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  • 101.
    Holmberg, Tommy
    et al.
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Börelius, L
    Andersson, I
    Foldemo, Anniqa
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Utvärdering av det psykosociala teamet inom primärvården i Norrköping.2009Report (Other academic)
  • 102.
    Hulting, Karin
    et al.
    Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Rehabilitation in Central County.
    Holmberg, Tommy
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Mindfulness för patienter med psykisk ohälsa: uppföljning av behandlingseffekter inom primärvården2011Report (Other academic)
    Abstract [sv]

    Mindfulness är en ny inriktning inom kognitiv beteendeterapi. Det är en form av uppmärksamhetsträning för att öva förmågan att vara närvarande i nuet och hitta ett accepterande, icke värderande förhållningssätt gentemot sig själv, sin kropp, sina tankar och känslor. I klinisk tillämpning har programmet mindfulnessbaserad kognitiv terapi utarbetats som en åtta veckor lång behandling med dagliga mindfulnessövningar och gruppträffar varje vecka.

    Syftet med studien var att över tid följa en grupp patienter med psykisk ohälsa som deltog i mindfulnessbehandling med fokus på symtomlindring och förbättrad hälsorelaterad livskvalitet.

    Patientens (n=95) psykiska ohälsa skattades med The Comprehensive Psychopathological Rating Scale-Self Assessment, den hälsorelaterade livskvaliteten med EuroQol 5D och graden av mindfulness med Kentucky Inventory of Mindfulness Skills. En kategorisering genomfördes av svaren på de öppna frågorna i en uppföljningsenkät.

    Inklusionskriterier för deltagande i denna behandling var patienter med depressionstillstånd, ångest-, smärt- eller stressrelaterad problematik och utmattningssyndrom. Patienterna remitterades från kuratorer, läkare och sjukgymnaster i närsjukvården i centrala länsdelen till huvudförfattaren. Bortfall utgjordes av de patienter som inte deltog i gruppträffarna vid minst fyra tillfällen och av patienter som valde att tacka nej till behandlingen i samband med det individuella bedömningstillfället före gruppstart. Den vanligaste behandlingsorsaken var stressrelaterade besvär följt av depression och ångest.

    Andelen patienter som skattade måttlig eller svår depression minskade med 26 procent efter genomgången mindfulnessbehandling. Den hälsorelaterade livskvaliteten skattades som förbättrad och var störst föroro/nedstämdhet. Skattningarna visade att patienterna ökade sin  förmåga att observera, att agera med medvetenhet och att acceptera utan att döma.

    Studien visade att mindfulness som behandling av patienter med stress-, ångest eller depressionsproblematik kan bidra till att patienten får bättre förståelse för sina problem och redskap som hjälper dem att bättre bemästra besvären. Behandlingen bör ses som ett komplement till individuell samtalsbehandling och/eller läkemedelsbehandling. En begränsning som måste beaktas då resultaten värderas är avsaknaden av kontrollgrupp.

  • 103.
    Hägg, Mary
    et al.
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Hudiksvall, Uppsala University/County Council of Gävleborg, Gävle, Uppsala, Sweden.
    Tibbling, Lita
    Hudiksvall, Uppsala University/County Council of Gävleborg, Gävle, Uppsala, Sweden.
    Effect of oral IQoro(R) and palatal plate training in post-stroke, four-quadrant facial dysfunction and dysphagia: A comparison study2015In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 135, no 9, p. 962-968Article in journal (Refereed)
    Abstract [en]

    Conclusion: Training with either a palatal plate (PP) or an oral IQoro(R) screen (IQS) in patients with longstanding facial dysfunction and dysphagia after stroke can significantly improve facial activity (FA) in all four facial quadrants as well as swallowing capacity (SC). Improvements remained at late follow-up. The training modalities did not significantly differ in ameliorating facial dysfunction and dysphagia in these patients. However, IQS training has practical and economic advantages over PP training. Objectives: This study compared PP and oral IQS training in terms of (i) effect on four-quadrant facial dysfunction and dysphagia after a first-ever stroke, and (ii) whether the training effect persisted at late follow-up. Methods: Patients were included during two periods; 13 patients in 2005-2008 trained with a PP, while 18 patients in 2009-2012 trained with an IQS. Four-quadrant facial dysfunction was assessed with an FA test and swallowing dysfunction with a SC test: before and after a 3-month training period and at late follow-up. FA and SC significantly improved (p less than 0.001) in both groups. FA test scores after training and at late follow-up did not differ significantly between the groups, irrespective of whether the interval between stroke incidence and the start of training was long or short.

  • 104.
    Håkansson, A
    et al.
    Lund.
    André, Malin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Björklund, C
    Göteborg.
    Borgquist, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Holmberg, S
    FoU Växjö.
    General practice research is growing quickly enough?2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 103, p. 24-25Article in journal (Other academic)
  • 105.
    Jacobsson, Fredric
    et al.
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Arts and Sciences.
    Carstensen, John
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Borgquist, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Caring externalities in health economic evaluation: How are they related to severity of illness?2005In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 73, no 2, p. 172-182Article in journal (Refereed)
    Abstract [en]

    In health economic evaluations, altruistic preferences in the form of caring externalities, i.e. that people care about others' health, is usually not taken into account. In this study we examined how people value their own and others' health. This pilot study was carried out by letting people answer willingness to pay (WTP) questionnaires where internal WTP (own health) and altruistic WTP (others' health) were isolated and examined. A common method used in health economic evaluations is cost-utility analysis, which is based on the maximisation of QALYs. QALY maximisation may be appropriate if altruistic preferences are non-existent or if they are linear in relation to internal preferences (QALYs gained). We found evidence for the existence of altruistic preferences and that these preferences were relatively higher for severe health states (and lower for mild states of health) compared to internal preferences, i.e. when severity of illness increased, the relative increase in caring was higher concerning others than oneself. The difference was statistically significant (P < 0.001). Our results indicate that more attention and resources should be directed to severe health states, as compared to mild health states, than advocated by internal preferences in order to obtain more efficient resource allocation in the health care sector. © 2004 Elsevier Ireland Ltd. All rights reserved.

