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  • 1.
    Abazi, Doresa
    et al.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Företagsekonomiska institutionen.
    Vasilevski, Daniella
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Företagsekonomiska institutionen.
    Management Control in Swedish healthcare: A study of how cost control affects physicians' performance and their ability to maintain patient safety2022Självständigt arbete på avancerad nivå (masterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    The purpose of this study is to gain insight into how cost control affects physicians’ performance in terms of motivation and dysfunctional behaviour, and their ability to maintain patient safety. In the study, a qualitative method was used and four participants from Danderyd hospital were interviewed with semi-structured questions to gain material to answer the research question. In order to analyse the data, transcriptions of the interviews were made, and a thematic analysis method was used. Based on the analysis, four main themes emerged; Cost control, Motivation, Change in Behaviour and Patient safety.

    Among the physicians, results showed that physicians’ performance is negatively affected by cost control, resulting in decreased patient safety. Motivation was found to be indirectly affected and dysfunctional behaviours were found to be negatively affected by cost control. Resulting of cost control, physicians cannot fulfil their ethical obligations and perform more poorly because resources are decreased, primarily due to lack of care beds. Furthermore, the findings indicate that patient safety is negatively affected by the influence of cost control on dysfunctional behaviour. There is no adverse effect of cost control on patient safety when it comes to motivation.

    Ladda ner fulltext (pdf)
    fulltext
  • 2.
    Adamiak, Grazyna Teresa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Påverkan av organisatoriska och miljömässiga faktorer på tillgänglighet till akutsjukvården2004Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [sv]

    De studerade enheterna var kliniker för internmedicin, ortopedi och kirurgi vid akutsjukhus i Sverige. Studiernas syfte var att identifiera exogena och endogena determinanter av tillgänglighet till sjukvården. Kvalitativa och kvantitativa analyser av vårdutnyttjande utfördes på nationell och regional nivå av dataaggregering. Studierna utmynnar i slutsatsen att tillgängligheten till akutsjukvården påverkas av exogena faktorer, delvis utanför kontrollen för de professionella inom sjukvården, såsom säsong, fysiskt avstånd och totalt utbud. Organisatoriska egenskaper som tillgången till vårdplatser, sjukhusens och läkarnas specialisering och graden av systemintegration mellan producenter av akutvård har effekter på vårdens kvalitet. Det nya fyndet utgörs av upptäckten av en stark association mellan akuta återinskrivningar och övriga inskrivningar. Sambandet indikerar effekterna av vårdplatsutbudet på totalt slutenvårdsutnyttjande inom internmedicinen. Slutsatserna är som följer:

    § strukturell förändring på systemnivå fungerar som metod för prioritering mellan patientgrupper genom förändrad tillgänglighet;

    § den naturliga och den organisatoriska miljön determinerar servicekvaliteten på akutmottagningar vid sjukhusen och tillgängligheten till det akuta vårdutnyttjandet genom fluktuationer i efterfrågan;

    § den geografiska tillgängligheten samvarierar med utbudet, dvs. överutnyttjandet eller underutnyttjandet som återspeglas i medicinskt utfall;

    § vårdsystemets utfall mätt som akuta återinskrivningar i sluten vård inom internmedicinen (effektiv tillgänglighet) beror på distributionen av vårdens resurser, framförallt fördelningen mellan sluten och poliklinisk vård och det totala utbudet av slutenvårdsplatser;

    § den ökande efterfrågan på akut omhändertagande inom internmedicinen kan härledas till problem i vården av kroniskt sjuka, äldre patienter;

    § informationsöverföring och kommunikation mellan vårdgivare och med patienter varierar i effektivitet beroende på samordning och mekanismer för systemintegration;

    § effektiv tillgänglighet till och ändamålsenlighet i den slutna internmedicinska vården påverkas av läkarnas specialisering.

    Det finns uppenbara konflikter mellan tillgänglighet, produktivitet och vårdgivarens ändamålsenlighet. Det fordras större uppmärksamhet på kapaciteten att tillgodogöra sig behandling utöver behov som ett kriterium för prioritering mellan patientgrupper.

    Delarbeten
    1. Integrated care for the elderly.: The background and effects of the reform of Swedish care of the elderly.
    Öppna denna publikation i ny flik eller fönster >>Integrated care for the elderly.: The background and effects of the reform of Swedish care of the elderly.
    2000 Ingår i: International Journal of Integrated Care, ISSN 1568-4156, nr 1Artikel i tidskrift (Refereegranskat) Published
    Identifikatorer
    urn:nbn:se:uu:diva-91354 (URN)
    Tillgänglig från: 2004-02-13 Skapad: 2004-02-13Bibliografiskt granskad
    2. Lack of inegration and seasonal variation in demand explained performance problems and waiting times for patients at emergency departments: A 3 years evaluation of the shift of responsibility between primary and secondary care by closure of two acute hospitals
    Öppna denna publikation i ny flik eller fönster >>Lack of inegration and seasonal variation in demand explained performance problems and waiting times for patients at emergency departments: A 3 years evaluation of the shift of responsibility between primary and secondary care by closure of two acute hospitals
    2001 Ingår i: Health Policy, Vol. 55, s. 187-207Artikel i tidskrift (Refereegranskat) Published
    Identifikatorer
    urn:nbn:se:uu:diva-91355 (URN)
    Tillgänglig från: 2004-02-13 Skapad: 2004-02-13Bibliografiskt granskad
    3. Impact of proximity and hospital specialisation on appropriateness of emergency readmissions
    Öppna denna publikation i ny flik eller fönster >>Impact of proximity and hospital specialisation on appropriateness of emergency readmissions
    (Engelska)Ingår i: Journal of Evaluation in Clinical PracticeArtikel i tidskrift (Refereegranskat) Accepted
    Identifikatorer
    urn:nbn:se:uu:diva-91356 (URN)
    Tillgänglig från: 2004-02-13 Skapad: 2004-02-13 Senast uppdaterad: 2010-05-24Bibliografiskt granskad
    4. Situation in Sweden
    Öppna denna publikation i ny flik eller fönster >>Situation in Sweden
    2003 Ingår i: Integrated Care in Europe.: Description and comparison of integrated care in six EU countries., 2003, s. 41-68Kapitel i bok, del av antologi (Övrigt vetenskapligt) Published
    Identifikatorer
    urn:nbn:se:uu:diva-91357 (URN)90 352 2605-4 (ISBN)
    Tillgänglig från: 2004-02-13 Skapad: 2004-02-13Bibliografiskt granskad
    5. The impact of physician training level on emergency readmissions within internal medicine
    Öppna denna publikation i ny flik eller fönster >>The impact of physician training level on emergency readmissions within internal medicine
    2004 (Engelska)Ingår i: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 20, nr 4, s. 516-23Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objectives: The research question was whether training level of admitting physicians and referrals from practitioners in primary health care (PHC) are risk factors for emergency readmission within 30 days to internal medicine.

    Methods: This report is a prospective multicenter study carried out during 1 month in 1997 in seven departments of internal medicine in the County of Stockholm, Sweden. Two of the units were at university hospitals, three at county hospitals and two in district hospitals. The study area is metropolitan–suburban with 1,762,924 residents. Data were analyzed by multiple logistic regression.

    Results: A total of 5,131 admissions, thereby 408 unplanned readmissions (8 percent) were registered (69.8 percent of 7,348 true inpatient episodes). The risk of emergency readmission increased with patient's age and independently 1.40 times (95 percent confidence interval [CI], 1.13–1.74) when residents decided on hospitalization. Congestive heart failure as primary or comorbid condition was the main reason for unplanned readmission. Referrals from PHC were associated with risk decrease (odds ratio, 0.53; 95 percent CI, 0.38–0.73).

    Conclusion: The causes of unplanned hospital readmissions are mixed. Patient contact with primary health care appears to reduce the recurrence. In addition to the diagnoses of cardiac failure, training level of admitting physicians in emergency departments was an independent risk factor for early readmission. Our conclusion is that it is cost-effective to have all decisions on admission to hospital care confirmed by senior doctors. Inappropriate selection of patients to inpatient care contributes to poor patient outcomes and reduces cost-effectiveness and quality of care.

    Nyckelord
    Emergency readmission; Clinical experience; Training level; Internal medicine; Referrals.
    Identifikatorer
    urn:nbn:se:uu:diva-91358 (URN)10.1017/S0266462304001448 (DOI)
    Tillgänglig från: 2004-02-13 Skapad: 2004-02-13 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
    Ladda ner fulltext (pdf)
    FULLTEXT01
  • 3.
    Ahlstedt, Carina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Registered nurses' work motivation and intention to stay at the workplace2024Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    There is currently a shortage of registered nurses (RNs) and high turnover of RNs, both nationally and internationally. Work motivation is an important part of a healthy work environment and something we need to know more about from an RN perspective.

    The overarching aim of this thesis was to enhance our understanding of the organisational and social workplace factors that contribute to an attractive environment for RNs, by exploring factors associated with work motivation. Four research questions were posed. (i) What factors create the conditions for motivation in RNs’ daily work? (ii) What role does social support in the workplace play in RNs’ work motivation? (iii) What role does the opportunity to work with relevant tasks play in RNs’ work motivation? (iv) Are there differences between healthcare settings regarding RNs’ social support, illegitimate tasks, and associations with work motivation? Four empirical studies were performed to answer these questions. Two were qualitative studies based on an ethnographic approach and two were quantitative cross-sectional studies based on a stratified national sample of RNs. The results of the qualitative studies indicate that crucial factors for RNs' work motivation include a friendly and permissive atmosphere in daily work. Visible progress and receiving feedback from the work itself also positively contributed to motivation. Additionally, RNs' opportunities to learn and support each other through ongoing communication during daily work tended to have a positive impact on work motivation. Effective collaboration between physicians and RNs with mutual respect, understanding of each other's competencies, and creating an environment where RNs could seek clarification were also central to work motivation. The quantitative studies revealed that the opportunity for social support from the immediate manager or co-workers was significant for dimensions related to RNs’ work motivation and the willingness to stay in the workplace. The associations differed in strength between healthcare settings. Furthermore, the results indicated that a factor in RNs' work motivation was the ability to work with tasks perceived as relevant, not illegitimate. However, the results highlighted that a significant portion of RNs performed illegitimate tasks, and that illegitimate tasks were more prevalent for RNs in home healthcare than those in primary care and hospitals. This is something to consider as more complex care is being conducted outside of hospitals. The thesis adds new knowledge that can be useful to the development of attractive workplaces, which could contribute to more RNs choosing to remain in their position for a longer period.

    Delarbeten
    1. What makes registered nurses remain in work?: An ethnographic study
    Öppna denna publikation i ny flik eller fönster >>What makes registered nurses remain in work?: An ethnographic study
    2019 (Engelska)Ingår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 89, s. 32-38Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background: Registered nurses' work-related stress, dissatisfaction and burnout are some of the problems in the healthcare and that negatively affect healthcare quality and patient care. A prerequisite for sustained high quality at work is that the registered nurses are motivated. High motivation has been proved to lead to better working results. The theory of inner work life describes the dynamic interplay between a person's perceptions, emotions and motivation and the three key factors for a good working life: nourishment, progress and catalysts. Objectives: The aim of the study was to explore registered nurses' workday events in relation to inner work life theory, to better understand what influences registered nurses to remain in work. Design: A qualitative explorative study with an ethnographic approach. Methods: Participant observation over four months; in total 56 h with 479 events and 58 informal interviews during observation; all registered nurses employed at the unit (n = 10) were included. In addition, individual interviews were conducted after the observation period (n = 9). The dataset was analysed using thematic analysis and in the final step of the analysis the categories were reflected in relation to the three key factors in theory of inner work life. Results: Nourishment in a registered nurse context describes the work motivation created by the interpersonal support between colleagues. It was important to registered nurses that physicians and colleagues respected and trusted their knowledge in the daily work, and that they felt comfortable asking questions and supporting each other. Progress in the context of registered nurses' work motivation was the feeling of moving forward with a mix of small wins and the perception of solving more complex challenges in daily work. It was also fundamental to the registered nurses' development through new knowledge and learning during daily work. Catalysts, actions that directly facilitate the work, were highlighted as the possibility to work independently along with the opportunity to work together with other registered nurses. Conclusion: This study has a number of implications for future work and research on creating an attractive workplace for registered nurses. Working independently, with colleagues from the same profession, integrated with learning, visible progress, and receiving feedback from the work itself, contribute to work motivation.

