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  • 1.
    Birgitta Gunnarsson, A.
    et al.
    Department of Research and Development, Region Kronoberg, PO Box 1223, SE-351 12, Växjö, Sweden. birgitta.gunnarsson@kronoberg.se; Department of Clinical Neuroscience and Rehabilitation, University of Gothenburg, Gothenburg, Sweden. birgitta.gunnarsson@kronoberg.se.
    Wagman, Petra
    School of Health and Welfare, Department of Rehabilitation, Jönköping University, Jönköping, Sweden.
    Hedin, Katarina
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Department of Clinical Sciences in Malmö, Family Medicine Lund University, Lund, Sweden.
    Håkansson, Carita
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Treatment of depression and/or anxiety - outcomes of a randomised controlled trial of the tree theme method® versus regular occupational therapy2018Ingår i: BMC Psychology, E-ISSN 2050-7283, Vol. 6, nr 1, artikel-id 25Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Depression and anxiety disorders are a major concern in western countries, and because these often have a negative affect on everyday life interventions based on activities in everyday life are needed. The Tree Theme Method® (TTM) is a client-centred occupational therapy intervention designed to increase the ability to cope with, and to enhance satisfaction with, everyday life, both at home and at work. The aim of this study was to compare the short term outcomes of the TTM intervention with regular occupational therapy treatment for people with depression and/or anxiety disorders.

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  • 2.
    Bogelund Hansen, Matilde
    et al.
    Univ Copenhagen, Denmark.
    Arpi, Magnus
    Univ Copenhagen, Denmark.
    Hedin, Katarina
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Futurum, Reg Jonkoping Cty, Linkoping, Sweden; Lund Univ, Sweden.
    Melander, Eva
    Skane Reg, Sweden; Lund Univ, Sweden.
    Hertz, Frederik Boetius
    Univ Copenhagen, Denmark; Slagelse Hosp, Denmark.
    Thorsted, Anne Bonde
    Univ Southern Denmark, Denmark.
    Jakobsen, Helle Neel
    Bispebjerg and Frederiksberg Hosp, Denmark.
    Hyllebusk, Lena
    Dept Clin Microbiol, Sweden.
    Brogaard, Emma
    Skane Reg, Sweden.
    Jensen, Jette Nygaard
    Univ Copenhagen, Denmark; Capital Reg Denmark, Denmark.
    Antibiotic-prescribing and antibiotic-resistance patterns among elderly citizens residing in two Nordic regions2020Ingår i: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The objective of this study was to compare antibiotic-prescribing rates in 2016 and antibiotic-resistance rates in 2017 among citizens aged amp;gt;= 85 years between the Capital Region in Denmark and the Skane Region in Sweden, with regards to overall antibiotic use and antibiotics of choice for urinary tract infections (UTIs) and skin and soft tissue infections (SSTIs). Methods: Inhabitants amp;gt;= 85 year old on the date of prescription during 2016 and residing in the Capital Region or the Skane Region were included for antibiotic-prescription analyses. Samples from 2017 from residents of the same regions who were amp;gt;= 85 years old were included for antibiotic-resistance analyses. Antimicrobial use was determined according to the drugs of choice for UTIs and SSTIs in Denmark and Sweden. Students t-tests were used to compare antibiotic prescribing while a Chi-Squared test was performed to compare antibiotic resistance. Results: There was a significantly higher overall prescription rate among citizens amp;gt;= 85 years in the Capital Region than in the Skane Region. The same pattern was evident for the antibiotics of choice for UTIs and SSTIs except for clindamycin. Antibiotic resistance against all antibiotics included was more prominent in the Capital Region than in the Skane Region. Conclusion: Considerable variation in antibiotic prescribing and resistance exists among elderly citizens between these two adjacent Nordic regions. Information and reflection on current practices and resistance patterns may direct attention towards antimicrobial stewardship as a higher priority and may help inform and motivate prescribing behaviours.