  • 106.
    Jacobsson, Fredric
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Johannesson, Magnus
    Handelshögskolan.
    Borgquist, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Is Altruism Paternalistic?2007In: Economic Journal, ISSN 0013-0133, E-ISSN 1468-0297, Vol. 117, p. 761-781Article in journal (Refereed)
    Abstract [en]

     We test if altruism is paternalistic with respect to health. Subjects can donate money or nicotine patches to a smoking diabetes patient whose willingness to pay for nicotine patches is positive but below the market price. In a between-subjects treatment, average donations are 40% greater in the nicotine patches group. When subjects can donate both nicotine patches and money more than 90% of the donations are given in kind rather than cash. These results are also confirmed in three additional stability experiments that vary the framing, use food stamps instead of money, and use exercise instead of nicotine patches.

  • 107.
    Jansson, Inger
    et al.
    School of Social and Health Sciences, Halmstad University, Sweden.
    Törnvall, Eva
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Implementation of evidence-based practice by standardized care plans: A study protocol2013In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 3, no 8A, p. 51-57Article in journal (Refereed)
    Abstract [en]

    Background: Patient records should both transfer and create knowledge about patients and their health care. A standardized care plan could be a way to implement evidence-based care directly in practice and improve the documentation in patient records. The aim of this study is to investigate and compare the development and implementation process of a standardized care plan in hospital and primary health care. A further aim is to evaluate the effects on the quality of documentation and the care given in two contexts. Methods and Analysis: Realistic evaluation will be used as a framework to investigate the implementation process. According to this framework, possible contexts, mechanisms, and outcomes in the study will be considered. The study will be performed in two contexts: an orthopedic clinic and primary health care centers. In both contexts, the two key mechanisms will be the same: the implementation process will be driven by internal facilitators (practitioners at the units) and the process will be guided by the Rules and Regulations for interoperability in the Health and Social Care specification, “National information structure for standardized care plans”. Two outcomes of the study will be studied: to investigate the development and implementation process by an evaluation of fidelity and to evaluate how a standardized care plan affects the quality of documentation and the use of evidence-based care. Discussion: Implementation of the SCP will probably meet the same resistance as implementation of guidelines. Documentation of care is an important but resource-consuming requirement in health care, a more standardized method of documenting is requested by health professionals. This project can provide insight into the complex process of developing and implement an SCP in different contexts, which will be useful in further implementation processes.

  • 108.
    Jennersjö, Pär E.
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Primary Health Care in Motala.
    Wijkman, Magnus
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Wiréhn, Ann-Britt
    Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Länne, Toste
    Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Nyström, Fredrik H.
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology and Gastroenterology UHL.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Primary Health Care in Motala.
    Circadian blood pressure variation in patients with type 2 diabetes - relationship to macro- and microvascular subclinical organ damage2011In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 5, no 3, p. 167-173Article in journal (Refereed)
    Abstract [en]

    Aims

    To explore the association between nocturnal blood pressure (BP) dipper status and macro- and microvascular organ damage in type 2 diabetes.

    Methods

    Cross-sectional data from 663 patients with type 2 diabetes, aged 55–66 years, were analysed. Nurses measured office BP and ambulatory BP during 24 h. Individuals with ≥10% difference in nocturnal systolic blood pressure (SBP) relative to daytime values were defined as dippers. Non-dippers were defined as <10% nocturnal decrease in SBP. Estimated glomerular filtration rate (GFR) was calculated and microalbuminuria was measured by albumin:creatinine ratio (ACR). Aortic pulse wave velocity (PWV) was measured with applanation tonometry over the carotid and femoral arteries.

    Results

    We identified 433 dippers and 230 subjects with a nocturnal non-dipping pattern. Nocturnal SBP dipping was independently of office SBP associated with decreased PWV (p = 0.008), lower ACR (p = 0.001) and NT-proBNP (p = 0.001) and increased GFR (p < 0.001).

    Conclusions

    We conclude that diurnal BP variation provides further information about early macro- and microvascular subclinical organ damage that goes beyond standardized office BP measurements in patients with type 2 diabetes.

  • 109. Johansson, Gun
    et al.
    Eliasson, Agneta
    Löbu, Sven
    Holmberg, Tommy
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Närståendes delaktighet i den psykiatriska vården - en enkätundersökning i Östergötland 20062007Report (Other academic)
  • 110.
    Johansson, Kjell
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Åkerlind, Ingemar
    Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland. Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
    Advice to patients in Swedish primary care regarding alcohol and other lifestyle habits: how patients report the actions of GPs in relation to their own expectations and satisfaction with the consultation2005In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 15, no 6, p. 615-620Article in journal (Refereed)
    Abstract [en]

    Background: Lifestyle advice given by general practitioners (GPs) may be a cost-effective means of health promotion; however, it is not fully put into routine practice. The aim of this study was to explore to what extent GPs' patients expect and receive advice concerning alcohol, tobacco, exercise and diet in relation to sociodemographic characteristics, type of visit and patient satisfaction.

    Methods: A postal questionnaire was sent to a representative sample (n = 9750) of patients who had consulted GPs in a county in Sweden. The response rate was 69% (n = 6734).

    Results: Exercise was the most (16%) and alcohol the least (5%) common type of advice. The patients received advice more often than they expected in all areas except alcohol. The patients reported the highest rate of unfulfilled advice expectation and the lowest rate of unexpected advice in the case of alcohol. Male gender, poorer self-rated health and scheduled appointment were independent predictors of all types of advice. Continuity of GP contact was only favourable for exercise and diet advice. The patients who received advice were more satisfied with their visit to the doctor.

    Conclusions: A tertiary preventive perspective guides GPs' practice of giving advice. Male patients with advanced illnesses are given priority. Women and patients with long-term risk habits are more neglected. The GPs tend to misjudge the expectations and needs of their patients and are too restrained in their counselling practice. Alcohol is the most disregarded area of advice in proportion to the patients' expectations and needs.