    Nationell ämneskategori
    Annan hälsovetenskap
    Forskningsämne
    Hälso- och sjukvårdsforskning
    Identifikatorer
    urn:nbn:se:uu:diva-364722 (URN)10.1016/j.ijnurstu.2018.09.008 (DOI)000454965700006 ()30339953 (PubMedID)
    Tillgänglig från: 2018-10-31 Skapad: 2018-10-31 Senast uppdaterad: 2024-02-22Bibliografiskt granskad
    2. Flourishing at work: Nurses' motivation through daily communication - An ethnographic approach
    Öppna denna publikation i ny flik eller fönster >>Flourishing at work: Nurses' motivation through daily communication - An ethnographic approach
    2020 (Engelska)Ingår i: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 22, nr 4, s. 1169-1176Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Shortage and turnover of registered nurses are worldwide challenges, and work motiva-tion is one factor in retaining staff in the healthcare sector. The aim of this study was toexplore registered nurses' motivation expressed in daily communication, using the basicneeds in self-determination theory as a framework. A secondary analysis of ethno-graphic data, collected through participant observations, informal interviews duringobservations, and individual interviews, was used. A total sample of all registered nursesemployed at a hospital unit in Sweden (n = 10) participated. The data were analyzed the-matically through the lens of the basic needs in self-determination theory: autonomy,competence, and relatedness. Self-regulation of learning, the possibilities to discuss work-related challenges with colleagues, and having registered nurses lead dialogues with phy-sicians were factors connected to autonomy. Having a registered nurse and physiciansolve problems together was a factor connected to competence.Asenseofbelongingand security in a permissive climate between registered nurses was co nnected to relat-edness. This paper has implications for increased awareness of the three basic motiva-tional needs, which could be used in the development of attractive workplaces

    Ort, förlag, år, upplaga, sidor
    Australia: John Wiley & Sons, 2020
    Nyckelord
    Nurse, Motivation, Collegiality, Communication, Self-determination theory, SDT, Sjuksköterska, Kommunikation, Självbestämmande teori, SDT
    Nationell ämneskategori
    Omvårdnad
    Forskningsämne
    Hälso- och sjukvårdsforskning
    Identifikatorer
    urn:nbn:se:uu:diva-427494 (URN)10.1111/nhs.12789 (DOI)000589631400001 ()33104296 (PubMedID)
    Tillgänglig från: 2020-12-08 Skapad: 2020-12-08 Senast uppdaterad: 2024-02-22Bibliografiskt granskad
    3. Social support from manager and co-workers in relation to registered nurses' work motivation in three healthcare settings: A cross-sectional study of a Swedish national sample
    Öppna denna publikation i ny flik eller fönster >>Social support from manager and co-workers in relation to registered nurses' work motivation in three healthcare settings: A cross-sectional study of a Swedish national sample
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Hälsovetenskaper
    Identifikatorer
    urn:nbn:se:uu:diva-523641 (URN)
    Tillgänglig från: 2024-02-21 Skapad: 2024-02-21 Senast uppdaterad: 2024-02-22
    4. Do illegitimate tasks matter for registered nurses' work motivation?: A cross-sectional study based on a nationally representative sample of Swedish nurses
    Öppna denna publikation i ny flik eller fönster >>Do illegitimate tasks matter for registered nurses' work motivation?: A cross-sectional study based on a nationally representative sample of Swedish nurses
    2023 (Engelska)Ingår i: The International Journal of Nursing Studies Advances (IJNS Advances), E-ISSN 2666-142X, Vol. 5, artikel-id 100159Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background: A challenge in Western countries is the growing need for registered nurses (RNs') in hospitals, primary care and home healthcare. Decreasing illegitimate tasks and strengthening RNs' work motivation are some strategies to address this challenge.

    Objective: Our overall aim was to explore the association between RNs' experiences of illegitimate tasks and work motivation operationalised as four dimensions: work engagement, opportunities to provide high-quality care, employer satisfaction and intention to remain at the workplace. To address this aim, three specific research questions were asked: (1) Is there an association between illegitimate tasks and work motivation? (2) Do the levels of reported illegitimate tasks differ between RNs working in hospitals and those working in primary care or home healthcare settings? (3) Do associations between illegitimate work tasks and work motivation differ with type of workplace?

    Design: A cross-sectional design.

    Methods: We used responses from a stratified population of RNs in Sweden, n = 2,333, working either in hospitals, primary care or home healthcare. Calibrating weights were applied in all analyses to ascertain the generalisability of the findings. Illegitimate tasks were measured with the Bern Illegitimate Tasks Scale. Data were analysed using chi-squared tests and linear or logistic regression analysis. Interaction was measured on the multiplicative scale by adding an interaction term to the fully adjusted models.

    Results: Overall, approximately 25 % of RNs reported frequently experiencing illegitimate tasks. There were statistically significant associations between higher perceptions of illegitimate tasks and lower ratings in the four dimensions of work motivation: work engagement [beta coefficient [beta] = -0.14, confidence interval [CI] 95 % = -0.18; -0.10], opportunities to provide highquality care [beta = -0.46, CI 95 % = -0.51; -40] and employer satisfaction [beta = -0.60, CI 95 % = -0.67; -0.54]. Experiencing higher levels of illegitimate tasks also related to a decreased intention to remain at the workplace [illegitimate tasks: odds ratio = 0.32, CI 95 % = 0.27; 0.29]. RNs who worked in home healthcare reported higher levels of illegitimate tasks than RNs who worked in hospitals.

    Conclusions: Reducing the amount of illegitimate tasks may contribute to counteracting the shortage of RNs by increasing work motivation and willingness to remain at the workplace.

    Ort, förlag, år, upplaga, sidor
    Elsevier, 2023
    Nyckelord
    Cross-sectional survey, Healthcare organisations, Motivation, Registered nurses, Work engagement
    Nationell ämneskategori
    Omvårdnad Tillämpad psykologi
    Identifikatorer
    urn:nbn:se:uu:diva-517487 (URN)10.1016/j.ijnsa.2023.100159 (DOI)001102021300001 ()
    Tillgänglig från: 2023-12-11 Skapad: 2023-12-11 Senast uppdaterad: 2024-02-22Bibliografiskt granskad
    Ladda ner fulltext (pdf)
    UUThesis_C-Ahlstedt-2024
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    preview image
  • 4.
    Ahmadi, Zainab
    et al.
    Lund Univ, Dept Clin Sci Lund, Resp Med Allergol & Palliat Med, Lund, Sweden..
    Björk, Joar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Centrum för forsknings- och bioetik. Karolinska Inst, Stockholm Ctr Healthcare Eth CHE, LIME, Stockholm, Sweden.
    Gilljam, Hans
    Karolinska Inst, Dept Global Publ Hlth, Stockholm, Sweden..
    Gogineni, Madhuri
    Stockholms Sjukhem, Palliat Home Care & Hosp Wards, Stockholm, Sweden..
    Gustafsson, Torbjörn
    Runold, Michael
    Karolinska Univ Hosp, Dept Resp Med & Allergy, Stockholm, Sweden.;Karolinska Inst, Dept Med Solna, Resp Med Unit, Stockholm, Sweden..
    Ringbæk, Thomas
    Univ Hosp Umeå, Dept Resp Med & Allergy, Umeå, Sweden.;Allergy & Lung Clin, Elsinore, Denmark..
    Wahlberg, Josefin
    Blekinge Hosp, Dept Med, Karlskrona, Sweden..
    Wendel, Lotta
    Malmö Univ, Fac Hlth & Soc, Malmö, Sweden..
    Ekström, Magnus
    Lund Univ, Dept Clin Sci Lund, Resp Med Allergol & Palliat Med, Lund, Sweden..
    Smoking and home oxygen therapy: a review and consensus statement from a multidisciplinary Swedish taskforce2024Ingår i: European Respiratory Review, ISSN 0905-9180, E-ISSN 1600-0617, Vol. 33, nr 171, artikel-id 230194Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Home oxygen therapy (HOT) improves survival in patients with hypoxaemic chronic respiratory disease. Most patients evaluated for HOT are former or active smokers. Oxygen accelerates combustion and smoking may increase the risk of burn injuries and fire hazards; therefore, it is considered a contraindication for HOT in many countries. However, there is variability in the practices and policies regarding this matter. This multidisciplinary Swedish taskforce aimed to review the potential benefits and risks of smoking in relation to HOT, including medical, practical, legal and ethical considerations.

    Methods: The taskforce of the Swedish Respiratory Society comprises 15 members across respiratory medicine, nursing, medical law and ethics. HOT effectiveness and adverse risks related to smoking, as well as practical, legal and ethical considerations, were reviewed, resulting in five general questions and four PICO (population–intervention–comparator–outcome) questions. The strength of each recommendation was rated according to the GRADE (grading of recommendation assessment, development and evaluation) methodology.

    Results: General questions about the practical, legal and ethical aspects of HOT were discussed and summarised in the document. The PICO questions resulted in recommendations about assessment, management and follow-up of smoking when considering HOT, if HOT should be offered to people that meet the eligibility criteria but who continue to smoke, if a specific length of time of smoking cessation should be considered before assessing eligibility for HOT, and identification of areas for further research.

    Conclusions: Multiple factors need to be considered in the benefit/risk evaluation of HOT in active smokers. A systematic approach is suggested to guide healthcare professionals in evaluating HOT in relation to smoking.

    Ladda ner fulltext (pdf)
    FULLTEXT01
  • 5.
    Ahmed, Anisuddin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell barnhälsa och nutrition. Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Sayeed, Abu
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Tanwi, Tania Sultana
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Saha, Nondo
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Hanson, Molly
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell barnhälsa och nutrition.
    Protyai, Dipanjan Adhikary
    Univ Dhaka, Inst Stat Res & Training, Dhaka, Bangladesh..
    Hossain, Aniqa Tasnim
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Ahmed, Ali
    Western Sydney Univ, Penrith Campus, Sydney, Australia..
    Rahman, Fariya
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Akter, Ema
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Nusrat, Nowrin
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Badsha, Md Shawon
    Univ Dhaka, Inst Stat Res & Training, Dhaka, Bangladesh..
    Rahman, Afruna
    Int Ctr Diarrhoeal Dis Res Icddr B, Infect Dis Div IDD, Dhaka, Bangladesh..
    Islam, Md Khairul
    WaterAid, Dhaka, Bangladesh..
    Alam, Md. Shah
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Nahar, Quamrun
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Arifeen, Shams El
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Rahman, Ahmed Ehsanur
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Tahsina, Tazeen
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Trends and inequity in improved sanitation facility utilisation in Bangladesh: Evidence from Bangladesh Demographic and Health Surveys2023Ingår i: BMC Research Notes, E-ISSN 1756-0500, Vol. 16, artikel-id 303Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Improved sanitation is indispensable to human health. However, lack of access to improved sanitation remains one of the most daunting public health challenges of the twenty-first century in Bangladesh. The aim of the study was to describe the trends in access to improved sanitation facilities following the inequity gap among households in different socioeconomic groups in Bangladesh. Data from the Bangladesh Demographic and Health Survey (BDHS) 2007, 2011, 2014, and 2017-18 were extracted for this study. Inequity in access to improved sanitation was calculated using rich-poor ratio and concentration index to determine the changes in inequity across the time period. In Bangladesh, the proportion of households with access to improved sanitation increased steadily from 25.4% to 45.4% between 2007 and 2014, but slightly decreased to 44.0% in 2017-18. Age, educational status, marital status of household head, household wealth index, household size, place of residence, division, and survey year were significantly associated with the utilisation of improved sanitation. There is a pro-rich situation, which means that utilisation of improved sanitation was more concentrated among the rich across all survey years (Concentration Index ranges: 0.40 to 0.27). The government and other relevant stakeholders should take initiatives considering inequity among different socioeconomic groups to ensure the use of improved sanitation facilities for all, hence achieving universal health coverage.

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  • 6. Aktaa, Suleman
    et al.
    Batra, Gorav
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    Wallentin, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    Baigent, Colin
    Erlinge, David
    James, Stefan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    Ludman, Peter
    Maggioni, Aldo P.
    Price, Susanna
    Weston, Clive
    Casadei, Barbara
    Gale, Chris P.
    European Society of Cardiology methodology for the development of quality indicators for the quantification of cardiovascular care and outcomes2022Ingår i: European Heart Journal - Quality of Care and Clinical Outcomes, ISSN 2058-5225, E-ISSN 2058-1742, Vol. 8, nr 1, s. 4-13Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    AIMS: It is increasingly recognised that tools are required for assessing and benchmarking quality of care in order to improve it. The European Society of Cardiology (ESC) is developing a suite of quality indicators (QIs) to evaluate cardiovascular care and support the delivery of evidence-based care. This paper describes the methodology used for their development.

