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  • 301. Malki, Ninoa
    et al.
    Hägg, Sara
    Tiikkaja, Sanna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin/CHAP.
    Koupil, Ilona
    Sparén, Pär
    Ploner, Alexander
    Short-term and long-term case-fatality rates for myocardial infarction and ischaemic stroke by socioeconomic position and sex: a population-based cohort study in Sweden, 1990-1994 and 2005-20092019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 7, artikel-id e026192Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Case-fatality rates (CFRs) for myocardial infarction (MI) and ischaemic stroke (IS) have decreased over time due to better prevention, medication and hospital care. It is unclear whether these improvements have been equally distributed according to socioeconomic position (SEP) and sex. The aim of this study is to analyse differences in short-term and long-term CFR for MI and IS by SEP and sex between the periods 1990-1994 to 2005-2009 for the entire Swedish population.

    DESIGN: Population-based cohort study based on Swedish national registers.

    METHODS: We used logistic regression and flexible parametric models to estimate short-term CFR (death before reaching the hospital or on the disease event day) and long-term CFR (1 year case-fatality conditional on surviving short-term) across five distinct SEP groups, as well as CFR differences (CFRDs) between SEP groups for both MI and IS from 1990-1994 to 2005-2009.

    RESULTS: Overall short-term CFR for both MI and IS decreased between study periods. For MI, differences in short-term and long-term CFR between the least and most favourable SEP group were generally stable, except in long-term CFR among women; intermediate SEP groups mostly managed to catch up with the most favourable SEP group. For IS, short-term CFRD generally decreased compared with the most favourable group; but long-term CFRD were mostly stable, except for an increase for older subjects.

    CONCLUSION: Despite a general decline in CFR for MI and IS across all SEP groups and both sexes as well as some reductions in CFRD, we found persistent and even increasing CFRD among the least advantaged SEP groups, older patients and women. We speculate that targeted prevention rather than treatment strategies have the potential to reduce these inequalities.

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  • 302. Malki, Ninoa
    et al.
    Hägg, Sara
    Tiikkaja, Sanna
    Koupil, Ilona
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Sparén, Pär
    Ploner, Alexander
    Short-term and long-term case-fatality rates for myocardial infarction and ischaemic stroke by socioeconomic position and sex: a population-based cohort study in Sweden, 1990-1994 and 2005-20092019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 7, artikel-id e026192Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective Case-fatality rates (CFRs) for myocardial infarction (MI) and ischaemic stroke (IS) have decreased over time due to better prevention, medication and hospital care. It is unclear whether these improvements have been equally distributed according to socioeconomic position (SEP) and sex. The aim of this study is to analyse differences in short-term and long-term CFR for MI and IS by SEP and sex between the periods 1990-1994 to 2005-2009 for the entire Swedish population.

    Design Population-based cohort study based on Swedish national registers.

    Methods We used logistic regression and flexible parametric models to estimate short-term CFR (death before reaching the hospital or on the disease event day) and long-term CFR (1 year case-fatality conditional on surviving short-term) across five distinct SEP groups, as well as CFR differences (CFRDs) between SEP groups for both MI and IS from 1990-1994 to 2005-2009.

    Results Overall short-term CFR for both MI and IS decreased between study periods. For MI, differences in short-term and long-term CFR between the least and most favourable SEP group were generally stable, except in long-term CFR among women; intermediate SEP groups mostly managed to catch up with the most favourable SEP group. For IS, short-term CFRD generally decreased compared with the most favourable group; but long-term CFRD were mostly stable, except for an increase for older subjects.

    Conclusion Despite a general decline in CFR for MI and IS across all SEP groups and both sexes as well as some reductions in CFRD, we found persistent and even increasing CFRD among the least advantaged SEP groups, older patients and women. We speculate that targeted prevention rather than treatment strategies have the potential to reduce these inequalities.