  • 111.
    Johansson, Kjell
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Åkerlind, Ingemar
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland. Linköping University, Faculty of Health Sciences.
    Early intervention for problem drinkers: readiness to participate among general practitioners and nurses in Swedish primary health care2002In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 37, no 1, p. 38-42Article in journal (Refereed)
    Abstract [en]

    An exploration was made of attitudes and practices of general practitioners (GPs) and nurses concerning early identification of, and intervention for, alcohol-related problems. Sixty-five GPs and 141 nurses in 19 primary health centres in a county in southern Sweden answered a 28-item questionnaire before implementation of an intervention programme. The questionnaire covered experiences with patients with alcohol-related health problems, knowledge and perceived capacity concerning early identification and intervention, attitudes towards the role of primary care staff in early identification and intervention and current intervention methods in use at the health centre. Self-reported frequency of asking about alcohol use was higher among GPs than nurses. Both groups reported more frequently asking about alcohol consumption in cases where they believed that the health status was influenced by alcohol. For both professions, knowledge and skills concerning identification were rated as better understood than that concerning intervention methods. Nurses rated their knowledge and skills less confidently than GPs. The overall attitude was fairly positive towards early identification and intervention, but nurses were more worried than GPs that patients would react negatively to questions about alcohol. Attitudes, self-rated capacity, and practice were related. The low level of early identification and intervention in primary care appears to be related more to insufficient practical skills than to attitudes. Nurses appear to be an unexploited resource, in need of training and support. Nurses may need to be convinced that an active role does not interfere with the nurse-patient relationship. Building teams of GPs and nurses in primary care might enhance the dissemination of alcohol prevention into regular practice.

  • 112.
    Johansson, Kjell
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Åkerlind, Ingemar
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland. Linköping University, Faculty of Health Sciences.
    Factors influencing GPs' decisions regarding screening for high alcohol consumption: a focus group study in Swedish primary care2005In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 119, no 9, p. 781-788Article in journal (Refereed)
    Abstract [en]

    Objective The aim of this study was to explore factors that influence general practitioners' (GPs') decisions regarding screening for high alcohol consumption.

    Methods GPs working at three primary healthcare centres in Sweden participated in focus group interviews. The interviews were recorded and transcribed verbatim, and a deductive framework approach was used for the analysis.

    Results The majority of the participating GPs did not believe in asking all patients about their alcohol consumption. Reported factors that influenced how many and which patients were questioned about alcohol consumption were time, age of the patient, consultation setting, patient–physician relationship, what symptoms the patient presented with, and knowledge of measures if patients appear to have a high alcohol consumption. Thus, alcohol screening and intervention were not performed in all patient groups as was originally intended, but were performed in limited groups of patients such as those with alcohol-related symptoms.

    Conclusions Although the number of participants in this study was small and the conclusions cannot be generalized, the results provide some valuable insights into why GPs are hesitant to engage in screening for high alcohol consumption. Since prevention of alcohol-related health problems is an important public health issue, many different screening and intervention strategies have to be formulated and evaluated in order to reach patients with both hazardous and harmful alcohol consumption within the healthcare system. Screening all consecutive patients for a limited period or screening patient groups known to include a fairly high frequency of high alcohol consumers are two ways of limiting the time requirements and increasing role legitimacy. Still, there is a need for a broader public health strategy involving many players in the community in alcohol preventive measures, especially in more primary preventive approaches.

  • 113.
    Johansson, Kjell
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Åkerlind, Ingemar
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Under what circumstances are nurses willing to engage in brief alcohol interventions?: a qualitative study from primary care in Swedena2005In: Addictive Behaviours, ISSN 0306-4603, E-ISSN 1873-6327, Vol. 30, no 5, p. 1049-1053Article in journal (Refereed)
    Abstract [en]

    To improve alcohol prevention in primary health care, it has been suggested that primary care nurses are an under-utilised resource. The aim of this study was to identify under what circumstances primary care nurses in Sweden are willing to engage in alcohol prevention. All nurses at three primary health care centres in Östergötland, Sweden were invited to participate in focus group interviews; 26 nurses participated. The nurses considered primary health care to be just one among other sectors within the community with responsibility for alcohol prevention. The role of health care in alcohol prevention was perceived to be important but mainly secondary preventive. The nurses felt justified screening all patients' alcohol habits only when they could refer to an obligation or a time-limited project. Otherwise, they mainly wanted to engage in screening patients with alcohol-related symptoms or diagnoses and other risk groups. Reasons for refraining from alcohol screening and intervention included lack of self-efficacy, time consumption and fear of harming their relationship with the patient. New strategies for alcohol prevention in primary care are discussed.

  • 114.
    Josefsson, Ann
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Wiréhn, Ann-Britt
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Lindberg, Malou
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Foldemo, Anniqa
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Continuation rates of oral hormonal contraceptives in a cohort of first-time users: a population-based registry study, Sweden 2005-20102013In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 10Article in journal (Refereed)
    Abstract [en]

    Objective To investigate if continuation rates in first-time users of oral hormonal contraceptives differed between different formulations and to measure if the rates were related to the prescribing categories, that is, physicians and midwives.                                

    Design A longitudinal national population-based registry study.                                

    Setting The Swedish prescribed drug register.                                

    Participants All women born between 1977 and 1994 defined as first-time users of hormonal contraceptives from 2007 to 2009 (n=226 211).                                

    Main outcome measures A tendency to switch the type of hormonal contraceptive within 6 months use and repeated dispensation identical to the first were estimated as percentages and relative risks (RRs). Physicians’ and midwives’ prescription patterns concerning the women's                                    continuation rates of oral hormonal contraceptive type.                                

    Results In Sweden, there were 782 375 women born between 1977 and 1994 at the time of the study. Of these, 226 211 women were identified as first-time users of hormonal contraceptives. Ethinylestradiol+levonorgestrel, desogestrel-only and ethinylestradiol+drospirenone were the hormonal contraceptives most commonly dispensed to first-time users at rates of 43.3%, 24.4% and 11.1%, respectively. The overall rate of switching contraceptive types in the first 6 months was 11.3%, which was highest for desogestrel-only (14.3%) and lowest for ethinylestradiol+drospirenone (6.6%). The switching rate for all three products was highest in the 16-year to 19-year age group. Having a repeated dispensation identical to the initial dispensation was highest for users of ethinylestradiol either combined with levonorgestrel or drospirenone, 81.4% and 81.2%, respectively, whereas this rate for the initial desogestrel-only users was 71.5%. The RR of switching of contraceptive type within the first 6 months was 1.35 (95% CI 1.32 to 1.39) for desogestrel-only and 0.63 (0.59 to 0.66) for ethinylestradiol+drospirenone compared with ethinylestradiol+levonorgestrel as the reference category. There were no differences in the women's continuation rates depending on the prescriber categories.                                

