significant results, for low and high control.

    CONCLUSIONS: Our study shows that lowered work burden would be beneficial for home care personnel. Furthermore, our results suggest that interventions aimed at increasing social support could reduce work-related illness.

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  • 42.
    Sun, Sun
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Research Group Health Outcomes and Economic Evaluation, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Chuang, Ling-Hsiang
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Norström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Estimating a social value set for EQ-5D-5L in Sweden2022Ingår i: Health and Quality of Life Outcomes, E-ISSN 1477-7525, Vol. 20, nr 1, artikel-id 167Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The study aims to elicit a value set based on the EQ-VT for the EQ-5D-5L that can be used to support decision-making in Sweden.

    Methods: Participants were recruited from the general population based on age, sex and urban/rural area quota sampling from five regions across Sweden. In total, 785 interviews were conducted from February 2020 to April 2021 using the EQVT 2.1 protocol, and both composite time trade-off (c-TTO) and discrete choice experiments (DCE) were used to elicit health preferences. A variety of models have been tested for the c-TTO data (generalized least square, Tobit, heteroskedastic models) and DCE data (conditional logit model), as well as the combined c-TTO and DCE data (hybrid modelling). Model selection was based on theoretical considerations, logical consistency of the parameter estimates, and significance of the parameters (p = 0.05). Model goodness-of-fit was assessed by AIC and BIC, and prediction accuracy was assessed in terms of mean absolute error. The predictions for the EQ-5D-5L health states between models were compared using scatterplots.

    Results: The preferred model for generating the value set was the heteroskedastic model based on the c-TTO data, with the health utilities ranging from -0.31 for the worst (55,555) to 1 for the best (11111) EQ-5D-5L states.

    Conclusion: This is the first c-TTO-based social value set for the EQ-5D-5L in Sweden. It can be used to support the health utility estimation in economic evaluations for reimbursement decision making in Sweden.

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  • 43.
    Sun, Sun
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Research Group Health Outcomes and Economic Evaluation, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Center for Cancer Control and Policy Research, Shandong University, Jinan, Shandong Province, China.
    Jonsson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Andén, Mats
    Beckman, Lars
    Fransson, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Is ultra-hypo-fractionated radiotherapy more cost-effective relative to conventional fractionation in treatment of prostate cancer? A cost–utility analysis alongside a randomized HYPO-RT-PC trial2023Ingår i: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 24, s. 237-246Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Economic evidence for comparing low fraction with ultra-hypo fractionated (UHF) radiation therapy in the treatment of intermediate-to-high-risk prostate cancer (PC) is lacking, especially in Europe. This study presents an economic evaluation performed alongside an ongoing clinical trial.

    Aim: To investigate up to 6 years’ follow-up whether conventional fractionation (CF, 78.0 Gy in 39 fractions, 5 days per week for 8 weeks) is more cost-effective than UHF (42.7 Gy in 7 fractions, 3 days per week for 2.5 weeks inclusive of 2 weekends) radiotherapy in treatment for patients with intermediate-to-high-risk PC.

    Method: HYPO-RT-PC trial is an open-label, randomized, multicenter (10 in Sweden; 2 in Denmark) phase-3 trial. Patients from Sweden (CF 434; UHF 445) were included in this study. The trial database was linked to the National Patient Registry (NPR). Costs for inpatient/non-primary outpatient care for each episode were retrieved. For calculating Quality-adjusted life years (QALYs), the EORTC QLQ-C30 questionnaire was mapped to the EQ-5D-3L index. Multivariable regression analyses were used to compare the difference in costs and QALYs, adjusting for age and baseline costs, and health status. The confidence interval for the difference in costs, QALYs and incremental cost-effectiveness ratio effectiveness ratio (ICER) was estimated by the bootstrap percentile method.

    Results: No significant differences were found in ICER between the two arms after 6 years of follow-up.

    Conclusion: The current study did not support that the ultra-hypo-fractionated treatment was more cost-effective than the conventional fraction treatment up to the sixth year of the trial.