  • 303.
    Malmberg, Milijana
    et al.
    Habilitation and Health, Region Västra Götaland, Sweden; Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden .
    Lunner, Thomas
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV). Eriksholm Research Centre, Oticon A/S Snekkersten, Snekkersten, Denmark.
    Kähäri, Kim
    Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institutet, Stockholm, Sweden.
    Evaluating the short-term and long-term effects of an internet-based aural rehabilitation programme for hearing aid users in general clinical practice: a randomised controlled trial.2017Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 5, artikel-id e013047Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Guided internet-based intervention beyond hearing aid (HA) fitting has been shown to be efficacious in randomised controlled trials (RCTs). However, internet interventions have rarely been applied clinically as a part of regular aural rehabilitation (AR). Our aim was to evaluate the effectiveness of internet-based AR for HA users from a clinical population.

    OUTCOME MEASURES: The Hearing Handicap Inventory for the Elderly (HHIE) was used as the primary outcome measure, and the Communication Strategies Scale (CSS) and the Hospital Anxiety and Depression Scale were used as secondary outcome measures. All questionnaires were administered before and directly after the intervention and at 6 months postintervention.

    METHODS: We used a parallel group design (RCT). The data were collected in 2013-2014 at three different clinics. Seventy-four HA users were randomly assigned to receive either full internet-based AR (intervention group, n=37) or one element of the internet-based AR (control group, n=37).

    RESULTS: Data were analysed following the intention-to-treat principle. Each group showed improved HHIE scores over time and did not differ significantly from each other. The intervention group showed significantly greater improvement compared with the control group for the CSS total and the non-verbal subscale scores. The intervention group and control group were also subdivided into two age groups: 20-59 years and 60-80 years. Significantly better improvement on the CSS total and non-verbal subscale scores was found in the older group compared with the younger participants.

    CONCLUSIONS: This study indicates that participants in an internet-based intervention applied in general clinical practice showed improved self-reported communication skills compared with a control group. Receiving a full intervention was not more effective in improving self-reported hearing problems than receiving just one element of the internet-based intervention.

    TRIAL REGISTRATION NUMBER: This trial is registered at ClinicalTrals.gov, NCT01837550; results.

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  • 304.
    Manchaiah, Vinaya
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV). Anglia Ruskin University, England.
    Gomersall, Philip A.
    Anglia Ruskin University, England.
    Tome, David
    Polytech Institute Porto, Portugal.
    Ahmadi, Tayebeh
    University of Social Welf and Rehabil Science, Iran.
    Krishna, Rajalakshmi
    University of Mysore, India.
    Audiologists preferences for patient-centredness: a cross-sectional questionnaire study of cross-cultural differences and similarities among professionals in Portugal, India and Iran2014Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, nr 10, s. 1-11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Patient-centredness has become an important aspect of health service delivery; however, there are a limited number of studies that focus on this concept in the domain of hearing healthcare. The objective of this study was to examine and compare audiologists preferences for patient-centredness in Portugal, India and Iran. Design: The study used a cross-sectional survey design with audiologists recruited from three different countries. Participants: A total of 191 fully-completed responses were included in the analysis (55 from Portugal, 78 from India and 58 from Iran). Main outcome measure: The Patient-Practitioner Orientation Scale (PPOS). Results: PPOS mean scores suggest that audiologists have a preference for patient-centredness (ie, mean of 3.6 in a 5-point scale). However, marked differences were observed between specific PPOS items suggesting these preferences vary across clinical situations. A significant level of difference (pless than0.001) was found between audiologists preferences for patient-centredness in three countries. Audiologists in Portugal had a greater preference for patient-centredness when compared to audiologists in India and Iran, although no significant differences were found in terms of age and duration of experience among these sample populations. Conclusions: There are differences and similarities in audiologists preferences for patient-centredness among countries. These findings may have implications for the training of professionals and also for clinical practice in terms of optimising hearing healthcare across countries.

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  • 305.
    Manchaiah, Vinaya K C
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Filosofiska fakulteten. Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, UK .
    Molander, Peter
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Filosofiska fakulteten.
    Rönnberg, Jerker
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Lunner, Thomas
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Filosofiska fakulteten. Eriksholm Research Centre, Snekkersten, Denmark.
    The acceptance of hearing disability among adults experiencing hearing difficulties: a cross-sectional study2014Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, nr e004066Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective This study developed the Hearing Disability Acceptance Questionnaire (HDAQ) and tested its construct and concurrent validities.

    Design Cross-sectional.

    Participants A total of 90 participants who were experiencing hearing difficulties were recruited in the UK.