    Conclusions Desogestrel-only users conferred the highest switcher rate to another hormonal contraceptive within a 6-month period. Users of ethinylestradiol+levonorgestrel were more prone to switch to another product within 6 months than women using ethinylestradiol+drospirenone. These findings may be of clinical importance when tailoring hormonal contraceptives on an individual basis.

  • 115.
    Kjellman, Görel
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Effect of different exercise programmes for patients with neck pain and prognostic factors for long term follow up2002In: Annual Congress of the Nordic Ergonomics Society,2002, 2002Conference paper (Other academic)
  • 116.
    Kjellman, Görel
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Nackbesvär, prognostiska faktorer och behandlingseffekter2004In: Incitament, ISSN 1103-503X, no 6, p. 427-429Article in journal (Other (popular science, discussion, etc.))
  • 117.
    Kjellman, Görel
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Öberg, Birgitta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    A randomized clinical trial comparing general exercise, McKenzie treatment and a control group in patients with neck pain2002In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 34, no 4, p. 183-190Article in journal (Refereed)
    Abstract [en]

    Seventy-seven patients with neck pain in the primary health care were included in a prospective, randomized clinical trial and randomly assigned to general exercise, McKenzie treatment, or a control group. Seventy patients completed the treatment, response rate 93% at 12-month follow-up. All three groups showed significant improvement regarding the main outcomes, pain intensity and Neck Disability Index, even at 12-month follow-up, but there was no significant difference between the groups. In all, 79% reported that they were better or completely restored after treatment, although 51% reported constant/daily pain. In the McKenzie group compared with the control group, a tendency toward greater improvement was noted for pain intensity at 3 weeks and at 6-month follow-up, and for post-treatment Neck Disability Index. Significant improvement in Distress and Risk Assessment Method scores was shown in the McKenzie group only. The three groups had similar recurrence rates, although after 12 months the McKenzie group showed a tendency toward fewer visits for additional health care. The study did not provide a definite evidence of treatment efficacy in patients with neck pain, however, there was a tendency toward a better outcome with the two active alternatives compared with the control group.

  • 118.
    Kjellman, Görel
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Öberg, Birgitta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Comparison of three disability questionnaries for low back and neck pain with focus on test-retest reliability and sensitivity of change2006In: The 8th Low Back Pain Forum,2006, 2006Conference paper (Other academic)
  • 119.
    Kärner, Anita
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, East County Primary Health Care.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Wodlin, Peter
    Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Hjelmfors, Lisa
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    The effect of problem-based learning in patient education after an event of CORONARY heart disease - a randomised study in PRIMARY health care: design and methodology of the COR-PRIM study2012In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 13, no 110Article in journal (Refereed)
    Abstract [en]

    Background

    Even though there is convincing evidence that self-care, such as regular exercise         and/or stopping smoking, alters the outcomes after an event of coronary heart disease         (CHD), risk factors remain. Outcomes can improve if core components of secondary prevention         programmes are structurally and pedagogically applied using adult learning principles         e.g. problem-based learning (PBL). Until now, most education programs for patients         with CHD have not been based on such principles. The basic aim is to discover whether         PBL provided in primary health care (PHC) has long-term effects on empowerment and         self-care after an event of CHD.     

    Methods/Design

    A randomised controlled study is planned for patients with CHD. The primary outcome         is empowerment to reach self-care goals. Data collection will be performed at baseline         at hospital and after one, three and five years in PHC using quantitative and qualitative         methodologies involving questionnaires, medical assessments, interviews, diaries and         observations. Randomisation of 165 patients will take place when they are stable in         their cardiac condition and have optimised cardiac medication that has not substantially         changed during the last month. All patients will receive conventional care from their         general practitioner and other care providers. The intervention consists of a patient         education program in PHC by trained district nurses (tutors) who will apply PBL to         groups of 6–9 patients meeting on 13 occasions for two hours over one year. Patients         in the control group will not attend a PBL group but will receive home-sent patient         information on 11 occasions during the year.     

    Discussion

    We expect that the 1-year PBL-patient education will improve patients’ beliefs, self-efficacy         and empowerment to achieve self-care goals significantly more than one year of standardised         home-sent patient information. The assumption is that PBL will reduce cardiovascular         events in the long-term and will also be cost-effective compared to controls. Further,         the knowledge obtained from this study may contribute to improving patients’ ability         to handle self-care, and furthermore, may reduce the number of patients having subsequent         CHD events in Sweden.

  • 120.
    Kärner, Anita
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Behavioural Sciences and Learning, Studies in Adult, Popular and Higher Education. Linköping University, Faculty of Educational Sciences.
    Dahl, Lena
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Asklund, Eva
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    COR-PRIM: Patient education after coronary disease - Long-term evaluation in primary care2010Conference paper (Other academic)
  • 121.
    Larsson, Harriet
    et al.
    RörelseHälsa, Neuro, Poliomottagningen, Ljungsbro Lio.
    Kjellman, Görel
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Polio- en bortglömd sjukdom2007In: Incitament, ISSN 1103-503X, Vol. 5, p. 403-406Article in journal (Other (popular science, discussion, etc.))
  • 122.
    Larsson, Harriet
    et al.
    Rörelse Hälsa Neuro Poliomottagningen Ljungsbro Lio.
    Kjellman, Görel
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Riskfaktorer för benskörhet och frakturer efter polio2007In: Incitament, ISSN 1103-503X, Vol. 4, p. 301-304Article in journal (Other (popular science, discussion, etc.))
  • 123.
    Lidholm, Anette Gente
    et al.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Bergfors, Elisabet
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Inerot, Annica
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Blomgren, Ulla
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Gillestedt, Martin
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Trollfors, Birger
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Unexpected loss of contact allergy to aluminium induced by vaccine2013In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 68, no 5, p. 286-292Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    In studies in Gothenburg, Sweden, in the 1990s of an aluminium hydroxide-adsorbed pertussis toxoid vaccine, 745 of ~76 000 vaccinated children developed long-lasting itchy subcutaneous nodules at the vaccination site. Of 495 children with itchy nodules patch tested for aluminium allergy, 376 (76%) were positive.