    METHODS AND RESULTS: We propose a four-step process for the development of the ESC QIs. For a specific clinical area with a gap in care delivery, the QI development process includes: 1) the identification of key domains of care by constructing a conceptual framework of care; 2) the construction of candidate QIs by conducting a systematic review of the literature; 3) the selection of a final set of QIs by obtaining expert opinions using the modified Delphi method; and 4) the undertaking of a feasibility assessment by evaluating different ways of defining the QI specifications for the proposed data collection source. For each of the four steps, key methodological areas need to be addressed to inform the implementation process and avoid misinterpretation of the measurement results.

    CONCLUSION: Detailing the methodology for the ESC QIs construction enables healthcare providers to develop valid and feasible metrics to measure and improve the quality of cardiovascular care. As such, high-quality evidence may be translated into clinical practice and the 'evidence-practice' gap closed.

  • 7.
    Alexandre, Luana
    et al.
    Univ Porto, Fac Med, Porto, Portugal..
    Pereira, Ana Margarida
    Univ Porto, Fac Med, Dept Community Med Informat & Hlth Decis Sci MEDCI, Porto, Portugal.;CUF Porto Hosp, Allergy Unit, Porto, Portugal.;Institute, Porto, Portugal..
    Amaral, Rita
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrisk inflammations- och metabolismforskning samt barnhälsa. Univ Porto, Fac Med, CINTESISRISE MEDCIDS, Porto, Portugal.;Polytech Inst Porto, Sch Hlth, Dept Cardiovasc & Resp Sci, Porto, Portugal..
    Alves-Correia, Magna
    CUF Porto Hosp, Allergy Unit, Porto, Portugal.;Institute, Porto, Portugal..
    Almeida, Rute
    Univ Porto, Fac Med, CINTESISRISE MEDCIDS, Porto, Portugal..
    Fonseca, Joao Almeida
    CUF Porto Hosp, Allergy Unit, Porto, Portugal.;Institute, Porto, Portugal.;Univ Porto, Fac Med, CINTESISRISE MEDCIDS, Porto, Portugal.;MEDIDA Med Educ Invest Desenvolvimento & Avaliacao, Porto, Portugal..
    Jacome, Cristina
    Univ Porto, Fac Med, CINTESISRISE MEDCIDS, Porto, Portugal.;Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res, Dept Community Med Informat & Hlth Decis Sci, Rua Placido da Costa, P-4200450 Porto, Portugal..
    Patients' Satisfaction with Remote Asthma Medical Follow-Up Before and During the COVID-19 Pandemic2023Ingår i: Telemedicine journal and e-health, ISSN 1530-5627, E-ISSN 1556-3669, Vol. 29, nr 9, s. 1383-1389Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The COVID-19 pandemic forced the change of health care services, favoring the use of remote consultations.

    Objective: To assess the differences in asthma medical follow-up before and during the COVID-19 pandemic and to evaluate patients' satisfaction regarding remote consultations.

    Methods: A cross-sectional, observational, web-based study, including 335 Portuguese patients with self-reported physician-diagnosed asthma, was conducted. The survey was available between February and May 2021 and included questions about patients' sociodemographic and clinical characteristics and follow-up (consultations' type and satisfaction in 2019 and 2020). Satisfaction was assessed using 10 statements on different aspects of patient experience (Likert scale 1-5), with a total score between 10 and 50.

    Results: The 335 patients included had a median [P25-P75] age of 27 [21-43] years and 75% had uncontrolled asthma. Overall, fewer participants had consultations during the pandemic compared to 2019 (161 vs. 185; p < 0.001). Most patients had >= 1 face-to-face consultation both in 2020 and 2019 (131 vs. 184; p < 0.001). In 2020, there was an increase in the proportion of participants reporting >= 1 remote (telephonic plus video) consultation (40% vs. 3%; p < 0.001). This increase was mainly attributed to the use of telephonic consultation (38% vs. video 3%, p < 0.001). Patients' satisfaction was similar in 2020 and 2019 for face-to-face consultations (44 [38-47] and 44 [39-48], p = 0.136). In 2020, satisfaction with remote consultations was slightly lower than with face-to-face (43 [37-46] vs. 44 [38-47], p < 0.001).

    Conclusions: Even though patients were slightly more satisfied with face-to-face consultations, remote consultations can be an alternative in follow-up services for patients with asthma in the near future.

  • 8. Al-Janabi, Hareth
    et al.
    Coast, Joanna
    Flynn, Terry N
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Centrum för forsknings- och bioetik.
    What do people value when they provide unpaid care for an older person? A meta-ethnography with interview follow-up.2008Ingår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 67, nr 1, s. 111-21Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Government policies to shift care into the community and demographic changes mean that unpaid (informal) carers will increasingly be relied on to deliver care, particularly to older people. As a result, careful consideration needs to be given to informal care in economic evaluations. Current methods for economic evaluations may neglect important aspects of informal care. This paper reports the development of a simple measure of the caring experience for use in economic evaluations. A meta-ethnography was used to reduce qualitative research to six conceptual attributes of caring. Sixteen semi-structured interviews were then conducted with carers of older people, to check the attributes and develop them into the measure. Six attributes of the caring experience comprise the final measure: getting on, organisational assistance, social support, activities, control, and fulfilment. The final measure (the Carer Experience Scale) focuses on the process of providing care, rather than health outcomes from caring. Arguably this provides a more direct assessment of carers' welfare. Following work to test and scale the measure, it may offer a promising way of incorporating the impact on carers in economic evaluations.

  • 9. Allander, E
    et al.
    Bjurulf, P
    Isacsson, SO
    Smedby, B
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Svanström, L
    Westrin, CG
    Skilj mellan besluts- och forskningsregister!1985Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 82, s. 4383-84Artikel i tidskrift (Refereegranskat)
  • 10.
    Almblad, Ann-Charlotte
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell barnhälsa och nutrition.
    Målqvist, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell barnhälsa och nutrition.
    Engvall, Gunn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Barnneurologi/Barnonkologi.
    From skepticism to assurance and control: Implementation of a patient safety system at a pediatric hospital in Sweden2018Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 13, nr 11, artikel-id e0207744Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The use of evidence-based practice among healthcare professionals directly correlates to better outcomes for patients and higher professional satisfaction. Translating knowledge in practice and mobilizing evidence-based clinical care remains a continuing challenge in healthcare systems across the world.

    Purpose: To describe experiences from the implementation of an Early Detection and Treatment Program for Children (EDT-C) among health care professionals at a pediatric hospital in Sweden.

    Design and Methods: Sixteen individual interviews were conducted with physicians, nurses and nurse assistants, which of five were instructors. Data were analyzed with qualitative content analysis.

    Results: An overarching theme was created: From uncertainty and skepticism towards assurance and control. The theme was based on the content of eight categories: An innovation suitable for clinical practice, Differing conditions for change, Lack of organizational slack, Complex situations, A pragmatic implementation strategy, Delegated responsibility, Experiences of control and Successful implementation.

    Conclusions: Successful implementation was achieved when initial skepticism among staff was changed into acceptance and using EDT-C had become routine in their daily work. Inter-professional education including material from authentic patient cases promotes knowledge about different professions and can strengthen teamwork. EDT-C with evidenced-based material adapted to the context can give healthcare professionals a structured and objective tool with which to assess and treat patients, giving them a sense of control and assurance.

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  • 11. Almkvist, Henrik
    et al.
    Bergman, Ulf
    Karolinska Universitetssjukhuset Huddinge.
    Edlert, Maria
    Juhasz-Haverinen, Maria
    Pehrsson, Åke
    Thörnwall Bergendahl, Gunilla
    Vég, Anikó
    Läkemedelscentrum, Centrum för vårdutveckling, Stockholms läns landsting.
    Wettermark, Björn
    Kvalitetsbokslut minskade läkemedelskostnaderna i primärvården: Stockholms läns landstings modell för decentraliserat kostnadsansvar2008Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, nr 42, s. 2930-2934Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Increasing drug expenditures have resulted in various models to increase cost consciousness among prescribing doctors. In the County of Stockholm, Sweden, a model for quality assessment of prescribing was introduced in 2006. In all, 139 of 154 primary healthcare centres (PHCs) signed a contract linking extra payment to the adherence to the Drug and Therapeutics Committee guidelines if they analysed their prescribing behaviour in an annual quality report. During the first year, the adherence to guidelines increased from 80 to 83%, substantially higher than the 0-2% annual increase that had been observed previous years. The increase was similar for those PHCs not participating in the program. Qualitative analyses of all written quality reports indicate that the incentive scheme has resulted in an increased interest in quality assessment of drug prescribing. In total, 20 million SEK was spent on incentives, with estimated savings of 100 million SEK on drug expenditures.

  • 12.
    Alriksson-Schmidt, Ann
    et al.
    Lund Univ, Fac Med, Dept Orthoped, Lund, Sweden.
    Jarl, Johan
    Lund Univ, Fac Med, Dept Hlth Econ, Lund, Sweden.
    Rodby-Bousquet, Elisabet
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Lund Univ, Fac Med, Dept Orthoped, Lund, Sweden.
    Josenby, Annika Lundkvist
    Lund Univ, Fac Med, Dept Hlth Sci, Lund, Sweden;Skane Univ Hosp, Childrens Hosp, Lund, Sweden.
    Westbom, Lena
    Skåne Univ Hosp, Childrens Hosp, Lund, Sweden; Lund Univ, Fac Med, Dept Paediat, Lund, Sweden.
    Himmelmann, Kate
    Univ Gothenburg, Inst Clin Sci, Dept Pediat, Sahlgrenska Acad, Gothenburg, Sweden.
    Stadskleiv, Kristine
    Oslo Univ Hosp, Dept Clin Neurosci Children, Oslo, Sweden.
    Ödman, Pia
    Linköping Univ, Fac Med, Dept Med & Hlth Sci, Linköping, Sweden.
    Svensson, Ingrid
    Lund Univ, Dept Biomed Engn, Lund, Sweden.
    Antfolk, Christian
    Lund Univ, Dept Biomed Engn, Lund, Sweden.
    Malesevic, Nebojsa
    Lund Univ, Dept Biomed Engn, Lund, Sweden.
    Jeglinsky, Ira
    Arcada Univ Appl Sci, Dept Hlth & Welf, Helsinki, Finland.
    Saha, Sanjib
    Lund Univ, Fac Med, Dept Hlth Econ, Lund, Sweden.
    Hägglund, Gunnar
    Lund Univ, Fac Med, Dept Orthoped, Lund, Sweden.
    Improving the Health of Individuals With Cerebral Palsy: Protocol for the Multidisciplinary Research Program MOVING ON WITH CP2019Ingår i: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 8, nr 10, artikel-id e13883Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Cerebral palsy (CP) is one of the most common early onset disabilities globally. The causative brain damage in CP is nonprogressive, yet secondary conditions develop and worsen over time. Individuals with CP in Sweden and most of the Nordic countries are systematically followed in the national registry and follow-up program entitled the Cerebral Palsy Follow-Up Program (CPUP). CPUP has improved certain aspects of health care for individuals with CP and strengthened collaboration among professionals. However, there are still issues to resolve regarding health care for this specific population.

    Objective: The overall objectives of the research program MOVING ON WITH CP are to (1) improve the health care processes and delivery models; (2) develop, implement, and evaluate real-life solutions for Swedish health care provision; and (3) evaluate existing health care and social insurance benefit programs and processes in the context of CP.

    Methods: MOVING ON WITH CP comprises 9 projects within 3 themes. Evaluation of Existing Health Care (Theme A) consists of registry studies where data from CPUP will be merged with national official health databases, complemented by survey and interview data. In Equality in Health Care and Social Insurance (Theme B), mixed methods studies and registry studies will be complemented with focus group interviews to inform the development of new processes to apply for benefits. In New Solutions and Processes in Health Care Provision (Theme C), an eHealth (electronic health) procedure will be developed and tested to facilitate access to specialized health care, and equipment that improves the assessment of movement activity in individuals with CP will be developed.

    Results: The individual projects are currently being planned and will begin shortly. Feedback from users has been integrated. Ethics board approvals have been obtained.

    Conclusions: In this 6-year multidisciplinary program, professionals from the fields of medicine, social sciences, health sciences, and engineering, in collaboration with individuals with CP and their families, will evaluate existing health care, create conditions for a more equal health care, and develop new technologies to improve the health care management of people with CP.