    Outcome measures The HDAQ was developed based on the Tinnitus Acceptance Questionnaire (TAQ). Participants completed self-report measures regarding hearing disability acceptance, hearing disability, symptoms of anxiety and depression and a measure of stages of change.

    Results The HDAQ has a two-factor structure that explains 75.69% of its variance. The factors identified were activity engagement and avoidance and suppression. The scale showed a sufficient internal consistency (Cronbach's α=0.86). The HDAQ also had acceptable concurrent validity with regard to self-reported hearing disability, self-reported anxiety and depression and readiness to change measures.

    Conclusions Acceptance is likely an important aspect of coping with chronic health conditions. To our knowledge, no previously published and validated scale measures the acceptance of hearing disability; therefore, the HDAQ might be useful in future research. However, the role of acceptance in adjusting to hearing disability must be further investigated

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  • 306.
    Manousou, Sofia
    et al.
    Univ Gothenburg, Sweden; Kungälvs Hosp, Sweden.
    Johansson, Birgitta
    Univ Gothenburg, Sweden.
    Chmielewska, Anna
    Umea Univ, Sweden; Med Univ Warsaw, Poland.
    Eriksson, Janna
    Univ Gothenburg, Sweden.
    Gutefeldt, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Endokrinmedicinska kliniken.
    Tornhage, Carl-Johan
    Skaraborg Hosp, Sweden; Univ Gothenburg, Sweden.
    Eggertsen, Robert
    Univ Gothenburg, Sweden; Molnlycke Hlth Care Ctr, Sweden.
    Malmgren, Helge
    Univ Gothenburg, Sweden.
    Hulthen, Lena
    Univ Gothenburg, Sweden.
    Domellof, Magnus
    Umea Univ, Sweden.
    Filipsson, Helena Nystrom
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Role of iodine-containing multivitamins during pregnancy for childrens brain function: protocol of an ongoing randomised controlled trial: the SWIDDICH study2018Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 4, artikel-id e019945Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction Iodine is essential for normal brain development. Moderate and severe fetal iodine deficiency results in substantial to serious developmental delay in children. Mild iodine deficiency in pregnancy is associated with neurodevelopmental deficits in the offspring, but evidence from randomised trials is lacking. The aim of the Swedish Iodine in Pregnancy and Development in Children study is to determine the effect of daily supplementation with 150 mu g iodine during pregnancy on the offsprings neuropsychological development up to 14 years of age. Methods and analysis Thyroid healthy pregnant women (n=1275: age range 18- 40 years) at amp;lt;= 12 weeks gestation will be randomly assigned to receive multivitamin supplements containing 150 mu g iodine or non-iodine-containing multivitamin daily throughout pregnancy. As a primary outcome, IQ will be measured in the offspring at 7 years (Wechsler Intelligence Scale for Children-V). As secondary outcomes, IQ will be measured at 3.5 and 14 years, psychomotor development at 18 months and 7 years, and behaviour at 3.5, 7 and 14 years. Iodine status (urinary iodine concentration) will be measured during pregnancy and in the offspring at 3.5, 7 and 14 years. Thyroid function (thyroid hormones, thyroglobulin), and deiodinase type 2 polymorphisms will be measured during pregnancy and in the offspring at 7 and 14 years. Structural MRI or other relevant structural or functional brain imaging procedures will be performed in a subgroup of children at 7 and 14 years. Background and socioeconomic information will be collected at all follow-up times. Ethics and dissemination This study is approved by the Ethics Committee in Goteborg, Sweden (Diary numbers: 431-12 approved 18 June 2012 (pregnancy part) and 1089-16 approved 8 February 2017 (children follow-up)). According to Swedish regulations, dietary supplements are governed by the National Food Agency and not by the Medical Product Agency. Therefore, there is no requirement for a monitoring committee and the National Food Agency does not perform any audits of trial conduct. The trial will be conducted in accordance with the Declaration of Helsinki. The participating sites will be contacted regarding important protocol changes, both orally and in writing, and the trial registry database will be updated accordingly. Study results will be presented at relevant conferences, and submitted to peer-reviewed journals with open access in the fields of endocrinology, paediatrics and nutrition. After the appropriate embargo period, the results will be communicated to participants, healthcare professionals at the maternal healthcare centres, the public and other relevant groups, such as the national guideline group for thyroid and pregnancy and the National Food Agency.