    OBJECTIVES:

    To study the prognosis of the vaccine-induced aluminium allergy.

    PATIENTS AND METHODS:

    Two hundred and forty-one children with demonstrated aluminium allergy in the previous study were patch tested again 5-9 years after the initial test, with the same procedure as used previously.

    RESULTS:

    Contact allergy to aluminium was no longer demonstrable in 186 of the retested 241 children (77%). A negative test result was more common in children who no longer had itching at the vaccination site; it was also related to the age of the child, the time after the first aluminium-adsorbed vaccine dose, and the strength of the reaction in the first test.

    CONCLUSIONS:

    Patch test reactivity to aluminium seems to disappear or weaken with time.

  • 124.
    Lindberg, Malou
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    AGREE in Sweden, Östergötlands county council2003In: AGREE and Guidelindes International Network GIN,2003, 2003Conference paper (Other academic)
  • 125.
    Lindberg, Malou
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Månadens forskare. Att forska har gett Malou tålamod2003In: Vårdfacket, ISSN 0347-0911, Vol. 9, p. 56-57Article in journal (Refereed)
  • 126.
    Lindberg, Malou
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Utvärdering av sjuksköterskeledda astmamottagningar i primärvården. Mer vårdkvalitet för mindre pengar?2002In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 20, p. 2277-2280Article in journal (Other academic)
  • 127.
    Lindberg, Malou
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Foldemo, Anniqa
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Differences in prescription rates and odds ratios of antidepressant drugs in relation to individual hormonal contraceptives: A nationwide population-based study with age-specific analyses2012In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 17, no 2, p. 106-118Article in journal (Refereed)
    Abstract [en]

    Objectives To examine, among young women, the association of individual hormonal contraceptives, within two broad groupings, with antidepressant therapy. less thanbrgreater than less thanbrgreater thanMethods In a nationwide register-based study, we examined the prescription rates of antidepressant drugs in relation to individual combined hormonal and progestin-only contraceptives among Swedish women aged 16-31 years (N = 917,993). Drug data were obtained from the Swedish Prescribed Drug Register for the period 1 July 2005-30 June 2008. Data on the total population of women aged 16-31 in 2008 were obtained from the Total Population Register of Statistics Sweden. The proportion of women using both hormonal contraception and antidepressants, and odds ratios (ORs) for antidepressant use for hormonal contraceptive users versus non-users, were calculated, the latter by logistic regression, for each formulation. less thanbrgreater than less thanbrgreater thanResults The highest antidepressant OR in all age groups, particularly in the 16-19 years age group, related to medroxyprogesterone-only, followed by etonogestrel-only, levonorgestrel-only and ethinylestradiol/norelgestromin formulations. Oral contraceptives containing ethinylestradiol combined with lynestrenol or drospirenone had considerably higher ORs than other pills. ORs significantly lower than 1 were observed when ethinylestradiol was combined with norethisterone, levonorgestrel or desogestrel. less thanbrgreater than less thanbrgreater thanConclusion The association between use of hormonal contraceptives and antidepressant drugs varies considerably within both the combined hormonal contraceptive and the progestin-only groups.

  • 128.
    Lindberg, Malou
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Foldemo, Anniqa
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Wiréhn, Ann-Britt
    Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Differences in prescription rates of antidepressant drugs in relation to individual hormonal contraceptives: a nationwide population-based study2012Conference paper (Other academic)
  • 129.
    Lindberg, Malou
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Lind, Mildrid
    Petersson, Susanne
    Wilhelmsson, Susan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV). Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    The use of clinical guidelines for asthma, diabetes, and hypertension in primary health care2005In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 17, p. 217-220Article in journal (Refereed)
  • 130.
    Lindberg, Malou
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Schöld, Anna-Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Östgren, Carl-Johan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland.
    Tilling, Björn
    Tunér, Kajsa
    AGREE-instrumentet praktisk metod för utvärdering av kliniska riktlinjer2005In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, no 41, p. 2942-2943Article in journal (Other academic)
  • 131.
    Lindberg, Malou
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Wilhelmsson, Susan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV). Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Have national goals for public health been implemented in Swedish primary care?2006In: Ninth international congress of behavioral medicine,2006, 2006, p. 246-246Conference paper (Other academic)
    Abstract [en]

       

  • 132.
    Lindberg, Malou
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Wilhelmsson, Susan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV). Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Health prevention and health promotion methods and methodology used by nurses in primary health care2005In: International Council of Nurses 23rd Quadrennial Congress,2005, 2005, p. 51-51Conference paper (Refereed)
  • 133.
    Lindberg, Malou
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Wilhelmsson, Susan
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    National public health target awareness of staff at two organisational levels in health care2007In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 84, p. 243-248Article in journal (Refereed)
  • 134.
    Lindberg, Malou
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Wilhelmsson, Susan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV). Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    The use of clinical guidelines for asthma, diabetes and hypertension in primary health care2004In: WONCA,2004, 2004, p. 99-99Conference paper (Refereed)
  • 135.
    Lindberg, Malou
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Wilhelmsson, Susan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV). Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    "Vem bryr sig?" Distriktssköterskans förebyggande och hälsofrämjande arbete : ett svårprioriterat uppdrag och en outnyttjad resurs2005Report (Other academic)
  • 136.
    Lorefelt, Birgitta
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Wilhelmsson, Susan
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Nutritional status and health care costs for the elderly living in municipal residential homes — An intervention study2011In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 15, no 2, p. 92-97Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    The aim was to study the effect of individualised meals on nutritional status among older people living in municipal residential homes and to compare the results with a control group. An additional aim was to estimate direct health care costs for both groups.

    SETTING:

    Six different municipal residential homes in the south-east of Sweden.

    PARTICIPANTS:

    Older people living in three residential homes constituted the intervention group n=42 and the rest constituted the control group n=67.