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  • 44.
    Sun, Sun
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Research Group Health Outcomes and Economic Evaluation, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Luo, Nan
    Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
    Stenberg, Erik
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Franklin, Karl A.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Cao, Yang
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Sequential Multiple Imputation for Real-World Health-Related Quality of Life Missing Data after Bariatric Surgery2022Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 17, artikel-id 10827Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    One of the main challenges for the successful implementation of health-related quality of life (HRQoL) assessments is missing data. The current study examined the feasibility and validity of a sequential multiple imputation (MI) method to deal with missing values in the longitudinal HRQoL data from the Scandinavian Obesity Surgery Registry. All patients in the SOReg who received bariatric surgery between 1 January 2011 and 31 March 2019 (n = 47,653) were included for the descriptive analysis and missingness pattern exploration. The patients who had completed the short-form 36 (SF-36) at baseline (year 0), and one-, two-, and five-year follow-ups were included (n = 3957) for the missingness pattern simulation and the sequential MI analysis. Eleven items of the SF-36 were selected to create the six domains of SF-6D, and the SF-6D utility index of each patient was calculated accordingly. The multiply-imputed variables in previous year were used as input to impute the missing values in later years. The performance of the sequential MI was evaluated by comparing the actual values with the imputed values of the selected SF-36 items and index at all four time points. At the baseline and year 1, where missing proportions were about 20% and 40%, respectively, there were no statistically significant discrepancies between the distributions of the actual and imputed responses (all p-values > 0.05). In year 2, where the missing proportion was about 60%, distributions of the actual and imputed responses were consistent in 9 of the 11 SF-36 items. However, in year 5, where the missing proportion was about 80%, no consistency was found between the actual and imputed responses in any of the SF-36 items. Relatively high missing proportions in HRQoL data are common in clinical registries, which brings a challenge to analyzing the HRQoL of longitudinal cohorts. The experimental sequential multiple imputation method adopted in the current study might be an ideal strategy for handling missing data (even though the follow-up survey had a missing proportion of 60%), avoiding significant information waste in the multivariate analysis. However, the imputations for data with higher missing proportions warrant more research.

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  • 45.
    Sun, Sun
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Research Group Health Outcomes and Economic Evaluation, Department of Learning, Informatics, Management and Ethics, Karolinska Instiutet, Solna, Sweden.
    Stenberg, Erik
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Cao, Yang
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Franklin, Karl A.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Luo, Nan
    NUS Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
    Mapping the obesity problems scale to the SF-6D: results based on the Scandinavian Obesity Surgery Registry (SOReg)2023Ingår i: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 24, s. 279-292Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Obesity Problem Scale (OP) is a widely applied instrument for obesity, however currently calculation of health utility based on OP is not feasible as it is not a preference-based measure. Using data from the Scandinavian Obesity Surgery Registry (SOReg), we sought to develop a mapping algorithm to estimate SF-6D utility from OP. Furthermore, to test whether the mapping algorithm is robust to the effect of surgery.

    METHOD: The source data SOReg (n = 36 706) contains both OP and SF-36, collected at pre-surgery and at 1, 2 and 5 years post-surgery. The Ordinary Least Square (OLS), beta-regression and Tobit regression were used to predict the SF-6D utility for different time points respectively. Besides the main effect model, different combinations of patient characteristics (age, sex, Body Mass Index, obesity-related comorbidities) were tested. Both internal validation (split-sample validation) and validation with testing the mapping algorithm on a dataset from other time points were carried out. A multi-stage model selection process was used, accessing model consistency, parsimony, goodness-of-fit and predictive accuracy. Models with the best performance were selected as the final mapping algorithms.

    RESULTS: The final mapping algorithms were based on OP summary score using OLS models, for pre- and post-surgery respectively. Mapping algorithms with different combinations of patients' characteristics were presented, to satisfy the user with a different need.

    CONCLUSION: This study makes available algorithms enabling crosswalk from the Obesity Problem Scale to the SF-6D utility. Different mapping algorithms are recommended for the mapping of pre- and post-operative data.

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  • 46.
    Sun, Sun
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Stenberg, Erik
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Franklin, Karl A.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Luo, Nan
    Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
    Cao, Yang
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Prediction of quality-adjusted life years (QALYs) after bariatric surgery using regularized linear regression models: results from a Swedish nationwide quality register2023Ingår i: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 33, nr 8, s. 2452-2462Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To investigate whether the quality-adjusted life years (QALYs) of the patients who underwent bariatric surgery could be predicted using their baseline information.

    Materials and Methods: All patients who received bariatric surgery in Sweden between January 1, 2011 and March 31, 2019 were obtained from the Scandinavian Obesity Surgery Registry (SOReg). Baseline information included patients' sociodemographic characteristics, details regarding the procedure, and postsurgical conditions. QALYs were assessed by the SF-6D at follow-up years 1 and 2. The general and regularized linear regression models were used to predict postoperative QALYs.

    Results: All regression models demonstrated satisfactory and comparable performance in predicting QALYs at follow-up year 1, with R2 and relative root mean squared error (RRMSE) values of about 0.57 and 9.6%, respectively. The performance of the general linear regression model increased with the number of variables; however, the improvement was ignorable when the number of variables was more than 30 and 50 for follow-up years 1 and 2, respectively. Although minor L1 and L2 regularization provided better prediction ability, the improvement was negligible when the number of variables was more than 20. All the models showed poorer performance for predicting QALYs at follow-up year 2.