  • 3.
    Isberg, Helena Kornfalt
    et al.
    Lund Univ, Sweden.
    Melander, Eva
    Reg Ctr Communicable Dis Control, Sweden; Lund Univ, Sweden.
    Hedin, Katarina
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Lund Univ, Sweden.
    Molstad, Sigvard
    Lund Univ, Sweden.
    Beckman, Anders
    Lund Univ, Sweden.
    Uncomplicated urinary tract infections in Swedish primary care; etiology, resistance and treatment2019Ingår i: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 19, artikel-id 155Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Uncomplicated urinary tract infection (uUTI) is common and a majority of patients are prescribed antibiotics. There is little knowledge about antibiotic resistance in urine samples from patients with uUTI in primary health care (PHC). The aim was to describe antibiotic treatment, bacterial findings, the prevalence of resistant E.coli and factors associated with antibiotic resistance. The aim was also to compare the prevalence of resistant E.coli in clinical practice with the prevalence of resistant E.coli in routine microbiological laboratory data. Methods: This observational study in PHC setting started in November 2014 and ended in March 2016. Women aged 17 years and older with symptoms indicating uUTI from eight PHCs were included. Questionnaires were used to retrieve anamnestic data. All urine samples were sent to the local laboratory of microbiology for diagnostic analysis and susceptibility testing. Proportions of resistant E.coli were compared with corresponding data from the regional laboratory. Results: Urine cultures were analysed in 304 women with a median age of 46 (IQR 32-66) years. Bacterial growth was found in 243 (80%) of urine samples, and E.coli in 72% of the positive samples. A total of 80% of detected E.coli isolates were susceptible to all tested antimicrobials and resistance rates to ciprofloxacin were lower than reported from the local clinical laboratory. Antibiotic treatment within the last year was independently associated with antibiotic resistant E.coli in the urine sample adjusted OR 4.97 (95% CI 2.04-12.06). A total of 74% of the women were treated with antibiotics. The most prescribed was pivmecillinam followed by nitrofurantoin. Conclusions: Antibiotic resistance in E.coli was low. Antibiotic treatment within the last year was associated with antibiotic resistant E.coli. Data from the clinical microbiology laboratory indicates that laboratory data may overestimate antibiotic resistance and lead to an unnecessary change in empiric antibiotic treatment of uUTI in primary care. The empirically prescribed antibiotics, were inline with Swedish treatment recommendations for uUTI.

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  • 4.
    Kornfalt Isberg, Helena
    et al.
    Lund Univ, Sweden.
    Hedin, Katarina
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Lund Univ, Sweden; Futurum, Sweden.
    Melander, Eva
    Reg Ctr Communicable Dis Control, Sweden; Lund Univ, Sweden.
    Molstad, Sigvard
    Lund Univ, Sweden.
    Beckman, Anders
    Lund Univ, Sweden.
    Increased adherence to treatment guidelines in patients with urinary tract infection in primary care: A retrospective study2019Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, nr 3, artikel-id e0214572Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Urinary tract infection (UTI) is common in primary care and leads to a high number of antibiotic prescriptions. Antimicrobial resistance is a global health problem; better antimicrobial prescribing is one way to limit antimicrobial resistance. We aimed to describe the number of consultations for patients diagnosed with lower urinary tract infection (LUTI) and pyelonephritis and changes in prescribing of antibiotics to men and women with LUTI and pyelonephritis in Swedish PHC between the years 2008 and 2013. Methods We performed a descriptive study of changes in UTI diagnosis and antibiotic prescribing in UTI for the years 2008, 2010 and 2013. The Primary Care Record of Infections in Sweden, a database regarding diagnosis linked antibiotic prescribing in primary care, was analyzed concerning data for men and women of all ages regarding UTI visits and antibiotic prescribing. The results were analyzed in relation to current national guidelines. Results There was a variability in consultation incidence for LUTI with an increase between 2008 and 2010 and a decrease between 2010 and 2013, resulting in a slight rise in consultation incidence between 2008 and 2013. The use of recommended nitrofurantoin or pivmecillinam in LUTI in women increased from 54% in 2008 to 69% in 2013. Fluoroquinolones or trimethoprim were prescribed in 24% of LUTI cases in women in 2008 and in 7% of cases in 2013. Prescriptions of pivmecillinam or nitrofurantoin in male LUTI cases increased from 13% in 2008 to 31% in 2013. Fluoroquinolones or trimethoprim were prescribed in 54% of male LUTI cases in 2008 and 32% in 2013. Conclusions Swedish GPs seem to follow national guidelines in the treatment of LUTI in women. In male LUTI cases, the prescriptions of fluoroquinolones remain high and further research is needed to follow prescription patterns and enhance more prudent prescribing to this group of patients.