    INTERVENTION:

    A multifaceted intervention design was used. Based on an interview with staff a tailored education programme about nutritional care, including both theoretical and practical issues, was carried through to staff in the intervention group. Nutritional status among the elderly was measured by Mini Nutritional Assessment (MNA), individualised meals were offered to the residents based on the results of the MNA. Staff in the control group only received education on how to measure MNA and the residents followed the usual meal routines.

    MEASUREMENTS:

    Nutritional status was measured by MNA at baseline and after 3 months. Cost data on health care visits during 2007 were collected from the Cost Per Patient database.

    RESULTS:

    Nutritional status improved and body weight increased after 3 months in the intervention group. Thus, primary health care costs constituted about 80% of the total median cost in the intervention group and about 55% in the control group.

    CONCLUSION:

    With improved knowledge the staff could offer the elderly more individualised meals. One of their future challenges is to recognise and assess nutritional status among this group. If malnutrition could be prevented health care costs should be reduced.

  • 137.
    Lovén Wickman, Ulrica
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Yngman-Uhlin, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Hjortswang, Henrik
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Gastroentorology.
    Riegel, Barbara
    University of Pennsylvania, School of Nursing, Philadelphia, USA.
    Stjernman, Henrik
    County Hospital Ryhov, Jönköping, Sweden.
    Hollman Frisman, Gunilla
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Gastroentorology.
    Self-care among patients with Inflammatory Bowel Disease - an interview study2014Conference paper (Other academic)
  • 138.
    Lundgren, Oskar
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Garvin, Peter
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Jonasson, Lena
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Andersson, Gerhard
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Stockholm, Sweden.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Psychological Resources are Associated with Reduced Incidence of Coronary Heart Disease: An 8-Year Follow-up of a Community-Based Swedish Sample2014In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 22, no 1, p. 77-84Article in journal (Refereed)
    Abstract [en]

    Background

    A large number of studies have provided clear evidence for a link between the risk of coronary heart disease and psychological risk factors. Much less attention has been given to the potential protective effect of psychological resources.

    Purpose

    The major aim of this study was to investigate the independent association between psychological resources and incidence of coronary heart disease (CHD) in an 8-year follow-up study of a Swedish community-based cohort.

    Methods

    The cohort consisted of 484 men and 497 women, aged 45–69 years at baseline. The incidence of first-time major event of CHD was analysed in relation to baseline levels of psychological resources, including mastery, self-esteem, and sense of coherence as well as psychological risk factors including cynicism and hostile affect, vital exhaustion, hopelessness, and depressive symptoms. In Cox proportional hazard models, adjustments were made for age, sex, eight traditional cardiovascular risk factors, and depressive symptoms.

    Results

    A total of 56 CHD events had occurred after the 8-year follow-up. After adjustment for age, sex, and eight traditional risk factors, a significantly decreased risk of CHD was found for mastery (HR 0.62 per SD, p = 0.003), self-esteem (HR 0.64, p = 0.004), and sense of coherence (HR 0.70, p = 0.031). An increased risk of CHD was found for vital exhaustion (HR 1.46, p = 0.014), hopelessness (HR 1.59, p = 0.003), and depressive symptoms (HR 1.45, p = 0.009). After further adjustment for depressive symptoms, significant associations remained for mastery (HR 0.67, p = 0.034), self-esteem (HR 0.69, p = 0.048), and hopelessness (HR 1.48, p = 0.023).

    Conclusions

    The psychological resources, mastery and self-esteem, showed robust protective effects on CHD, also after adjustment for established risk factors as well as depressive symptoms. In parallel, hopelessness was an independent risk factor for CHD. The results may have implications for novel approaches in preventive efforts

  • 139.
    Malmgren, Malin
    et al.
    Hospital of Halland, Varberg, Sweden.
    Törnvall, Eva
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Jansson, Inger
    School of Social and Health Sciences, Halmstad University, Halmstad, Sweden.
    Patients with hip fracture: Experiences of participation in care2014In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 18, no 3, p. 143-150Article in journal (Refereed)
    Abstract [en]

    Health care staff are obliged to help patients participate in their care. Previous research has shown that information and relationships with staff are important factors for patients to feel involved. The aim of the study was to describe patients’ experiences of participation during hospitalization for hip fracture. Eleven patients being treated for hip fracture were included and data were collected using interviews. Analysis of the data was carried out through qualitative content analysis. The results illustrate that the experiences of participation are governed by the patient’s personal circumstances, needs and wishes and are affected by how responsive the staff are to these. Patients’ experience of participation is also affected by having to adapt to the health care organization and structure. To pursue individualized care, staff need to start from patient preferences and it is a challenge to adapt care to both the individual and the organization. By paying attention to patient preferences, the staff have a greater opportunity to implement changes in health care that will benefit a large patient population. This can lead to patients gaining better functional capacity and quality of life.

  • 140.
    Marcusson, Agneta
    et al.
    Östergötlands Läns Landsting, Reconstruction Centre, Department of Oral Surgery UHL. Östergötlands Läns Landsting, Sinnescentrum.
    Åkerlind, Ingemar
    Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Paulin, Gunnar
    Östergötlands Läns Landsting, Reconstruction Centre, Department of Oral Surgery UHL. Linköping University, Faculty of Health Sciences.
    Quality of life in adults with repaired complete cleft lip and palate2001In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 38, no 4, p. 379-385Article in journal (Refereed)
    Abstract [en]

    Objective: This study evaluated the quality of life in adult Swedish subjects with repaired complete cleft lip and palate (CLP).

    Design/Patients: Sixty-eight adults with repaired CLP were compared with a group of 66 adults without cleft matched by gender and age.

    Outcome Measures: The outcome measures included a self-report questionnaire concerning quality of life in general, well-being, and health-related quality of life.

    Results: The CLP group rated their quality of life significantly lower than did the control group in the areas of life meaning (p < .05), family life (p < .0001), and private economy (p < .01). There were no significant differences between the groups concerning well-being. In the CLP group, the health-related quality of life was significantly lower concerning global life (p < .0001), disturbance to life (p < .01), well-being (p < .0001), social contacts (p < .0001), and family life (p < .05) but significantly higher concerning ability to make the most of leisure time (p < .001) and to be active (p < .001).