    Conclusions: Patient characteristics before bariatric surgery including health related quality of life, age, sex, BMI, postoperative complications within six weeks, and smoking status, may be adequate in predicting their postoperative QALYs after one year. Understanding these factors can help identify individuals who require more personalized and intensive support before, during, and after surgery. 

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  • 47.
    Sun, Sun
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Stenberg, Erik
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Luo, Nan
    Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
    Franklin, Karl A.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Cao, Yang
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    SF-6D normative values among patients undergoing bariatric surgery: results based on real-world evidence from the Scandinavian obesity surgery registry (SOREG)2024Ingår i: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 34, s. 558-567Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The SF-6D index can be used to calculate quality-adjusted life years in economic evaluations, which is required by reimbursement agencies and national advisory bodies, including the Swedish ones. However, despite that SF-36 has been largely applied among patients undergoing bariatric surgery, almost no study has accessed the short form six-dimensions (SF-6D) after bariatric surgery.

    Aim: To establish normative values for the SF-6D index among patients undergoing bariatric surgery.

    Materials and Methods: All patients who received bariatric surgery in Sweden between 2011–01-01 and 2019–03-31 were obtained from the Scandinavian Obesity Surgery Registry (SOReg). Information includes patients’ sociodemographic characteristics, details regarding the procedure, and postsurgical conditions. The SF-36 is applied at baseline and at follow-up years 1, 2, and 5. The multiple sequential imputation method was applied to handle missingness on SF-6D items. Based on the UK tariff, the SF-6D preference scores were calculated. The normative values for the mean (SD) SF-6D index were reported by timepoint and surgical complications for men and women, respectively. Multivariate analyses were applied to investigate how the SF-6D index is associated with timepoint, controlling for age, sex, BMI, and comorbidities in a stepwise manner.

    Results: The SF-6D index increased at 1 year relative to baseline and was roughly maintained at the same level at 2 years. The normative value of the SF-6D index can be used in economic evaluations for bariatric surgery. 

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  • 48.
    Swai, Elia Asanterabi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Department of Physiotherapy, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania.
    Moshi, Haleluya Imanueli
    Department of Physiotherapy, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania.
    Msuya, Sia Emmanueli
    Community Health Department, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania; Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania; Department of Community Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sörlin, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Adaptive adjustment to the needs of families caring for children and adolescents with physical disabilities in north-eastern Tanzania: a grounded-theory study2024Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 17, nr 1, artikel-id 2354009Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Family interactions, which are always multi-faceted, are complicated further by family members with disabilities. In resource-poor settings, policies and programmes that address the needs of and challenges faced by families are often inaccessible or unavailable. Approximately 13% of the families in Tanzania have at least one member with a disability, yet family-centred research on caring for disabled children and adolescents is scarce in this context.

    OBJECTIVE: The aim is to explore the needs and challenges faced by families that care for children and adolescents with physical disabilities in the Kilimanjaro Region of north-eastern Tanzania.

    METHODS: This qualitative study had a constructivist grounded-theory design. In-depth interviews, using a semi-structured interview guide based on the social-capital framework, were conducted with 12 female participants aged between 24 and 80. A conceptual model of family needs, inspired by Maslow's hierarchy of needs, informed the analysis.

    RESULTS: Challenging needs were grouped into five categories, which were linked to Maslow's hierarchy of needs and related to the central concept of 'adaptive adjustment': (1) 'barely surviving'; (2) 'safety needs in jeopardy'; (3) 'sociocultural protection'; (4) 'self-esteem far beyond reach', and (5) 'dreaming of self-actualisation'.

    CONCLUSION: Families caring for children and adolescents with physical disabilities in north-eastern Tanzania have needs that extend beyond the available and accessible resources. Families can adjust and adapt by avoiding certain situations, accepting the reality of their circumstances and exploring alternative ways of coping. A sustainable support system, including social networks, is essential for meeting basic needs and ensuring safety.

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  • 49.
    Swai, Elia Asanterabi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Physiotherapy, Faculty of Rehabilitation Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
    Msuya, Sia E
    Moshi, Haleluya
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sörlin, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Children and adolescents with physical disabilities: describing characteristics and disability-related needs in the Kilimanjaro region, north-eastern Tanzania – a cross-sectional survey2023Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 13, nr 1, artikel-id e064849Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To describe the characteristics and disability-related needs of children and adolescents with physical disabilities in the Kilimanjaro region, North-Eastern Tanzania.

    Design: A cross-sectional community survey was conducted from November 2020 to June 2021. Trained research assistants interviewed primary children’s carers using a questionnaire based on the International Classification of Functioning, Disability and Health-Children and Youth Framework. Data were analysed using IBM SPSS Statistics V.27. The Pearson χ2 test was used to examine differences between age, gender and self-reported needs. The independent t-test assessed difference in needs according to age and gender.