    International Registered Report Identifier (IRRID): DERR1-10.2196/13883

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  • 13.
    Amroussia, Nada
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa. Malmö Univ, Fac Hlth & Soc HS, Ctr Sexol & Sexual Studies CSS, Malmö, Sweden.
    Providing sexual and reproductive health services to migrants in Southern Sweden: a qualitative exploration of healthcare providers' experiences2022Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, nr 1, artikel-id 1562Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: While a large body of research has focused on the challenges experienced by healthcare staff when providing sexual and reproductive health services, little attention has been paid to the ways healthcare providers navigate these challenges. This study examined healthcare providers' accounts of encounters when providing sexual and reproductive health (SRH) services to migrants in Southern Sweden. It sought to examine challenges and dilemmas experienced by healthcare providers, strategies used to navigate these challenges and dilemmas, and assumptions underlying participants' accounts. Methods: The data collection was conducted between September 2020 and March 2021. Qualitative thematic analysis was used to analyze thirty-one interviews with healthcare providers working in youth clinics and women healthcare clinics. The analysis was guided by a conceptual framework combining person-centered care approach, Foucault's concepts on power/knowledge, and theories to navigate diversity in healthcare setting: cultural competency and cultural humility. Results: Three themes were identified in the analysis: 1) Between person centeredness and cultural considerations; 2) Knowledge positions and patient involvement; and 3) beyond the dyadic interaction healthcare provider-patient. Some participants understood person-centered care as individualized care where the influence of culture on the encounter should be de-emphasized, whereas others tended to highlight this influence. Many participants viewed the influence of culture as primarily driven by migrants' cultural backgrounds, and as a source of challenges and dilemmas. Participants' strategies to navigate these perceived challenges and dilemmas included practicing cultural humility and seeking cultural competency. Knowledge positions also emerged as an important aspect of participants' accounts of encounters with migrants. Many participants experienced that migrant patients were lacking knowledge about the body and sexuality. This disadvantaged knowledge position affected migrant involvement in care. Additionally, the study shows how participants placed their experiences in a broader organizational and social context. Participants highlighted several organizational challenges to encountering migrants and discussed dilemmas stemming from the interplay between migrants' structural and individual disadvantages. Conclusions: The study findings illuminate the complex links between person-centered care and two important dimensions of the encounters with migrants: culture and knowledge positions. They also shed the light on the organizational and structural challenges surrounding these encounters. These findings suggest that multilevel strategies are needed to improve the quality of encounters when providing SRH services to migrants. These strategies could include ensuring universal access to SRH services to migrants, adjusting the encounter duration when interpretation is needed, and providing necessary resources to healthcare providers to build their structural competency.

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  • 14.
    Anandavadivelan, Poorna
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Solna, Sweden..
    Wiklander, Maria
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden..
    Eriksson, Lars E.
    Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden.;City Univ London, Sch Hlth Sci, London, England.;Karolinska Univ Hosp, Dept Infect Dis, Huddinge, Sweden..
    Wettergren, Lena
    Karolinska Inst, Dept Womens & Childrens Hlth, Solna, Sweden..
    Lampic, Claudia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap. Karolinska Inst, Dept Womens & Childrens Hlth, Solna, Sweden.
    Cultural adaptation and psychometric evaluation of the Swedish version of the Reproductive Concerns After Cancer (RCAC) scale2020Ingår i: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 18, nr 1, artikel-id 273Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundReproductive concerns are common among young cancer survivors and include worries related to different aspects of fertility and parenthood. The Reproductive Concerns After Cancer (RCAC) scale is an 18-item scale with six dimensions, developed to capture a variety of such concerns. The aim of the present study was to describe the cultural adaptation of the RCAC scale into Swedish and evaluate its psychometric properties among young women who have undergone treatment for cancer.MethodsThe RCAC was forward translated from English into Swedish and assessed for cultural adaptation based on a two-panel approach followed by cognitive interviews with the target group. For the psychometric evaluation, a Swedish cohort of 181 female young adult breast cancer survivors completed a survey including the RCAC scale approximately 1.5years post-diagnosis. Psychometric properties were examined by analyses of construct validity (confirmatory factor analysis and convergent validity), data quality (score distribution, floor and ceiling effects), reliability and known-groups validity.ResultsThe confirmatory factor analysis yielded an acceptable fit (RMSEA 0.08, SRMR 0.09, CFI 0.92). Convergent validity was demonstrated by a negative correlation of moderate size (-0.36) between the RCAC total score and the emotional function scale of the EORTC QLQ-C30. Reliability measured with Revelle Omega total was satisfactory (0.73-0.92) for five of the dimensions, and poor for the dimension Becoming pregnant (Revelle Omega total=0.60); Cronbach's alpha showed a similar pattern. Known-groups validity was indicated by significant RCAC mean score differences (MD), reflecting more concerns among women with a certain (MD 4.56 [95% CI 3.13 to 5.99]) or uncertain (MD 3.41 [95% CI 1.68 to 5.14]) child wish compared to those with no wish for (additional) children.ConclusionThe translation and cultural adaptation of the Swedish RCAC has resulted in a scale demonstrating construct and known-groups validity, and satisfactory reliability for five of six dimensions. The dimension Becoming pregnant showed non-optimal internal consistency and should undergo further evaluation. The Swedish RCAC is recommended to be used in research settings for measurement of concerns related to fertility and parenthood in young women with cancer.

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  • 15.
    Ancillotti, Mirko
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Centrum för forsknings- och bioetik.
    Huls, Samare P. I.
    Krockow, Eva M.
    Veldwijk, Jorien
    Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
    Prosocial Behaviour and Antibiotic Resistance: Evidence from a Discrete Choice Experiment2023Ingår i: Patient, ISSN 1178-1653, E-ISSN 1178-1661, Vol. 17, nr 2, s. 191-202Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction

    The health of a community depends on the health of its individuals; therefore, individual health behaviour can implicitly affect the health of the entire community. This is particularly evident in the case of infectious diseases. Because the level of prosociality in a community might determine the effectiveness of health programmes, prosocial behaviour may be a crucial disease-control resource. This study aimed to extend the literature on prosociality and investigate the role of altruism in antibiotic decision making.

    Methods

    A discrete choice experiment was conducted to assess the influence of altruism on the general public’s preferences regarding antibiotic treatment options. The survey was completed by 378 Swedes. Latent class analysis models were used to estimate antibiotic treatment characteristics and preference heterogeneity. A three-class model resulted in the best model fit, and altruism significantly impacted preference heterogeneity.

    Results

    Our findings suggest that people with higher altruism levels had more pronounced preferences for treatment options with lower contributions to antibiotic resistance and a lower likelihood of treatment failure. Furthermore, altruism was statistically significantly associated with sex, education, and health literacy.

    Conclusions

    Antibiotic awareness, trust in healthcare systems, and non-discriminatory priority setting appear to be structural elements conducive to judicious and prosocial antibiotic behaviour. This study suggests that prosocial messages could help to decrease the demand for antibiotic treatments.

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  • 16. Andersen, R
    et al.
    Anderson, OW
    Smedby, B
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Perception of the response to symptoms of illness in Sweden and the United States1968Ingår i: Medical Care, Vol. 6, s. 18-30Artikel i tidskrift (Refereegranskat)
  • 17. Andersen, R
    et al.
    Smedby, B
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Changes in response to symptoms of illness in the United States and Sweden1979Ingår i: Health Handbook / [ed] George K Chacko, 1979, s. 942-55Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 18. Andersen, R
    et al.
    Smedby, B
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Comparative health systems - Part IV - Specific studies in several countries: Changes in response to symptoms of illness in the United States and Sweden1975Ingår i: Inquiry, ISSN 0046-9580, E-ISSN 1945-7243, Vol. 12, nr 2 SUPPL, s. 116-27Artikel i tidskrift (Refereegranskat)
  • 19. Andersen, R
    et al.
    Smedby, B
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Anderson, OW
    Medical care use in Sweden and the United States: A comparative analysis of systems and behavior1970Ingår i: Center for Health Administation Studies, University of Chicago, Research Series, Vol. 27Artikel, forskningsöversikt (Refereegranskat)
  • 20. Andersen, R
    et al.
    Smedby, B
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Eklund, G
    Uses of the Automatic Interaction Detector (AID) program for analyzing health survey data1971Ingår i: Health Services Research, ISSN 0017-9124, E-ISSN 1475-6773, Vol. 6, nr 2, s. 165-83Artikel i tidskrift (Refereegranskat)
  • 21.
    Andersson, Maria
    et al.
    AstraZeneca Nordic Baltic, Södertälje, Sweden..
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Kristensen, Thomas
    AstraZeneca Nordic Baltic, Södertälje, Sweden..
    Szende, Agota
    Covance, Leeds, W Yorkshire, England..
    Golam, Sarowar
    AstraZeneca, BioPharmaceut R&D, Global Market Access & Pricing, Gothenburg, Sweden..
    Cost effectiveness of benralizumab for severe, uncontrolled oral corticosteroid-dependent asthma in Sweden2020Ingår i: Journal of Medical Economics, ISSN 1369-6998, E-ISSN 1941-837X, Vol. 23, nr 8, s. 877-884Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: We investigated cost effectiveness of benralizumab vs. standard of care (SOC) plus oral corticosteroids (OCS) for patients with severe, eosinophilic OCS-dependent asthma in Sweden. Materials and methods: A three-state, cohort-based Markov model of data from three Phase III benralizumab clinical trials (ZONDA [NCT02075255], SIROCCO [NCT01928771], and CALIMA [NCT01914757]) was used to assess the incremental cost-effectiveness ratio of benralizumab vs. SOC plus OCS. Health outcomes were estimated in terms of quality-adjusted life-years (QALYs). The model included costs and disutilities associated with extrapolated OCS-related adverse events. Patients with severe asthma were defined as those receiving OCS >= 5 mg/day. Results: Benralizumab demonstrated a cost-effectiveness ratio vs. SOC plus OCS of 2018 Swedish Kronor (SEK) 366,855 (euro34,127) per QALY gained, based on increases of 1.33 QALYs and SEK 488,742 (euro45,344) per patient. Benralizumab treatment costs contributed most to incremental costs. The probability of benralizumab's being cost-effective with willingness-to-pay (WTP) thresholds between SEK 429,972 (euro40,000) and SEK 752,452 (euro70,000) ranged from 75% to 99%. Limitations: Potential limitations of these analyses include the use of combined data from three different clinical trials, a one-way sensitivity analysis that did not include mortality and transition estimates, and Observational & Pragmatic Research Institute (OPRI) data from the UK as a proxy of the Swedish health care system. Conclusions: The results of these analyses demonstrate that benralizumab has a high probability of being cost-effective compared with SOC plus OCS for a subgroup of patients with severe, eosinophilic asthma receiving regular OCS treatment and may support clinicians, payers and patients in making treatment decisions.

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  • 22.
    Andersén, Åsa
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Berglund, Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Carpentsier, Beatrice
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Anderzén, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Utvärdering av rehabiliteringskoordinator inom psykiatrisk specialistsjukvård: Slutrapport2023Rapport (Övrigt vetenskapligt)
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  • 23.
    Andre, Beate
    et al.
    Norwegian Univ Sci & Technol NTNU, Dept Publ Hlth & Nursing, N-7491 Trondheim, Norway.;NTNU Ctr Hlth Promot Res, Trondheim, Norway..
    Dahlo, Raija
    Norwegian Univ Sci & Technol NTNU, Dept Publ Hlth & Nursing, N-7491 Trondheim, Norway..
    Eilertsen, Tina
    Hlth Nord Trondelag, Clin Surg, Levanger, Norway..
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning. Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Shorey, Shefaly
    Natl Univ Singapore, Yong Loo Lin Sch Med, Singapore, Singapore..
    Ringdal, Gerd, I
    NTNU, Fac Social Sci & Technol Management, Dept Psychol, Trondheim, Norway..
    Coping Strategies of Norwegian Healthcare Professionals Facing Perinatal Death: A Qualitative Study2019Ingår i: International Journal of Childbirth, ISSN 2156-5287, E-ISSN 2156-5295, Vol. 9, nr 3, s. 107-119Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: Perinatal death is often regarded as a critical incident for the healthcare personnel involved. How healthcare personnel respond to traumatic events in their work is a function of their level of awareness or exposure to the incident, as well as their genuine expectations, support, and trust. The aim of this study was to explore coping strategies of Norwegian healthcare professionals including midwifes, obstetricians, and assistant nurses when faced with perinatal death in a clinical setting.

    METHOD: Midwives, obstetricians, and assistant nurses in two public hospitals in Norway participated in an in-depth and semi-structured interview. The data was analyzed using Kvale's approach, which involves condensing and thematic analysis.

    FINDINGS: The results are divided into three categories with eight subcategories. Having the support of one's colleagues was described as an important factor for coping with these situations. Both immediate support in the situation and talking about their feelings later with colleagues were found to be important. Discussing and sharing responsibility were also mentioned.

    CONCLUSION: Informants in this study stated that talking with one another about the challenges they faced in these situations was important. Appropriate education and training programs, together with healthy coping and debriefing strategies must be implemented in maternity units.