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  • 307. Manousou, Sofia
    et al.
    Johansson, Birgitta
    Chmielewska, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland.
    Eriksson, Janna
    Gutefeldt, Kerstin
    Tornhage, Carl-Johan
    Eggertsen, Robert
    Malmgren, Helge
    Hulthen, Lena
    Domellöf, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Nyström Filipsson, Helena
    Role of iodine-containing multivitamins during pregnancy for children’s brain function: protocol of an ongoing randomised controlled trial: the SWIDDICH study2018Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 4, artikel-id e019945Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Iodine is essential for normal brain development. Moderate and severe fetal iodine deficiency results in substantial to serious developmental delay in children. Mild iodine deficiency in pregnancy is associated with neurodevelopmental deficits in the offspring, but evidence from randomised trials is lacking. The aim of the Swedish Iodine in Pregnancy and Development in Children study is to determine the effect of daily supplementation with 150 µg iodine during pregnancy on the offspring’s neuropsychological development up to 14 years of age.

    Methods and analysis: Thyroid healthy pregnant women (n=1275: age range 18–40 years) at ≤12 weeks gestation will be randomly assigned to receive multivitamin supplements containing 150 µg iodine or non-iodine-containing multivitamin daily throughout pregnancy. As a primary outcome, IQ will be measured in the offspring at 7 years (Wechsler Intelligence Scale for Children-V). As secondary outcomes, IQ will be measured at 3.5 and 14 years, psychomotor development at 18 months and 7 years, and behaviour at 3.5, 7 and 14 years. Iodine status (urinary iodine concentration) will be measured during pregnancy and in the offspring at 3.5, 7 and 14 years. Thyroid function (thyroid hormones, thyroglobulin), and deiodinase type 2 polymorphisms will be measured during pregnancy and in the offspring at 7 and 14 years. Structural MRI or other relevant structural or functional brain imaging procedures will be performed in a subgroup of children at 7 and 14 years. Background and socioeconomic information will be collected at all follow-up times.

    Ethics and dissemination: This study is approved by the Ethics Committee in Göteborg, Sweden (Diary numbers: 431-12 approved 18 June 2012 (pregnancy part) and 1089-16 approved 8 February 2017 (children follow-up)). According to Swedish regulations, dietary supplements are governed by the National Food Agency and not by the Medical Product Agency. Therefore, there is no requirement for a monitoring committee and the National Food Agency does not perform any audits of trial conduct. The trial will be conducted in accordance with the Declaration of Helsinki. The participating sites will be contacted regarding important protocol changes, both orally and in writing, and the trial registry database will be updated accordingly. Study results will be presented at relevant conferences, and submitted to peer-reviewed journals with open access in the fields of endocrinology, paediatrics and nutrition. After the appropriate embargo period, the results will be communicated to participants, healthcare professionals at the maternal healthcare centres, the public and other relevant groups, such as the national guideline group for thyroid and pregnancy and the National Food Agency.

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  • 308.
    Marcusson, Jan
    et al.
    Linköpings universitet.
    Nord, Magnus
    Linköpings universitet.
    Johannsson, Maria
    Linköpings universitet.
    Alwin, Jenny
    Linköpings universitet.
    Levin, Lars-Åke
    Linköpings universitet.
    Dannapfel, Petra
    Thomas, Kristin
    Poksinska, Bonnie
    Sverker, Annette
    Olaison, Anna
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen, Centrum för socialt arbete - CESAR.
    Cedersund, Elisabet
    Kelfve, Susanne
    Motel-Klingebiel, Andreas
    Hellström, Ingrid
    Kullberg, Agneta
    Böttiger, Ylva
    Dong, Huan-Ji
    Peolsson, Anneli
    Wass, Malin
    Lyth, Johan
    Andersson, Agneta
    Proactive healthcare for frail elderly persons: study protocol for a prospective controlled primary care intervention in Sweden2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 5, artikel-id e027847Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction. Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire. Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.