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  • 5.
    Skoog Stahlgren, Gunilla
    et al.
    Publ Hlth Agcy Sweden, Sweden.
    Tyrstrup, Mia
    Lundbergsgatan Primary Hlth Care Ctr, Sweden; Lund Univ, Sweden.
    Edlund, Charlotta
    Publ Hlth Agcy Sweden, Sweden.
    Giske, Christian G.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Molstad, Sigvard
    Lund Univ, Sweden.
    Norman, Christer
    Salem Primary Hlth Care Ctr, Sweden.
    Rystedt, Karin
    Narhalsan Sodra Ryd Primary Hlth Care Ctr, Sweden; Univ Gothenburg, Sweden.
    Sundvall, Par-Daniel
    Univ Gothenburg, Sweden; RandD Ctr Sodra Alvsborg, Sweden.
    Hedin, Katarina
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Lund Univ, Sweden.
    Penicillin V four times daily for five days versus three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci: randomised controlled, open label, non-inferiority study2019Ingår i: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 367, artikel-id l5337Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE To determine whether total exposure to penicillin V can be reduced while maintaining adequate clinical efficacy when treating pharyngotonsillitis caused by group A streptococci. DESIGN Open label, randomised controlled non-inferiority study. SETTING 17 primary healthcare centres in Sweden between September 2015 and February 2018. PARTICIPANTS Patients aged 6 years and over with pharyngotonsillitis caused by group A streptococci and three or four Centor criteria (fever amp;gt;= 38.5 degrees C, tender lymph nodes, coatings of the tonsils, and absence of cough). INTERVENTIONS Penicillin V 800 mg four times daily for five days (total 16 g) compared with the current recommended dose of 1000 mg three times daily for 10 days (total 30 g). MAIN OUTCOMES MEASURES Primary outcome was clinical cure five to seven days after the end of antibiotic treatment. The noninferiority margin was prespecified to 10 percentage points. Secondary outcomes were bacteriological eradication, time to relief of symptoms, frequency of relapses, complications and new tonsillitis, and patterns of adverse events. RESULTS Patients (n=433) were randomly allocated to the five day (n=215) or 10 day (n=218) regimen. Clinical cure in the per protocol population was 89.6% (n=181/202) in the five day group and 93.3% (n=182/195) in the 10 day group (95% confidence interval -9.7 to 2.2). Bacteriological eradication was 80.4% (n=156/194) in the five day group and 90.7% (n=165/182) in the 10 day group. Eight and seven patients had relapses, no patients and four patients had complications, and six and 13 patients had new tonsillitis in the five day and 10 day groups, respectively. Time to relief of symptoms was shorter in the five day group. Adverse events were mainly diarrhoea, nausea, and vulvovaginal disorders; the 10 day group had higher incidence and longer duration of adverse events. CONCLUSIONS Penicillin V four times daily for five days was noninferior in clinical outcome to penicillin V three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci. The number of relapses and complications did not differ between the two intervention groups. Five day treatment with penicillin V four times daily might be an alternative to the currently recommended 10 day regimen.

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  • 6.
    Tyrstrup, M.
    et al.
    Lund Univ, Sweden.
    André, Malin
    Linköpings universitet, Institutionen för hälsa, medicin och vård. Linköpings universitet, Medicinska fakulteten. Uppsala Univ, Sweden.
    Brorsson, A.
    Lund Univ, Sweden; Ctr Primary Hlth Care Res, Sweden.
    Grondal, H.
    Uppsala Univ, Sweden.
    Strandberg, E-L
    Lund Univ, Sweden.
    Hedin, Katarina
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Lund Univ, Sweden; Fururum, Sweden.
    A study of guidelines for respiratory tract infections and their references from Swedish GPs: a qualitative analysis2020Ingår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 38, nr 1, s. 83-91Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: National guidelines are important instruments in reducing inappropriate antibiotic prescriptions. Low adherence to guidelines is an acknowledged problem that needs to be addressed.

    Method: We evaluated established characteristics for guidelines in the guidelines for lower respiratory tract infection, acute otitis media and pharyngotonsillitis in primary care. We studied how doctors used these guidelines by analysing interviews with 29 general practitioners (GPs) in Sweden.

    Results: We found important between-guidelines differences, which we believe affects adherence. The GPs reported persistent preconceptions about diagnosis and treatment, which we believe reduces their adherence to the guidelines.

    Conclusion: To increase adherence, it is important to consider doctors’ preconceptions when creating new guidelines.

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  • 7.
    Wagman, Petra
    et al.
    Jonkoping Univ, Sweden.
    Hjarthag, Fredrik
    Karlstad Univ, Sweden.
    Hakansson, Carita
    Lund Univ, Sweden.
    Hedin, Katarina
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Futurum, Sweden; Lund Univ, Sweden.
    Gunnarsson, A. Birgitta
    Kronoberg Cty Council, Sweden; Gothenburg Univ, Sweden.
    Factors associated with higher occupational balance in people with anxiety and/or depression who require occupational therapy treatment2020Ingår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Anxiety and depressive disorders are associated with problems with everyday occupations, including difficulties achieving occupational balance. The aim of this cross-sectional study was to describe occupational balance in people suffering from anxiety and/or depression and the factors that are associated with better self-rated occupational balance. Material: One hundred and eighteen participants were recruited from outpatient mental health care and primary health care. The participants were 18-65 years, had a diagnosis of anxiety and/or depression, and had problems in everyday occupations. They answered questionnaires on occupational balance, psychological symptoms, quality of life and everyday occupations. Results: A generally low rating of occupational balance was found; however, the scores differed depending on the participants degree of anxiety and depression, their quality of life, their occupational performance and satisfaction with their occupational performance. Logistic regression analyses revealed that high quality of life, high satisfaction with occupational performance and low level of depression were associated to occupational balance. Conclusion: The results indicate that enhanced satisfaction with life and with performance of everyday occupations are relevant factors for achieving occupational balance in clients diagnosed with anxiety and/or depression.

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