    Setting: Kilimanjaro region, Tanzania.

    Participants: Children and adolescents, aged 2–18 years, with physical disabilities (n=212).

    Results: Almost 40% had severe speech (n=84) and joint mobility (n=79) impairments, and more than half (n=124) had severe or complete difficulties walking. In aspects of self-care (caring for body parts, toileting, dressing, eating and drinking), most had severe and complete difficulties. Almost 70% (n=135) of households were located near health facilities without rehabilitation services. About one-quarter (n=51) had never received rehabilitation services. More than 90% (n=196) needed assistive devices, and therapeutic exercises (n=193). Over three-quarters needed nutritional supplements (n=162).

    Conclusion: Children and adolescents with physical disabilities in North-Eastern Tanzania have impaired speech and joint mobility, and difficulties in communication, self-care and walking. Rehabilitation services essential for addressing these impairments and activity limitations are either scarce or inaccessible. Action is needed to facilitate urban and rural access to rehabilitation services in order to improve the well-being of children and adolescents with physical disabilities.

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  • 50.
    Ubels, Jasper
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sable, Craig
    Children's National Health System, Washington, DC, US.
    Beaton, Andrea Z.
    The Heart Institute, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, US.
    Nunes, Maria Carmo P.
    Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.
    Oliveira, Kaciane K. B.
    Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.
    Rabelo, Lara C.
    Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.
    Teixeira, Isabella M.
    Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.
    Ruiz, Gabriela Z. L.
    Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.
    Rabelo, Letícia Maria M.
    Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.
    Tompsett, Alison R.
    The Heart Institute, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, US.
    Ribeiro, Antonio Luiz P.
    Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Nascimento, Bruno R.
    Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.
    Cost-Effectiveness of Rheumatic Heart Disease Echocardiographic Screening in Brazil: Data from the PROVAR+ Study2020Ingår i: Global heart, ISSN 2211-8179, Vol. 15, nr 1, artikel-id 18Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: In recent years, new technologies - noticeably ultra-portable echocardiographic machines - have emerged, allowing for Rheumatic Heart Disease (RHD) early diagnosis. We aimed to perform a cost-utility analysis to assess the cost-effectiveness of RHD screening with handheld devices in the Brazilian context.

    Methods: A Markov model was created to assess the cost-effectiveness of one-time screening for RHD in a hypothetical cohort of 11-year-old socioeconomically disadvantaged children, comparing the intervention to standard care using a public perspective and a 30-year time horizon. The model consisted of 13 states: No RHD, Undiagnosed Asymptomatic Borderline RHD, Diagnosed Asymptomatic Borderline RHD, Untreated Asymptomatic Definite RHD, Treated Asymptomatic Definite RHD, Untreated Mild Clinical RHD, Treated Mild Clinical RHD, Untreated Severe Clinical RHD, Treated Severe Clinical RHD, Surgery, Post-Surgery and Death. The initial distribution of the population over the different states was derived from primary echo screening data. Costs of the different states were derived from the Brazilian public health system database. Transition probabilities and utilities were derived from published studies. A discount rate of 3%/year was used. A cost-effectiveness threshold of $25,949.85 per Disability Adjusted Life Year (DALY) averted is used in concordance with the 3x GDP per capita threshold in 2015.

    Results: RHD echo screening is cost-effective with an Incremental Cost-Effectiveness Ratio of $10,148.38 per DALY averted. Probabilistic modelling shows that the intervention could be considered cost-effective in 70% of the iterations.

    Conclusion: Screening for RHD with hand held echocardiographic machines in 11-year-old children in the target population is cost-effective in the Brazilian context.

    Highlights: A cost-effectiveness analysis showed that Rheumatic Heart Disease (RHD) echocardiographic screening utilizing handheld devices, performed by non-physicians with remote interpretation by telemedicine is cost-effective in a 30-year time horizon in Brazil.The model included primary data from the first large-scale RHD screening program in Brazilian underserved populations and costs from the Unified Health System (SUS), and suggests that the Incremental Cost-Effectiveness Ratio of the intervention is considerably below the acceptable threshold for Brazil, even after a detailed sensitivity analysis.Considering the high prevalence of subclinical RHD in Brazil, and the significant economic burden posed by advanced disease, these data are important for the formulation of public policies and surveillance approaches.Cost-saving strategies first implemented in Brazil by the PROVAR study, such as task-shifting to non-physicians, computer-based training, routine use of affordable devices and telemedicine for remote diagnosis may help planning RHD control programs in endemic areas worldwide.

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