  • 309.
    Marcusson, Jan
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Medicinska och geriatriska akutkliniken.
    Nord, Magnus
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Johansson, Maria
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Medicinska och geriatriska akutkliniken.
    Alwin, Jenny
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Dannapfel, Petra
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Medicinska och geriatriska akutkliniken.
    Thomas, Kristin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Poksinska, Bozena
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Logistik- och kvalitetsutveckling. Linköpings universitet, Tekniska fakulteten.
    Sverker, Annette M.
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Region Östergötland, Närsjukvården i centrala Östergötland, Rörelse och Hälsa.
    Olaison, Anna
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Socialt arbete. Linköpings universitet, Filosofiska fakulteten.
    Cedersund, Elisabet
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen Åldrande och social förändring. Linköpings universitet, Filosofiska fakulteten.
    Kelfve, Susanne
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen Åldrande och social förändring. Linköpings universitet, Filosofiska fakulteten.
    Motel-Klingebiel, Andreas
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen Åldrande och social förändring. Linköpings universitet, Filosofiska fakulteten.
    Hellström, Ingrid
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Kullberg, Agneta
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Socialt arbete. Linköpings universitet, Filosofiska fakulteten.
    Böttiger, Ylva
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk farmakologi.
    Dong, Huan-Ji
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Wass, Malin
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och didaktik. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV).
    Lyth, Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Ledningsstab Region Östergötland, Enheten för forskningsstöd.
    Andersson, Agneta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Ledningsstab Region Östergötland, Enheten för forskningsstöd.
    Proactive healthcare for frail elderly persons: study protocol for a prospective controlled primary care intervention in Sweden2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 5, artikel-id e027847Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction.

    Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire.

    Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.

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  • 310. Marklund, Staffan
    et al.
    Gustafsson, Klas
    Aronsson, Gunnar
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Arbets- och organisationspsykologi.
    Leineweber, Constanze
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Helgesson, Magnus
    Working conditions and compensated sickness absence among nurses and care assistants in Sweden during two decades: a cross-sectional biennial survey study2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 11, artikel-id e030096Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The aims of the study were to trace the patterns of work environment factors and compensated sickness absence (SA) among nurses and care assistants compared with other occupations and to compare SA among exposed and non-exposed nurses and care assistants.

    Design: A cross-sectional survey on work environment factors based on the biennial Swedish Work Environment Surveys 1991–2013, linked to longitudinal register data on SA 1993–2014.

    Participants: The study included 98 249 individuals, stratified into nurses and care assistants (n=16 179) and a reference population including all other occupations (n=82 070).

    Outcome measure: Annual days of compensated SA (>14 days) 3 years after exposure years.

    Results: Nurses and care assistants had higher SA in 1993–2014 compared with all other occupations, and differences in background factors only partly explained this relationship. For both groups, exposure to physical work factors remained steady, but the number of exposed were 10%–30% higher among nurses and care assistants. Those exposed to heavy physical work and strenuous working postures had in most years significantly higher SA when compared with non-exposed (rate ratio range: 1.4–1.9). Exposure to high job demands increased 10%–25% in 1991–1999 among nurses and care assistants but became more stable in 2001–2013 and high proportions of high job demands coincided with the increase in SA in 1995–1999. Nurses and care assistants exposed to high job demands had for most years significantly higher SA than non-exposed (rate ratio range: 1.5–2.1). Low job control and low support from supervisors elevated SA significantly only for a few years.

    Conclusions: Exposure to negative work factors among nurses and care assistants was weakly associated with variations in SA, but may be related to their higher level of SA when compared with other occupations. Improved physical and psychosocial working conditions may reduce the elevated SA level in these occupations.

  • 311.
    Marques, Ana Patrícia
    et al.
    Nova University of Lisbon, Portugal.
    Macedo, António Filipe
    University of Minho, Portugal.
    Perelman, Julian
    Nova University of Lisbon, Portugal.
    Aguiar, Pedro
    Nova University of Lisbon, Portugal.
    Rocha-Sousa, Amândio
    University of Porto, Portugal.
    Santana, Rui
    Nova University of Lisbon, Portugal.
    Diffusion of anti-VEGF injections in the Portuguese National Health System2015Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, nr 11, s. 11-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives

    To analyse the temporal and geographical diffusion of antivascular endothelial growth factor (anti-VEGF) interventions, and its determinants in a National Health System (NHS).

    Setting

    NHS Portuguese hospitals.