    Conclusions: The CLP group perceived a marked impact of the handicap on their lives concerning global aspects, well-being, and social life. More practical and tangible aspects of their daily living, however, were not affected, and only some minor aspects of their quality of life in general were poor in comparison with the control group, which indicates a fairly good life adjustment in spite of the handicap.

  • 141.
    Marklund, B.
    et al.
    Research and Development Unit, Primary Health Care, Halland, Finland, Department of Primary Health Care, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden, Research and Development Unit, Primary Health Care, PO Box 113, SE-311 22 Falkenberg, Sweden.
    Strom, M.
    Ström, M., Research and Development Unit, Primary Health Care, Halland, Finland.
    Mansson, J.
    Månsson, J., Research and Development Unit, Primary Health Care, Halland, Finland, Department of Primary Health Care, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Borgquist, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Baigi, A.
    Research and Development Unit, Primary Health Care, Halland, Finland, Department of Primary Health Care, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Fridlund, B.
    Department of Primary Health Care, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden, School of Health Sciences and Social Work, Växjö University, Växjö, Sweden.
    Computer-supported telephone nurse triage: An evaluation of medical quality and costs2007In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 15, no 2, p. 180-187Article in journal (Refereed)
    Abstract [en]

    Aim: To evaluate a telephone nurse triage model in terms of appropriateness of referrals to the appropriate level of care, patient's compliance with given advice and costs. Background: A key concern in each telephonic consultation is to evaluate if appropriate. Method: An evaluative design in primary health care with consecutive patients (N = 362) calling telephone nurse triage between November 2002 and February 2003. Results: The advice was considered adequate in 325 (97.6%) cases. The patients' compliance with self-care was 81.3%, to primary health care 91.1% and to Accident and Emergency department 100%. The nurses referred self-care cases (64.7%) and Accident and Emergency cases (29.6%) from a less adequate to an appropriate level of care. The cost saving per call leading to a recommendation of self-care was €70.3, to primary health care €24.3 and to Accident and Emergency department €22.2. Conclusions The telephone nurse triage model showed adequate guidance for the patients concerning level of care and released resources for the benefit of both patients and the health care system. © 2007 The Authors. Journal compilation 2007 Blackwell Publishing Ltd.

  • 142.
    Mårtensson, Jan
    et al.
    Landstinget Jönköping.
    Carlsson, Per
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Arvidsson, Eva
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Frank, Linda
    Landstinget Jönköping.
    Lindström, Kjell
    Landstinget Jönköping.
    Borgquist, Lars
    Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Linköping University, Faculty of Health Sciences.
    Erfarenhet, kunskap och inställning till prioriteringar: En intervjustudie med personal i primärvården2006Report (Other academic)
    Abstract [sv]

    Den svenska primärvården med vårdcentraler har utvecklats under en 40-årsperiod. Utvecklingen har delvis varit en anpassning till den alltjämt dominerande specialistvården med anknytning till sjukhusen. I takt med den medicinteknologiska utvecklingen har det också skett en överföring av flera patientgrupper i öppna vårdformer och många av de stora folksjukdomarna utreds och behandlas numera i primärvården. Resurstillskottet till svensk primärvård har i relativa tal varit mindre än det till sjukhusvård under den 40-åriga perioden och det har skapat prioriteringsproblem.

    Frågor om hur prioriteringar går till och bör gå till blir alltmer aktuella i primärvården i takt med att man upplever att resurserna inte räcker till. Studier och diskussioner om prioriteringar saknas till stor del och det har inte funnits någon vana att hantera prioriteringssituationer inom primärvården. Inte heller har det funnits stöd eller verktyg för att underlätta prioriteringsarbetet för de som arbetar i primärvården.

    Detta projekt om prioriteringar i primärvård vill belysa hur primärvårdspersonal tänker och agerar i prioriteringsfrågor och hur prioriteringsarbetet sker i praktiken vid ett slumpmässigt urval av landets vårdcentraler. Vi anser därför att resultaten är representativa för svensk primärvård.

    Projektet utgår från Institutionen för hälsa och samhälle vid Linköpings universitet (Per Carlsson, Eva Arvidsson och Lars Borgquist) i samarbete med Primärvårdens FoU-enhet i Jönköpings läns landsting (Kjell Lindström, Jan Mårtensson och Linda Frank). Arbetet har genomförts med ekonomiskt stöd från forskningsprogrammet Sjukvårdens förändringar, ett samarbete mellan Region Skåne, Västra Götalands Regionen, Landstinget Västmanland, Landstinget i Östergötland, Stockholms läns landsting, Socialstyrelsen och Sveriges Kommuner och Landsting.

    Tack till alla de personer som medverkat vid intervjuerna, övriga personer i projektet samt anslagsgivaren.