  • 24. Araya, Ricardo
    et al.
    Flynn, Terry
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Centrum för forsknings- och bioetik.
    Rojas, Graciela
    Fritsch, Rosemarie
    Simon, Greg
    Cost-effectiveness of a primary care treatment program for depression in low-income women in Santiago, Chile.2006Ingår i: American Journal of Psychiatry, ISSN 0002-953X, E-ISSN 1535-7228, Vol. 163, nr 8, s. 1379-87Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The authors compared the incremental cost-effectiveness of a stepped-care, multicomponent program with usual care for the treatment of depressed women in primary care in Santiago, Chile.

    METHOD: A cost-effectiveness study was conducted of a previous randomized controlled trial involving 240 eligible women with DSM-IV major depression who were selected from a consecutive sample of adult women attending primary care clinics. The patients were randomly allocated to usual care or a multicomponent stepped-care program led by a nonmedical health care worker. Depression-free days and health care costs derived from local sources were assessed after 3 and 6 months. A health service perspective was used in the economic analysis.

    RESULTS: Complete data were determined for 80% of the randomly assigned patients. After we adjusted for initial severity, women receiving the stepped-care program had a mean of 50 additional depression-free days over 6 months relative to patients allocated to usual care. The stepped-care program was marginally more expensive than usual care (an extra 216 Chilean pesos per depression-free day). There was a 90% probability that the incremental cost of obtaining an extra depression-free day with the intervention would not exceed 300 pesos (1.04 US dollars).

    CONCLUSIONS: The stepped-care program was significantly more effective and marginally more expensive than usual care for the treatment of depressed women in primary care. Small investments to improve depression appear to yield larger gains in poorer environments. Simple and inexpensive treatment programs tested in developing countries might provide good study models for developed countries.

  • 25.
    Arndt, Helene
    et al.
    Univ Med Ctr Hamburg Eppendorf, Dept Vasc Med, Res Grp GermanVasc, Hamburg, Germany..
    Nordanstig, Joakim
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden..
    Bertges, Daniel J.
    Univ Vermont, Div Vasc Surg, Med Ctr, Burlington, VT USA..
    Budtz-Lilly, Jacob
    Aarhus Univ, Dept Cardiovasc Surg, Aarhus, Denmark..
    Venermo, Maarit
    Helsinki Univ Hosp, Abdominal Ctr, Vasc Surg, Helsinki, Finland.;Univ Helsinki, Helsinki, Finland..
    Espada, Cristina Lopez
    Univ Hosp Virgen Nieves, Dept Vasc Surg, Granada, Spain..
    Sigvant, Birgitta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Behrendt, Christian-Alexander
    Univ Med Ctr Hamburg Eppendorf, Dept Vasc Med, Res Grp GermanVasc, Hamburg, Germany.;Brandenburg Med Sch Theodor Fontane, Neuruppin, Germany..
    A Delphi Consensus on Patient Reported Outcomes for Registries and Trials Including Patients with Intermittent Claudication: Recommendations and Reporting Standard2022Ingår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 64, nr 5, s. 526-533Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: This study aimed to develop a core set of patient reported outcome quality indicators (QIs) for the treatment of patients with intermittent claudication (IC), that allow a broad international implementation across different vascular registries and within trials.

    Methods: A rigorous modified two stage Delphi technique was used to promote consensus building on patient reported outcome QIs among an expert panel consisting of international vascular specialists, patient representatives, and registry members of the VASCUNET and the International Consortium of Vascular Registries. Potential QIs identified through an extensive literature search or additionally proposed by the panel were validated by the experts in a preliminary survey and included for evaluation. Consensus was reached if >= 80% of participants agreed that an item was both clinically relevant and practical.

    Results: Participation rates in two Delphi rounds were 66% (31 participants of 47 invited) and 90% (54 of 60), respectively. Initially, 145 patient reported outcome QIs were documented. Following the two Delphi rounds, 18 quality indicators remained, all of which reached consensus regarding clinical relevance. The VascuQoL questionnaire (VascuQoL-6), currently the most common patient reported outcome measurement (PROM) used within vascular registries, includes a total of six items. Five of these six items also matched with high rated indicators identified in the Delphi study. Consequently, the panel recommends the use of the VascuQoL-6 survey as a preferred core PROM QI set as well as an optional extension of 12 additional patient reported QIs that were also identified in this study.

    Conclusion: The current recommendation based on the Delphi consensus building approach, strengthens the international harmonisation of registry data collection in relation to patient reported outcome quality. Continuous and standardised quality assurance will ensure that registry data may be used for future quality benchmarking studies and, ultimately, positively impact the overall quality of care provided to patients with peripheral arterial occlusive disease.

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  • 26.
    Arvidsson, Lisa
    et al.
    Univ Gävle, Fac Hlth & Occupat Studies, Dept Caring Sci, Gävle, Sweden..
    Skytt, Bernice
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap. Univ Gävle, Fac Hlth & Occupat Studies, Dept Caring Sci, Gävle, Sweden..
    Lindberg, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Univ Gävle, Fac Hlth & Occupat Studies, Dept Caring Sci, Gävle, Sweden..
    Lindberg, Magnus
    Univ Gävle, Fac Hlth & Occupat Studies, Dept Caring Sci, Gävle, Sweden..
    Nurses' assessed self-efficacy levels to medical asepsis and their relation to structural empowerment, work engagement and work-related stress2023Ingår i: Work: A journal of Prevention, Assessment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 74, nr 2, s. 501-513Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Nurses' working conditions are important for their well-being at work and for their ability to provide patients with safe care. Self-efficacy can influence employees' behaviour atwork. Therefore, it is valuable to study self-efficacy levels to medical asepsis in relation to working conditions.

    OBJECTIVE: To investigate the relationship between nurses' assessed self-efficacy levels to medical asepsis in care situations and structural empowerment, work engagement and work-related stress.

    METHODS: A cross-sectional study with a correlational design was conducted. A total of 417 registered nurses and licensed practical nurses at surgical and orthopaedic units responded to a questionnaire containing: the Infection Prevention Appraisal Scale, the Conditions ofWork Effectiveness Questionnaire-II, the UtrechtWork Engagement Scale-9 and the Health& Safety Executive Management Standards Indicator Tool. Correlational analyses and group comparisons were performed.

    RESULTS: The nurses rated high levels of self-efficacy to medical asepsis in care situations. The correlational analyses revealed that correlation coefficients between structural empowerment, work engagement, work-related stress and selfefficacy to medical asepsis were 0.254-0.268. Significant differences in self-efficacy were found in the grouped working conditions.

    CONCLUSIONS: This study revealed that nurses rated high self-efficacy levels to medical asepsis and, to some extent, this seemed related to structural empowerment, work engagement and work-related stress. This valuable knowledge could enable improvements at the managerial and organisational levels, benefiting both nurses and patients in the long run.

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  • 27.
    Asuman, Derek
    et al.
    Lund Univ, Dept Clin Sci Malmö, Hlth Econ, Lund, Sweden.;Lund Univ, Hlth Econ, Medicon Village 301:5,Nytankargatan 4, S-22363 Lund, Sweden..
    Gerdtham, Ulf-G.
    Lund Univ, Dept Clin Sci Malmö, Hlth Econ, Lund, Sweden.;Lund Univ, Dept Econ, Lund, Sweden.;Lund Univ, Ctr Econ Demog, Lund, Sweden..
    Alriksson-Schmidt, Ann I.
    Lund Univ, Dept Clin Sci Lund, Orthopaed, Lund, Sweden..
    Rodby-Bousquet, Elisabet
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Lund Univ, Dept Clin Sci Lund, Orthopaed, Lund, Sweden..
    Andersen, Guro L.
    Vestfold Hosp Trust, Norwegian Qual & Surveillance Registry Cerebral Pa, Tonsberg, Norway.;Norwegian Univ Sci & Technol, Dept Clin & Mol Med, Trondheim, Norway..
    Jarl, Johan
    Lund Univ, Dept Clin Sci Malmö, Hlth Econ, Lund, Sweden..
    Pain and labor outcomes: A longitudinal study of adults with cerebral palsy in Sweden2023Ingår i: Disability and Health Journal, ISSN 1936-6574, E-ISSN 1876-7583, Vol. 16, nr 3, artikel-id 101479Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Pain is a global health concern with substantial societal costs and limits the activity participation of individuals. The prevalence of pain is estimated to be high among individuals with cerebral palsy (CP).

    Objectives: To estimate the association between pain and labor outcomes for adults with CP in Sweden.

    Methods: A longitudinal cohort study based on data from Swedish population-based administrative registers of 6899 individuals (53,657 person-years) with CP aged 20-64 years. Individual fixed effects regression models were used to analyze the association between pain and labor outcomes (employment and earnings from employment), as well as potential pathways through which pain might affect employment and earnings.

    Results: Pain was associated with adverse outcomes varying across severity, corresponding to a reduction of 7-12% in employment and 2-8% in earnings if employed. Pain might affect employment and earnings through increased likelihood of both sickness leave and early retirement.

    Conclusion: Pain management could potentially be important to improve labor outcomes for adults with CP, in addition to improving the quality of life.& COPY; 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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  • 28.
    Augustsson, Hanna
    et al.
    Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Procome Res Grp, Stockholm, Sweden.;Ctr Epidemiol & Community Med CES, Unit Implementat & Evaluat, Stockholm, Sweden..
    Morici, B. Casales
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Företagsekonomiska institutionen. Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Procome Res Grp, Stockholm, Sweden..
    Hasson, Henna
    Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Procome Res Grp, Stockholm, Sweden.;Ctr Epidemiol & Community Med CES, Unit Implementat & Evaluat, Stockholm, Sweden..
    Schwarz, Ulrica von Thiele
    Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Procome Res Grp, Stockholm, Sweden.;Mälardalen Univ, Sch Hlth Care & Social Welf, Västerås, Sweden..
    Schalling, Sara Korlén
    Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Procome Res Grp, Stockholm, Sweden..
    Ingvarsson, Sara
    Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Procome Res Grp, Stockholm, Sweden..
    Wijk, Hanna
    Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Procome Res Grp, Stockholm, Sweden..
    Roczniewska, Marta
    Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Procome Res Grp, Stockholm, Sweden..
    Nilsen, Per
    Linköping Univ, Dept Hlth Med & Caring Sci, Div Publ Hlth, Linköping, Sweden..
    National governance of de-implementation of low-value care: a qualitative study in Sweden2022Ingår i: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 20, artikel-id 92Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The de-implementation of low-value care (LVC) is important to improving patient and population health, minimizing patient harm and reducing resource waste. However, there is limited knowledge about how the de-implementation of LVC is governed and what challenges might be involved. In this study, we aimed to (1) identify key stakeholders' activities in relation to de-implementing LVC in Sweden at the national governance level and (2) identify challenges involved in the national governance of the de-implementation of LVC.

    Methods: We used a purposeful sampling strategy to identify stakeholders in Sweden having a potential role in governing the de-implementation of LVC at a national level. Twelve informants from nine stakeholder agencies/organizations were recruited using snowball sampling. Semi-structured interviews were conducted, transcribed and analysed using inductive thematic analysis.

    Results: Four potential activities for governing the de-implementation of LVC at a national level were identified: recommendations, health technology assessment, control over pharmaceutical products and a national system for knowledge management. Challenges involved included various vested interests that result in the maintenance of LVC and a low overall priority of working with the de-implementation of LVC compared with the implementation of new evidence. Ambiguous evidence made it difficult to clearly determine whether a practice was LVC. Unclear roles, where none of the stakeholders perceived that they had a formal mandate to govern the de-implementation of LVC, further contributed to the challenges involved in governing that de-implementation.

    Conclusions: Various activities were performed to govern the de-implementation of LVC at a national level in Sweden; however, these were limited and had a lower priority relative to the implementation of new methods. Challenges involved relate to unfavourable change incentives, ambiguous evidence, and unclear roles to govern the de-implementation of LVC. Addressing these challenges could make the national-level governance of de-implementation more systematic and thereby help create favourable conditions for reducing LVC in healthcare.

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  • 29.
    Avdic, Daniel
    Uppsala universitet, Enheter med anknytning till universitetet, Institutet för arbetsmarknads- och utbildningspolitisk utvärdering (IFAU). CINCH, Essen, Germany.;Univ Duisburg Essen, Essen, Germany..
    Improving efficiency or impairing access? Health care consolidation and quality of care: Evidence from emergency hospital closures in Sweden2016Ingår i: Journal of Health Economics, ISSN 0167-6296, E-ISSN 1879-1646, Vol. 48, s. 44-60Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Recent health care consolidation trends raise the important policy question whether improved emergency medical services and enhanced productivity can offset adverse quality effects from decreased access. This paper empirically analyzes how geographical distance from an emergency hospital affects the probability of surviving an acute myocardial infarction (AMI), accounting for health-based spatial sorting and data limitations on out-of-hospital mortality. Exploiting policy-induced variation in hospital distance derived from emergency hospital closures and detailed Swedish mortality data over two decades, results show a drastically decreasing probability of surviving an AMI as residential distance from a hospital increases one year after a closure occurred. The effect disappears in subsequent years, however, suggesting that involved agents quickly adapted to the new environment.