    Participants

    All inpatient and day cases related to eye diseases at all Portuguese public hospitals for the period 2002–2012 were selected on the basis of four International Classification of Diseases 9th revision, Clinical Modification (ICD-9-CM) codes for procedures: 1474, 1475, 1479 and 149.

    Primary and secondary outcome measures

    We measured anti-VEGF treatment rates by year and county. The determinants of the geographical diffusion were investigated using generalised linear modelling.

    Results

    We analysed all hospital discharges from all NHS hospitals in Portugal (98 408 hospital discharges corresponding to 57 984 patients). National rates of hospitals episodes for the codes for procedures used were low before anti-VEGF approval in 2007 (less than 12% of hospital discharges). Between 2007 and 2012, the rates of hospital episodes related to the introduction of anti-VEGF injections increased by 27% per year. Patients from areas without ophthalmology departments received fewer treatments than those from areas with ophthalmology departments. The availability of an ophthalmology department in the county increased the rates of hospital episodes by 243%, and a 100-persons greater density per km2 raised the rates by 11%.

    Conclusions

    Our study shows a large but unequal diffusion of anti-VEGF treatments despite the universal coverage and very low copayments. The technological innovation in ophthalmology may thus produce unexpected inequalities related to financial constraints unless the implementation of innovative techniques is planned and regulated

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  • 312.
    Martinsson, Lisa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Fürst, Carl Johan
    Lundström, Staffan
    Nathanaelsson, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Axelsson, Bertil
    Registration in a quality register: a method to improve end-of-lifecare—a cross-sectional study2012Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, nr 4, artikel-id e001328Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Structured methods to assess and support improvement in the quality of end-of-life care are lacking and need to be developed. This need is particularly high outside the specialised palliative care. This study examines whether participation in a national quality register increased the quality of end-of-life care.

    DESIGN: This study is a cross-sectional longitudinal register study.

    SETTING: The Swedish Register of Palliative Care (SRPC) collects data about end-of-life care for deaths in all types of healthcare units all over Sweden. Data from all 503 healthcare units that had reported patients continuously to the register during a 3-year period were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES: Data on provided care during the last weeks of life were compared year-by-year with logistic regression.

    PARTICIPANTS: The study included a total 30 283 patients. The gender distribution was 54% women and 46% men. A total of 60% of patients in the study had a cancer diagnosis.

    RESULTS: Provided end-of-life care improved in a number of ways. The prevalence of six examined symptoms decreased. The prescription of 'as needed' medications for pain, nausea, anxiety and death rattle increased. A higher proportion of patients died in their place of preference. The patient's next of kin was more often offered a follow-up appointment after the patient's death. No changes were seen with respect to providing information to the patient or next of kin.

    CONCLUSIONS: Participation in a national quality register covariates with quality improvements in end-of-life care over time.

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  • 313.
    Martire, Riccardo Lo
    et al.
    KTH, Skolan för teknikvetenskap (SCI), Farkost och flyg. Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    De Alwis, Pahansen
    KTH, Skolan för teknikvetenskap (SCI), Farkost och flyg.
    Äng, B.O.
    Garme, Karl
    KTH, Skolan för teknikvetenskap (SCI), Farkost och flyg.
    Construction of a web-based questionnaire for longitudinal investigation of work exposure, musculoskeletal pain and performance impairments in high-performance marine craft populations2017Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 7, artikel-id e016006Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective High-performance marine craft personnel (HPMCP) are regularly exposed to vibration and repeated shock (VRS) levels exceeding maximum limitations stated by international legislation. Whereas such exposure reportedly is detrimental to health and performance, the epidemiological data necessary to link these adverse effects causally to VRS are not available in the scientific literature, and no suitable tools for acquiring such data exist. This study therefore constructed a questionnaire for longitudinal investigations in HPMCP. Methods A consensus panel defined content domains, identified relevant items and outlined a questionnaire. The relevance and simplicity of the questionnaire's content were then systematically assessed by expert raters in three consecutive stages, each followed by revisions. An item-level content validity index (I-CVI) was computed as the proportion of experts rating an item as relevant and simple, and a scale-level content validity index (S-CVI/Ave) as the average I-CVI across items. The thresholds for acceptable content validity were 0.78 and 0.90, respectively. Finally, a dynamic web version of the questionnaire was constructed and pilot tested over a 1-month period during a marine exercise in a study population sample of eight subjects, while accelerometers simultaneously quantified VRS exposure. Results Content domains were defined as work exposure, musculoskeletal pain and human performance, and items were selected to reflect these constructs. Ratings from nine experts yielded S-CVI/Ave of 0.97 and 1.00 for relevance and simplicity, respectively, and the pilot test suggested that responses were sensitive to change in acceleration and that the questionnaire, following some adjustments, was feasible for its intended purpose. Conclusions A dynamic web-based questionnaire for longitudinal survey of key variables in HPMCP was constructed. Expert ratings supported that the questionnaire content is relevant, simple and sufficiently comprehensive, and the pilot test suggested that the questionnaire is feasible for longitudinal measurements in the study population.