  • 143.
    Nettelbladt, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    The Lundby Study - fifty years of psychiatry2002In: 11th symposium of the AEP Section Epidemiology and Social Psychiatry,2002, 2002Conference paper (Refereed)
  • 144.
    Nettelbladt, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Bogren, M
    Hofvendahl, E
    Mattisson, C
    Toråker, P
    Öjesjö, L
    Hagnell, O
    The Lundby Study - fifty years of psychiatry2002In: 11th AEP Congress,2002, 2002Conference paper (Refereed)
  • 145.
    Nettelbladt, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Bogren, M
    Mattisson, C
    Hofvendahl, E
    Öjesjö, L
    Lundbystudien 1947-19972002In: FoU-konferens,2002, 2002Conference paper (Other academic)
  • 146.
    Nettelbladt, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Mattisson, Cecilia
    Bogren, Mats
    Holmqvist, Marika
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Suicide Rates in the Lundby Cohort before and after the Introduction of Tricyclic Antidepressant Drugs2007In: Archives of Suicide Research, ISSN 1381-1118, E-ISSN 1573-8159, no 11, p. 57-67Article in journal (Refereed)
  • 147.
    Nilsson, Staffan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Primary Health Care in Norrköping.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Karlsson, Jan-Erik
    County Hospital Ryhov, Sweden.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Cost consequences of point-of-care troponin T testing in a Swedish primary health care setting2014In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 32, no 4, p. 241-247Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate the safety and cost-effectiveness of point-of-care troponin T testing (POCT-TnT) for the management of patients with chest pain in primary care. Design. Prospective observational study with follow-up. Setting. Three primary health care (PHC) centres using POCT-TnT and four PHC centres not using POCT-TnT in south-east Sweden. Patients. All patients greater than= 35 years of age, contacting one of the PHC centres for chest pain, dyspnoea on exertion, unexplained weakness and/or fatigue, with no other probable cause than cardiac, were included. Symptoms must have commenced or worsened during the previous seven days. Main outcome measures. Emergency referral rates, diagnoses of acute myocardial infarction (AMI) or unstable angina (UA), and costs were collected for 30 days after the patient sought care at the PHC centre. Results. A total of 196 patients with chest pain were included: 128 in PHC centres with POCT-TnT and 68 in PHC centres without POCT-TnT. Fewer patients from the PHC centres with POCT-TnT (n = 32, 25%) were emergently referred to hospital than from centres without POCT-TnT (n = 29, 43%; p = 0.011). Eight patients (6.2%) from PHC centres with POCT-TnT were diagnosed with AMI or UA compared with six patients (8.8%) from centres without POCT-TnT (p = 0.565). Two patients with AMI or UA were classified as missed cases from PHC centres with POCT-TnT and there were no missed cases from PHC centres without POCT-TnT. SKr290 000 was saved per missed case of AMI or UA. Conclusion. The use of POCT-TnT in primary care may be cost saving but at the expense of missed cases.

  • 148.
    Nilsson, Staffan
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Primary Health Care in Norrköping.
    Andersson, Per O.
    Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care in Central County.
    Borgquist, Lars
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Grodzinsky, Ewa
    Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Kvick, Magnus
    Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Primary Health Care in Norrköping.
    Landberg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Nilsson, Håkan
    Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care in Central County.
    Karlsson, Jan-Erik
    Department of Internal Medicine, County Hospital Ryhov, Jönköping.
    Point-of-Care Troponin T Testing in the Management of Patients with Chest Pain in the Swedish Primary Care2013In: International Journal of Family Medicine, ISSN 2090-2042, E-ISSN 2090-2050, Vol. 2013Article in journal (Refereed)
  • 149.
    Nilsson, Staffan
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, East County Primary Health Care.
    Andersson, Pär
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Karlsson, Jan-Erik
    Department of Internal Medicine, Ryhov County Hospital, Jönköping, Sweden.
    Borgquist, Lars
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Efficiency of point-of-care Troponin-T testing in a Swedish primary care setting2011Conference paper (Other academic)
    Abstract [en]

    Rationale Swedish general practitioners and cardiologists are concerned of the use of point-of-care Troponin-T testing (PCTT) in primary care i.e. the risk of overlooking a recent acute myocardial infarction (AMI) or unstable angina (UA) relaying too much on a laboratory finding. In this study we aimed to evaluate both missed and properly managed AMI or UA in relation to the use of PCTT. Methods & Results Setting: Seven primary health care centres (PHCC) in southeast Sweden participated. In three of the PHCCs, PCTT was analysed in conjunction with clinical assessment of all study patients, i.e. PCTT-PHCCs. In four of the PHCCs, PCTT was not used, i.e. Control-PHCCs. All patients ≥ 35 years old consulting for chest pain, having commenced or aggravated the last seven days, were included in the study. A systematic review of hospital medical records was done of all patients hospitalised the same day as inclusion or within 30 days there after. In patients who were sent home from the PHCC and hospitalised for any reason within thirty days, the PHCC medical records were systematically reviewed, by one GP and one cardiologist. 196 patients were included, 128 patients in the three PCTT-PHCCs and 68 patients in the four Control-PHCCs. In the PCTT-PHCCs two patients were identified as missed AMI or UA and none in the Control-PHCCs. Properly managed patients with AMI or UA were five in the PCTT-PHCCs and six in the Control-PHCCs. Conclusion The use of PCTT in primary care does not seem to enhance a total safety manageing of chest pain patients. Clinical Relevance The use of PCTT in primary care could be discussed due to the risk of false safety.

  • 150.
    Nilsson, Staffan
    et al.
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, East County Primary Health Care.
    Scheike, Morten
    Engblom, David
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Karlsson, Lars-Göran
    Mölstad, Sigvard
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Åkerlind, Ingemar
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Örtoft, Kjell
    Nylander, Eva
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Chest pain and ischaemic heart disease in primary care2003In: British Journal of General Practice, ISSN 0960-1643, Vol. 53, no 490, p. 378-382Article in journal (Refereed)
    Abstract [en]

    Background: Chest pain is the main symptom of first presentation with ischaemic heart disease (IHD). Little is known about the incidence of IHD among patients consulting the general practitioner (GP) for chest pain.

    Aims: To estimate the occurrence of IHD among patients consulting for chest pain, to study the results of the bicycle exercise test, and to estimate the incidence of IHD in the population.

    Design of study: Prospective descriptive study.

    Setting: Three primary health centres in south-eastern Sweden

    Method: All patients without a current IHD diagnosis, aged 20 to 79 years, and consulting for a new episode of chest pain, were included consecutively. The outcome was classified as IHD, possible IHD or not IHD, according to the results of a postal questionnaire, an exercise test or hospital care. Data from the hospital registry on patients with a diagnosis of IHD were analysed retrospectively.

    Results: Out of 38 075 GP consultations, 577 (1.5%) were for chest pain. IHD was diagnosed in 41 (8%) of the chest pain patients, in 41 (83%) the diagnosis was excluded, and in 50 (9%) the diagnosis was judged as being uncertain. Even though the diagnostic criteria were strict, the exercise tests led to a diagnostic conclusion in 77% of the cases, most frequently a normal test result. Combining data from primary and hospital care, the yearly incidence of IHD was 6.5 diagnosed per 1000 inhabitants (aged 20 to 79 years old).

    Conclusion: The incidence of a new episode of chest pain bringing the patient to the GP was low. Eight per cent of the patients received an IHD diagnosis, and in 9% further investigation or clinical assessment is needed.

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