  • 30.
    Avdic, Daniel
    et al.
    Deakin Univ, Dept Econ, 70 Elgar Rd, Burwood, Vic 3125, Australia..
    Ivets, Maryna
    Ruhr Grad Sch Econ, Bochum, Germany.;CINCH Hlth Econ Res Ctr, Essen, Germany..
    Lagerqvist, Bo
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    Sriubaite, Ieva
    Monash Univ, Ctr Hlth Econ, Melbourne, Australia..
    Providers, peers and patients. How do physicians?: practice environments affect patient outcomes?2023Ingår i: Journal of Health Economics, ISSN 0167-6296, E-ISSN 1879-1646, Vol. 89, artikel-id 102741Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We study how physicians' practice environments affect their treatment decisions and quality of care. Using clinical registry data from Sweden, we compare stent choices of cardiologists moving across hospitals over time. To disentangle changes in practice styles attributable to hospital-and peer group-specific factors, we exploit quasi-random variation on cardiologists working together on the same days. We find that migrating cardiologists' stent choices rapidly adapt to their new practice environment after relocation and are equally driven by the hospital and peer environments. In contrast, while decision errors increase, treatment costs and adverse clinical events remain largely unchanged despite the altered practice styles.

  • 31.
    Avdic, Daniel
    et al.
    Univ Duisburg Essen, Duisburg, Germany;CINCH Essen, Essen, Germany.
    Lundborg, Petter
    Lund Univ, Dept Econ, Lund, Sweden;IZA Bonn, Bonn, Germany.
    Vikström, Johan
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Nationalekonomiska institutionen. Uppsala universitet, Enheter med anknytning till universitetet, Institutet för arbetsmarknads- och utbildningspolitisk utvärdering (IFAU).
    Estimating returns to hospital volume: Evidence from advanced cancer surgery2019Ingår i: Journal of Health Economics, ISSN 0167-6296, E-ISSN 1879-1646, Vol. 63, s. 81-99Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    High-volume hospitals typically perform better than low-volume hospitals. In this paper, we study whether such patterns reflect a causal effect of case volume on patient outcomes. To this end, we exploit closures and openings of entire cancer clinics in Swedish hospitals which provides sharp and arguably exogenous variation in case volumes. Using detailed register data on more than 100,000 treatment episodes of advanced cancer surgery, our results suggest substantial positive effects of operation volume on survival. Complementary analyses point to learning-by-doing as an important explanation. (C) 2018 Elsevier B.V. All rights reserved.

  • 32.
    Back, Maria
    et al.
    Sahlgrens Univ Hosp, Dept Occupat Therapy & Physiotherapy, Gothenburg, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.;Linköping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linköping, Sweden.;Sahlgrens Univ Hosp, Dept Physiotherapy, Vita Straket 13, S-41345 Gothenburg, Sweden..
    Leosdottir, Margret
    Skane Univ Hosp, Dept Cardiol, Malmö, Sweden.;Lund Univ, Dept Clin Sci Malmö, Malmö, Sweden..
    Ekstrom, Mattias
    Danderyd Hosp, Dept Clin Sci, Div Cardiovasc Med, Stockholm, Sweden..
    Hambraeus, Kristina
    Falun Cent Hosp, Dept Cardiol, Falun, Sweden..
    Ravn-Fischer, Annica
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden..
    Oberg, Birgitta
    Linköping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linköping, Sweden..
    Östlund, Ollie
    James, Stefan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    The remote exercise SWEDEHEART study-Rationale and design of a multicenter registry-based cluster randomized crossover clinical trial (RRCT)2023Ingår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 262, s. 110-118Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Despite proven benefits of exercise-based cardiac rehabilitation (EBCR), few patients with myocardial infarction (MI) participate in and complete these programs.

    Study design and objectives: The Remote Exercise SWEDEHEART study is a large multicenter registry-based cluster randomized crossover clinical trial with a planned enrollment of 1500 patients with a recent MI. Patients at intervention centers will be offered supervised EBCR, either delivered remotely, center-based or as a combination of both modes, as self -preferred choice. At control centers, patients will be offered supervised center-based EBCR, only. The duration of each time period (intervention/control) for each center will be 15 months and then cross-over occurs. The primary aim is to evaluate if remotely delivered EBCR, offered as an alternative to center-based EBCR, can increase participation in EBCR sessions. The proportion completers in each group will be presented in a supportive responder analysis. The key secondary aim is to investigate if remote EBCR is as least as effective as center-based EBCR, in terms of physical fitness and patient-reported outcome measures. Follow-up of major adverse cardiovascular events (cardiovascular-and all-cause mortality, recurrent hospitalization for acute coronary syndrome, heart failure hospitalization, stroke, and coronary revascularization) will be performed at 1 and 3 years. Safety monitoring of serious adverse events will be registered, and a cost-effectiveness analysis will be conducted to estimate the cost per quality-adjusted life-year (QALY) associated with the intervention compared with control.

    Conclusions: The cluster randomized crossover clinical trial Remote Exercise SWEDEHEART study is evaluating if par-ticipation in EBCR sessions can be increased, which may contribute to health benefits both on a group level and for individual patients including a more equal access to health care.Trial registration The study is registered at

    ClinicalTrials.gov (Identifier: NCT04260958) (Am Heart J 2023;262:110-118.)

  • 33. Banefelt, J.
    et al.
    Hallberg, S.
    Fox, K. M.
    Mesterton, J.
    Paoli, C. J.
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Levin, L. A.
    Sobocki, P.
    Gandra, S. R.
    Work Productivity Loss And Indirect Costs Associated With New Cardiovascular Events In High-Risk Patients With Hyperlipidemia - Estimates From Population-Based Register Data In Sweden2014Ingår i: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 17, nr 7, s. A327-A328, artikel-id CV2Artikel i tidskrift (Övrigt vetenskapligt)
  • 34. Banefelt, J.
    et al.
    Hallberg, S.
    Gandra, S. R.
    Mesterton, J.
    Fox, K. M.
    Paoli, C. J.
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Levin, L. A.
    Sobocki, P.
    Burden Of Hyperlipidemia Resulting From Productivity Loss - Estimates From Population-Based Register Data In Sweden2014Ingår i: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 17, nr 7, s. A491-A492, artikel-id PCV110Artikel i tidskrift (Övrigt vetenskapligt)
  • 35.
    Baraldi, Enrico
    et al.
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Tekniska sektionen, Institutionen för teknikvetenskaper, Industriell teknik.
    Ciabuschi, Francesco
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Företagsekonomiska institutionen.
    Callegari, Simone
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för informatik och media.
    Lindahl, Olof
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Företagsekonomiska institutionen.
    Economic incentives for the development of new antibiotics: Report commissioned by the Public Health Agency of Sweden2019Rapport (Övrigt vetenskapligt)
    Abstract [en]

    This report responds to a request by the Public Health Agency of Sweden (Folkhälsomyndigheten) concerning which incentives for antibiotics research and development (R&D) Sweden should take into consideration for potential public investments. Based on discussions and interviews with experts, feedback from stakeholders (i.e. potential recipients of Swedish incentives), company case studies and computer-based Monte Carlo simulations, this report provides a set of recommendations about the economic incentives that can be relevant for Sweden.

    The incentives identified for Sweden’s portfolio meet the following criteria: improving Sweden’s visibility in the antibiotics field, reinforcing Sweden’s national R&D infrastructure in this area, leveraging Sweden’s strengths and traditions, limiting the public expenditure per incentive, permitting rapid implementation and effects, providing highly needed support to the antibiotic pipeline in unique ways, and granting Sweden a key contribution and thus influence on the design and direction of each incentive.

    Based on these criteria, a Market Entry Reward (MER) was not considered a viable alternative for Sweden if implemented by Sweden alone, especially because of its demanding financial engagement (close to 1 B USD), which is necessary for this incentive to produce relevant effects on the antibiotics R&D pipeline. However, if Sweden were to decide to pilot an MER, it should focus on a fully delinked MER, which entirely substitutes market sales with lump sums paid on a yearly basis. An MER should moreover be financed primarily from the healthcare budget to avoid crowding out other incentives. A fully delinked MER would allow testing several features of this incentive model, such as the evaluation procedures to set the overall amount of the MER, the definition of the unit prizes to be paid by local healthcare facilities to the central government, and periodic reviews to reassess the amount of yearly lump-sum payments according to the confirmed therapeutic efficacy of the antibiotic.

    If Sweden were to collaborate with other countries, such as the G20 group or the 28 EU members, a reasonable amount for its share is 6 or 23 M USD, respectively, for a partially delinked MER and 9 or 34 M USD, respectively, for a fully delinked MER. There are, however, ways to combine push and pull incentives, which are quicker and more efficient than an MER, namely combinations of grants with milestone prizes, which are rewards paid to developers upon the successful completion of key R&D steps (e.g. Phase 1 clinical studies). In addition to producing better effects for the money spent, a combination of milestone prizes and grants also prevents large MERs from crowding out push investments as well as recipients such as small- and medium-sized firms (SMEs), who usually cannot wait for a reward that is delayed until the final approval of an antibiotic.

    The recommended portfolio of incentives for Sweden includes three incentives: grants, milestone prizes and Pipeline Coordinators, to be used in combination with each other as a way to cover the antibiotics R&D pipeline and achieve important synergies. The following features should be considered when implementing and funding the three selected incentives:

    1) Grants should be dedicated to early R&D projects (no later than Phase 2) and to reinforcing the national R&D infrastructure, with a longer-term perspective than the current 3-year timeframe. In this regard, Sweden should maintain and possibly increase its current yearly investments in antibiotics R&D grants of approximately 7 M USD/year (60 M SEK) over several years. These investments will pay off in the long run, both in terms of molecules that will enter the future R&D pipeline; and as a stock of competencies spread over an infrastructure of specialised R&D centres that can be leveraged

    for future antibiotics research. These competences must be built up immediately and the seeds for future R&D projects need to be planted as soon as possible.

    2) Two types of milestone prizes should be in focus for Sweden: first, a prize awarding a sum between 10 and 20 M USD at the end of Clinical Phase 1 to highly innovative molecules addressing specific pathogens and, second, a prize for projects successfully completing preclinical steps. Establishing a prize at the end of Clinical Phase 1 is a much needed and unique initiative, with significant effects on the early R&D pipeline, granting also strong international visibility to Sweden. Sweden could also take major responsibility for such a milestone prize by covering a relatively large share. The other recommended milestone prize, awarded at the end of the preclinical steps, would help refill the clinical pipeline and would therefore have more of a long-term effect.

    3) Pipeline Coordinators, that is, organizations that take an active role in selecting and supporting a portfolio of antibiotics R&D projects in various ways, are the last recommended incentive. Selecting among currently existing Pipeline Coordinators rather than creating a new one, Sweden should fund two types of such organizations: R&D Collaborations, which create collaboration platforms to perform early development activities for the antibiotic projects they support, and Non-Profit Developers, who conduct their own antibiotic projects with the aim of bringing antibiotics to market but without pursuing profit goals. The first type of Pipeline Coordinator, R&D Collaborations, is relevant for a Swedish public investment because they are potentially the most efficient incentive in making R&D projects profitable. However, to fully exploit this potential, R&D Collaborations must be refined to become more flexible, reduce bureaucratic burden and avoid conflicts between participants.

    Non-Profit Developers provide the most extensive support to selected products by intervening across the entire antibiotic pipeline to ensure products reach the market. Moreover, this model strongly promotes both global availability and responsible use (stewardship). Therefore, Sweden may fund Non-Profit Developers through its international aid budget and in this way make important contributions to global health.

    Both types of Pipeline Coordinators also offer the advantage that they can help connect Swedish antibiotics R&D centres to international platforms, which reinforce the effects of infrastructure-related grants. Moreover, all forms of Pipeline Coordinators are incentive models that can be used as tools to manage the other two incentives (grants and milestone prizes). In this capacity, they can, for instance, evaluate grant applications and the antibiotic projects eligible for milestone prizes, which require a deep insight into the details of a drug development project.

    A fourth model, regulatory simplifications, which radically cut costs and times for Clinical Phase 3, can also be relevant for Sweden due to its contained costs, rapid implementation and effects and connection with Sweden’s expertise. However, this incentive requires further analysis to fully grasp its implications for regulators and patient safety before being recommended for implementation.

    The three incentives recommended by this report – grants, milestone prizes and Pipeline Coordinators – should be used in combination to exploit the synergies between them and their ability to push and pull molecules in different phases of the R&D pipeline. For instance, when grants and milestones are used together, the public investment per approved new antibiotic is lower than the combined spending if the two incentives were used in isolation. If it is not possible to introduce and use the three incentives simultaneously, the following priorities should be applied: first of all, grants need to be kept at current levels and possibly increased to fund both single antibiotic projects and competence development in the R&D infrastructure, while starting to invest in a Non-Profit Developer and a milestone prize at the end of Phase 1, followed by the development and funding of R&D Collaborations and, finally, a preclinical milestone prize.

    Ladda ner fulltext (pdf)
    Economic-incentives-for-new-antibiotics
  • 36.
    Baraldi, Enrico
    et al.
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Tekniska sektionen, Institutionen för teknikvetenskaper, Industriell teknik.
    Ciabuschi, Francesco
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Företagsekonomiska institutionen.
    Callegari, Simone
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för informatik och media.
    Lindahl, Olof
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Företagsekonomiska institutionen.
    Ekonomiska incitamentsmodeller för utveckling av nya antibiotika: Rapport på uppdrag av Folkhälsomyndigheten2018Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    På uppdrag av Folkhälsomyndigheten utreder vi i denna rapport en rad incitamentsmodeller för forskning och utveckling (FoU) av antibiotika som kan vara aktuella för en svensk offentlig investering. Baserat på diskussioner och intervjuer med experter, återkoppling från intressenter (d.v.s. potentiella mottagare av svenska incitament), företagsfallstudier och datorbaserade Monte Carlo-simuleringar lämnar rapporten rekommendationer kring de ekonomiska modeller som Sverige bör investera i. De incitamentsmodeller som valdes ut för den svenska portföljen uppfyller följande kriterier: de kan öka Sveriges visibilitet och förbättra den nationella FoU-infrastrukturen i antibiotikafältet, de bygger på Sveriges styrkor och tradition i detta fält, de innefattar begränsade investeringar, de kan införas och ge resultat relativt snabbt, de tillfredsställer på ett unikt sätt viktiga behov i antibiotikapipelinen, och de ger Sverige en möjlighet att spela en avgörande roll i själva skapandet och inriktningen av incitamentet. I enlighet med dessa kriterier, bedömdes att en ”Market Entry Reward” (MER) inte är genomförbar för Sverige ensamt. Det beror främst på att det krävs ett stort finansiellt åtagande (närmare 1 miljard USD) för att ett incitament som en MER ska kunna ge relevanta resultat på pipelinen. Om Sverige trots detta skulle välja att pilottesta en MER på egen hand, borde ett sådant försök fokusera på en s.k. ”totalt losskopplad” MER (Fully Delinked), vilket betyder att MER helt och hållet ersätter marknadsförsäljningen och istället ger fasta årliga utbetalningar till utvecklaren. En MER borde primärt finansieras via sjukvårdsbudgeten för att undvika undanträngningseffekter mot incitament i andra utgiftsområden. En totalt losskopplad MER skulle tillåta testning av flera olika aspekter såsom utvärderingsprocessen för att bestämma det totala värdet på en MER, internprissättning till sjukhus för att återfinansiera de statliga betalningarna, samt regelbundna mellanlägesrevideringar av årliga betalningar beroende på resistensläget. Om Sverige skulle samarbeta med andra länder, som exempelvis G20 eller EU:s medlemsländer, skulle en rimlig storlek på den svenska andelen vara 6 respektive 23 miljoner USD för en partiellt losskopplad MER, och 9 respektive 34 miljoner USD för en totalt losskopplad MER. Det finns dock andra sätt att kombinera push- och pull-incitament som är mer effektiva och snabbare än en MER, nämligen en rad kombinationer av ”grants” (forskningsanslag) och ”milestone prizes”, där det senare är belöningar som betalas ut till utvecklare när de framgångsrikt avslutar viktiga steg i sin FoU (t.ex. Fas 1 i kliniska studier). Förutom bättre effekter per investerat belopp, undviker en kombination av ”grants” och ”milestone prizes” dessutom att stora MER tränger undan push investeringar och mottagare såsom små- och medelstora företag (SMEs) som vanligtvis inte kan vänta på ett incitament ända tills det slutgiltiga godkännandet av ett antibiotikum. Den föreslagna incitamentportföljen för Sverige omfattar tre incitament: ”grants”, ”milestone prizes” och ”Pipeline Coordinators”. Dessa tre incitament skall användas tillsammans för att säkerställa att hela FoU-pipelinen för antibiotika stödjs och att viktiga synergier skapas. Följande aspekter borde tas i beaktning vid implementering och finansiering av de tre valda incitamenten: 1) ”Grants” borde riktas mot tidiga FoU-projekt (fram till Fas 2) och att förstärka den nationella FoUinfrastrukturen, med ett tidsperspektiv som ska vara längre än den nuvarande 3-åriga tidsramen. Det är viktigt att Sverige bibehåller och om möjligt höjer sina nuvarande årliga investeringar i ”grants” för FoU om antibiotika på cirka 60 miljoner SEK/år (7 M USD) och att dessa investeringar får fortsätta över många år i framtiden. Investeringarna kommer att ge långsiktiga effekter både i form av nya molekyler som kan fylla på den framtida FoU-pipelinen och genom fördjupade kompetenser, exempelvis i form av en nationell forskningsinfrastruktur bestående av specialiserade FoU-centra som kan utnyttjas i framtida antibiotikaforskning. Det bör understrykas att man inte kan fördröja dessa investeringar eftersom den här typen av kompetenser behöver byggas omedelbart och frön för framtida FoU-projekt behöver sås i detta nu. 2) Två typer av ”milestone prizes” borde implementeras av Sverige. Först och främst ett ”prize” som delar ut mellan 10 och 20 miljoner USD (bedömningar gjorda av de små företagen i fallstudien) vid slutet av klinisk Fas 1 som bör riktas mot höginnovativa molekyler mot specifika patogener. Därutöver bör ett ”prize” tilldelas projekt som framgångsrikt avslutar de prekliniska stegen. Att inrätta ett ”prize” vid slutet av klinisk Fas 1 skulle vara ett nödvändigt och unikt initiativ, som förutom starka effekter på den tidiga FoU-pipelinen dessutom skulle ge Sverige en stark internationell visibilitet. Genom att finansiera en större del av detta ”milestone prize” skulle Sverige ta ett stort ansvar för att aktivt skapa dessa mycket viktiga incitament. Det andra rekommenderade ”milestone prize”, som delas ut vid slutet av de prekliniska stegen, skulle bidra till att fylla på den kliniska pipelinen och skulle därmed ha mera långsiktiga effekter. 3) ”Pipeline Coordinators”, d.v.s. organisationer som på flera sätt tar en aktiv roll i att välja och stödja en portfölj av FoU-projekt om antibiotika, är det sista rekommenderade incitamentet. Snarare än att skapa en ny ”Pipeline Coordinator”, borde Sverige välja bland de som redan finns och finansiera följande två typer av sådana organisationer: ”R&D Collaborations”, som skapar samarbetsplattformar för att genomföra tidiga FoU aktiviteter för de projekten de stödjer, och ”Nonprofit Developers”, som genomför egna antibiotikaprojekt i syftet att föra nya antibiotika hela vägen till marknaden, dock utan vinstintressen. Den första typen av ”Pipeline Coordinator”, ”R&D Collaborations” är relevant för Sverige att investera i eftersom det handlar om den incitamentsmodell som potentiellt är mest effektiv i att skapa lönsamma FoU projekt. Men för att kunna utnyttja denna potential fullt ut behöver ”R&D Collaborations” vidareutvecklas för att bli mer flexibla samt minska byråkrati och konflikter mellan deltagarna. ”Non-profit Developers” är å andra sidan den modell som erbjuder det mest omfattande stödet till utvalda produkter genom att agera över hela antibiotikapipelinen för att se till att dessa produkter når marknadslansering. Dessutom, ger denna modell starkt stöd gällande global tillgång och ansvarsfull användning (”stewardship”). Därför, skulle Sverige kunna finansiera ”Non-profit Developers” via sin internationella biståndsbudget och därmed även ge ett viktigt bidrag till global hälsa. Båda typer av ”Pipeline Coordinators” har fördelen att de kan hjälpa att koppla svenska FoU-centra för antibiotika till internationella plattformar, vilket skulle förstärka effekterna av infrastrukturrelaterade ”grants”. Dessutom, är alla sorters ”Pipeline Coordinators” incitamentsmodeller som kan användas som verktyg för att styra övriga två incitament (”grants” och ”milestone prizes”). Tack vare denna förmåga, kan de utvärdera ansökningar till ”grants” och de antibiotikaprojekt som är berättigade till ”milestone prizes”, vilket kräver både djupa och detaljerade kunskaper i specifika antibiotikaprojekt. Utöver dessa tre incitamentsmodeller kan även en fjärde modell vara relevant: ”regulatory simplifications”. Denna modell innefattar regulatoriska förenklingar som radikalt sänker kostnader och tider för kliniska Fas 3-studier. Modellen kan vara relevant för Sverige tack vare att kostnaderna är begränsade, implementeringen och effekterna snabba samt att det finns en koppling till svensk expertis. Trots dessa fördelar, kräver detta incitament fortfarande vidare analyser för att fullt ut förstå dess implikationer för regelverket och patientsäkerhet innan den kan rekommenderas för implementering. De tre incitamenten som rekommenderas i denna rapport – ”grants”, ”milestone prizes” och ”Pipeline Coordinators” – bör användas tillsammans i särskilda kombinationer för att utnyttja synergierna mellan dem och deras förmåga att både trycka (”push”) och dra (”pull) molekylerna i olika faser i FoU-pipelinen. Dessa synergier innebär att när exempelvis ”grants” och ”milestone prizes” används samtidigt, blir den offentliga investeringen för varje nytt antibiotikum lägre än den sammanlagda investeringen om de två incitamenten används separat. Om det skulle vara omöjligt att införa och använda de tre incitamenten samtidigt, borde följande prioriteringsordning tillämpas: först och främst behöver nuvarande nivåer på ”grants” bibehållas och om möjligt höjas för att finansiera både enskilda projekt om FoU om antibiotika och för utveckling av kompetenser samt för FoU-infrastruktur, medan investeringar påbörjas i en ”Non-profit Developer” och i en ”milestone prize” vid slutet av Fas 1, följd av vidareutveckling och finansiering av ”R&D Collaborations” och slutligen av ett prekliniskt ”milestone prize”.

    Ladda ner fulltext (pdf)
    Ekonomiska-incitamentsmodeller-för-utveckling-av-nya-antibiotika
  • 37. Barenthin, I
    et al.
    Smedby, B
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    A two-wave interview study of frequency of dental visits and dental complaints1979Ingår i: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 7, nr 3, s. 128-32Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A panel of 268 persons were interviewed twice at an interval of 2 years concerning their visits to dentists and their dental status. The answers they gave on the two occasions agreed well, except for the year of the last visit if it had taken place long ago. This was true both for the people who had gone to the dentist between the interviews and for those who had not. The panel was also asked whether they had any dental complaints. Sixteen percent of them reported complaints at one or both interviews. Complaints were more common among persons who did not often go to the dentist. The persons with complaints did not always get rid of them by going to a dentist. It is concluded that interview data be used for investigating the dental health and behavior of people who do not often go to the dentist, and that dentists are more successful in maintaining good dental health in people who have no dental complaints than in people who report having complaints.

  • 38.
    Bartels, Sara Laureen
    et al.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Johnsson, Sophie, I
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Boersma, Katja
    Örebro Univ, Ctr Hlth & Med Psychol CHAMP, Sch Law Psychol & Social Work, Örebro, Sweden..
    Flink, Ida
    Örebro Univ, Ctr Hlth & Med Psychol CHAMP, Sch Law Psychol & Social Work, Örebro, Sweden..
    McCracken, Lance
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Petersson, Suzanne
    Linnaeus Univ, Dept Med & Optometry, Kalmar, Sweden.;Maastricht Univ, Alzheimer Ctr Limburg, Sch Mental Hlth & Neurosci, Maastricht, Netherlands..
    Christie, Hannah L.
    Maastricht Univ, Dept Psychiat & Neuropsychol, Sch Mental Hlth & Neurosci, Maastricht, Netherlands..
    Feldman, Inna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin/CHAP.
    Simons, Laura E.
    Stanford Univ, Dept Anaesthesiol Perioperat & Pain Med, Sch Med, Stanford, CA USA..
    Onghena, Patrick
    Katholieke Univ Leuven, Res Grp Methods Individual & Cultural Differences, Leuven, Belgium..
    Vlaeyen, Johan W. S.
    Katholieke Univ Leuven, Res Grp Hlth Psychol, Leuven, Belgium.;Maastricht Univ, Res Grp Expt Hlth Psychol, Maastricht, Netherlands..
    Wicksell, Rikard K.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;Capio St Goran Hosp, Pain Clin, Stockholm, Sweden..
    Development, evaluation and implementation of a digital behavioural health treatment for chronic pain: study protocol of the multiphase DAHLIA project2022Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 12, nr 4, artikel-id e059152Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Chronic pain affects about 20%-40% of the population and is linked to mental health outcomes and impaired daily functioning. Pharmacological interventions are commonly insufficient for producing relief and recovery of functioning. Behavioural health treatment is key to generate lasting benefits across outcome domains. However, most people with chronic pain cannot easily access evidence-based behavioural interventions. The overall aim of the DAHLIA project is to develop, evaluate and implement a widely accessible digital behavioural health treatment to improve well-being in individuals with chronic pain.

    Methods and analysis: The project follows the four phases of the mHealth Agile Development and Evaluation Lifecycle: (1) development and pre-implementation surveillance using focus groups, stakeholder interviews and a business model; (2) iterative optimisation studies applying single case experimental design (SCED) method in 4-6 iterations with n=10 patients and their healthcare professionals per iteration; (3) a two-armed clinical randomised controlled trial enhanced with SCED (n=180 patients per arm) and (4) interview-based post-market surveillance. Data analyses include multilevel modelling, cost-utility and indicative analyses. In October 2021, inter-sectorial partners are engaged and funding is secured for four years. The treatment content is compiled and the first treatment prototype is in preparation. Clinical sites in three Swedish regions are informed and recruitment for phase 1 will start in autumn 2021. To facilitate long-term impact and accessibility, the treatment will be integrated into a Swedish health platform (www.1177.se), which is used on a national level as a hub for advice, information, guidance and e-services for health and healthcare.

    Ethics and dissemination: The study plan has been reviewed and approved by Swedish ethical review authorities. Findings will be actively disseminated through peer-reviewed journals, conference presentations, social media and outreach activities for the wider public.

    Ladda ner fulltext (pdf)
    fulltext
  • 39.
    Batra, Gorav
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    Aktaa, Suleman
    Benson, Lina
    Dahlström, Ulf
    Hage, Camilla
    Savarese, Gianluigi
    Vasko, Peter
    Gale, Chris P.
    Lund, Lars H.
    Association between heart failure quality of care and mortality: a population-based cohort study using nationwide registries2022Ingår i: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 24, nr 11, s. 2066-2077Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: To evaluate the quality of heart failure (HF) care using the European Society of Cardiology (ESC) quality indicators (QIs) for HF and to assess whether better quality of care is associated with improved outcomes.

    METHODS AND RESULTS: We performed a nationwide cohort study using the Swedish HF registry, consisting of patients with any type of HF at their first outpatient visit or hospitalization. Independent participant data for quality of HF care was evaluated against the ESC QIs for HF, and association with mortality estimated using multivariable Cox regression. In total, 43 704 patients from 80 hospitals across Sweden enrolled between 2013-2019 were included, with median follow-up 23.6 months. Of the 16 QIs for HF, 13 could be measured and 5 were inversely associated with all-cause mortality during follow-up. Higher attainment (≥50% vs. <50% attainment) of the composite opportunity-based score (combination of QIs into a single score) for patients with reduced ejection fraction was associated with lower all-cause mortality (adjusted hazard ratio 0.81; 95% confidence interval 0.72-0.91). Attainment of the composite score was less in the outpatient than inpatient setting (adjusted odds ratio 0.85; 95% confidence interval 0.72-0.99). Quality of care varied across hospitals, with assessment of health-related quality of life being the indicator with the widest variation in attainment (interquartile range 61.7%).

    CONCLUSION: Quality of HF care may be measured using the ESC HF QIs. In Sweden, attainment of HF care evaluated using the QIs demonstrated between and within hospital variation, and many QIs were inversely associated with mortality.

    Ladda ner fulltext (pdf)
    fulltext
  • 40.
    Baumann, Ana A.
    et al.
    Washington Univ, Brown Sch Social Work, St Louis, MO 63110 USA..
    Hooley, Cole
    Brigham Young Univ, Sch Social Work, Provo, UT 84602 USA..
    Goss, Charles W.
    Washington Univ, Div Biostat, St Louis, MO 63110 USA..
    Mutabazi, Vincent
    Reg Alliance Sustainable Dev, Kigali, Rwanda..
    Brown, Angela L.
    Washington Univ, Dept Med, Cardiovasc Div, St Louis, MO 63130 USA..
    Schechtman, Kenneth B.
    Washington Univ, Div Biostat, St Louis, MO 63110 USA..
    Twagirumukiza, Marc
    Reg Alliance Sustainable Dev, Kigali, Rwanda.;Univ Rwanda, Coll Med & Hlth Sci, Kigali, Rwanda..
    de las Fuentes, Lisa
    Washington Univ, Div Biostat, St Louis, MO 63110 USA.;Washington Univ, Sch Med, Dept Med, Cardiovasc Div, St Louis, MO 63110 USA..
    Reeds, Dominic
    Ctr Human Nutr, Dept Med, Div Geriatr & Nutr Sci, St Louis, MO USA..
    Williams, Makeda
    NHLBI, Bldg 10, Bethesda, MD 20892 USA..
    Mutimura, Eugene
    Reg Alliance Sustainable Dev, Kigali, Rwanda.;Natl Council Sci & Technol, Kigali, Rwanda.;Reg Alliance Sustainable Dev, Kigali, Rwanda..
    Bergström, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH), Global hälsa - implementering och hållbarhet.
    Nishimwe, Aurore
    Reg Alliance Sustainable Dev, Kigali, Rwanda.;Univ Rwanda, Coll Med & Hlth Sci, Kigali, Rwanda..
    Ingabire, Cecile
    Reg Alliance Sustainable Dev, Kigali, Rwanda.;Univ Rwanda, Coll Med & Hlth Sci, Kigali, Rwanda..
    Davila-Roman, Victor G.
    Washington Univ, Dept Med, Cardiovasc Div, St Louis, MO 63130 USA..
    Exploring contextual factors influencing the implementation of evidence-based care for hypertension in Rwanda: a cross-sectional study using the COACH questionnaire2021Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 11, nr 9, artikel-id e048425Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Importance

    Hypertension is the largest contributor to the Global Burden of Disease. In Rwanda, as in most low-income and middle-income countries, an increasing prevalence of hypertension and its associated morbidity and mortality is causing major healthcare and economic impact. Understanding healthcare systems context in hypertension care is necessary.

    Objective

    To study the hypertension healthcare context as perceived by healthcare providers using the Context Assessment for Community Health (COACH) tool.

    Design

    A cross-sectional cohort responded to the COACH questionnaire and a survey about hypertension training.

    Setting

    Three tertiary care hospitals in Rwanda.

    Participants

    Healthcare professionals (n=223).

    Primary outcome(s) and measure(s)

    The COACH tool consists of 49 items with eight subscales: resources, community engagement, commitment to work, informal payment, leadership, work culture, monitoring services for action (5-point Likert Scale) and sources of knowledge (on a 0-1 scale). Four questions surveyed training on hypertension.

    Results

    Responders (n=223, 75% women; 56% aged 20-35 years) included nurses (n=142, 64%, midwives (n=42, 19%), primary care physicians (n=28, 13%) and physician specialists (n=11, 5%)). The subscales commitment to work, leadership, work culture and informal payment scored between 4.7 and 4.1 and the community engagement, monitoring services for action and organizational resources scored between 3.1 and 3.5. Sources of knowledge had a mean score of 0.6 +/- 0.3. While 73% reported having attended a didactic hypertension seminar in the past year, only 28% had received long-term training and 51% had <3-year experience working with hypertension care delivery. The majority (99%) indicated a need for additional training in hypertension care.

    Conclusions

    There is a need for increased and continuous training in Rwanda. Healthcare responders stated a commitment to work and reported supportive leadership, while acknowledging limited resources and no monitoring systems. The COACH tool provides contextual guidance to develop training strategies prior to the implementation of a sustainable hypertension care programme.

    Ladda ner fulltext (pdf)
    FULLTEXT01
  • 41. Bengmark, S
    et al.
    Schersten, T
    Sterky, G
    Liljedahl, S O
    Smedby, B
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Wedel, H
    [Length of stay after gallstone operations]1979Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 76, nr 45, s. 3989-94Artikel i tidskrift (Refereegranskat)
  • 42. Bengtsson, Kajsa Rebecka
    et al.
    Eidhammer Rognan, Stine
    Kälvemark Sporrong, Sofia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaci.
    Berg Lie, Helene
    Andersson, Yvonne
    Mowe, Morten
    Mathiesen, Liv
    Health literacy in medication communication during hospital discharge: a qualitative study at an internal medicines ward in Norway2022Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 12, nr 6, artikel-id e058473Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective When discharged from hospital patients are often assumed to have sufficient health literacy (HL) to participate in their medical treatment and manage medical self-care after discharge. However, limited HL is a widespread concern and patient participation during discharge is lacking. In this study, we explore how HL influences medication communication during hospital discharge.

    Design A qualitative case study, comprising unstructured observations of patient–healthcare personnel (HCP) encounters followed by semistructured interviews. Data were analysed using content analysis.

    Setting An internal medicines ward at a university hospital in Norway.

    Participant Fifteen patients aged 40–89 years were included close to the day of discharge.

    Results The following themes describing dimensions of HL emerged: (1) access, (2) understand, (3) appraise and (4) apply. Most patients sought access to medication information from HCP, while some felt dependent on HCP to provide it. However, their abilities to understand, evaluate and make informed decisions were challenged, partly because HCPs’ ability to adapt their communication to the patient’s knowledgebase varied.

    Conclusion The results give a broader understanding of how HL influences medication communication during hospital discharge. To consider central dimensions of HL is important to achieve optimal medication communication, as the communication only can be exercised within the frames of the patient’s HL. The findings in this study support that HL should be described as a shared responsibility between the patients and HCP. Attention should be focused to the HCP’s responsibility to adapt the communication to the patient’s knowledgebase.

    Ladda ner fulltext (pdf)
    fulltext
  • 43. Berfenstam, R
    Medelvårdtiden vid svenska sjukhus1968Ingår i: Landstingens tidskrift, Vol. 55, nr 2, s. 29-30Artikel i tidskrift (Refereegranskat)
  • 44. Berfenstam, R
    et al.
    Berg, B
    Boström, H
    Smedby, B
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Waern, U
    [Levels of outpatient care: A study within the framework of the Tierp project]1976Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 73, nr 3, s. 127-30Artikel i tidskrift (Refereegranskat)
  • 45. Berfenstam, R
    et al.
    Berg, B
    Boström, H
    Smedby, B
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Waern, U
    Vårdnivåer i öppen vård: Kort-rapport nr 3 från Tierpsprojektet1978Rapport (Övrigt vetenskapligt)
  • 46. Berfenstam, R
    et al.
    Berg, B
    Smedby, B
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Sjukvårdskonsumtion i Tierpsområdet april-maj 1973: En personbaserad studie av olika slag av sjukvårdskontakter i en definierad befolkning1976Rapport (Övrigt vetenskapligt)
  • 47. Berfenstam, R
    et al.
    Hammarström, A
    Smedby, B
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Åberg, H
    [Sources of error in medical care statistics: Cerebrovascular lesions and hypertension]1980Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 77, nr 46, s. 4255-57Artikel i tidskrift (Refereegranskat)
  • 48. Berfenstam, R
    et al.
    Jonsson, E
    Smedby, B
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Sterky, G
    Thurburn, T
    Wennström, G
    Hälsoekonomi: Ett samlat synsätt på fördelning av resurser för hälsa1979Rapport (Övrigt vetenskapligt)
  • 49. Berfenstam, R
    et al.
    Lagerberg, D
    Smedby, B
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Victim characteristics in fatal home accidents: Alcohol, mental disorder, and suicidal intent in officially registered accidents in the home1969Ingår i: Acta socio-medica Scandinavica, ISSN 0044-6041, Vol. 1, nr 3, s. 145-64Artikel i tidskrift (Refereegranskat)
  • 50. Berfenstam, R
    et al.
    Petersson, O
    Smedby, B
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Evaluation research and measurement of benefits of health services (eds)1978Ingår i: Scandinavian journal of social medicine. Supplementum, ISSN 0301-7311, Vol. Suppl 13Artikel i tidskrift (Refereegranskat)
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