  • 314.
    Massad, Salwa
    et al.
    Palestinian Natl Inst Publ Hlth, Res Unit, Ramallah, Palestine.
    Dalloul, Hadil
    Palestinian Natl Inst Publ Hlth, Res Unit, Ramallah, Palestine.
    Ramlawi, Asad
    Minist Hlth, Res Unit, Deputy Minister Off, Ramallah, Palestine.
    Rayyan, Izzat
    Palestinian Natl Inst Publ Hlth, Res Unit, Ramallah, Palestine.
    Salman, Rand
    Palestinian Natl Inst Publ Hlth, Res Unit, Ramallah, Palestine.
    Johansson, Lars Age
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Accuracy of mortality statistics in Palestine: a retrospective cohort study2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 4, artikel-id e026640Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To examine the accuracy of mortality statistics in Palestine, to identify gaps and to provide evidence-based recommendations to improve mortality statistics in Palestine. Study design and setting A retrospective death registry-based study that examined a stratified random sample of death notification forms (DNFs) of patients who died in hospitals in Palestine was reported in 2012. We randomly selected 600 deceased from the Cause of Death Registry: 400 from the West Bank and 200 from the Gaza Strip. Analysis was based on the randomly selected deaths that we were able to retrieve the medical records for; 371 deaths in the West Bank and 199 deaths in the Gaza Strip. Results Data in the Palestinian Health Information Centre (PHIC) registry had a low degree of accuracy: less than half of the underlying causes stated the correct cause of death. In general, deaths due to malignant neoplasms were more accurately reported on DNFs than other causes of death, and metabolic diseases (including diabetes) were the most problematic. Issues with coding and classification at the PHIC were most apparent for perinatal conditions and congenital anomalies. Conclusion Procedures for coding and classification at the PHIC deviate considerably from the international norms defined in the International Statistical Classification of Diseases and Related Health Problems (ICD) and account to a considerable extent for the discrepancies between the cause of death determined on the medical data on the death extracted from the deceased patient's hospital records and the cause of death coded by the PHIC. We recommend the introduction of international coding software for coding and classification, and a review to improve data handling in hospitals, especially those with electronic patient records.

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  • 315.
    Mathias, Kaaren
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. New Delhi, India .
    Goicolea, Isabel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kermode, Michelle
    Victoria, Australia.
    Singh, Lawrence
    Uttarakhand, India.
    Shidhaye, Rahul
    New Delhi, India.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Cross-sectional study of depression and help-seeking in Uttarakhand, North India2015Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, nr 11, artikel-id e008992Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: This study sought to use a population-based cross-sectional survey to describe depression prevalence, healthcare seeking and associations with socioeconomic determinants in a district in North India.

    SETTING: This study was conducted in Sahaspur and Raipur, administrative blocks of Dehradun district, Uttarakhand, in July 2014.

    PARTICIPANTS: A population-based sample of 960 people over the age of 18 years was selected in 30 randomised clusters after being stratified by rural:urban census ratios.

    PRIMARY OUTCOME MEASURES: The survey used a validated screening tool, Patient Health Questionnaire, to identify people with depression, and collected information regarding socioeconomic variables and help-seeking behaviours. Depression prevalence and health seeking behaviours were calculated, and multivariable logistic regression was used to assess associations between risk factors and depression.

    RESULTS: Prevalence of depression was 6% (58/960), with a further 3.9% (37/960) describing a depressive episode of over 2 weeks in the past 12 months. Statistically significant adjusted OR for depression of more than 2 were found for people who were illiterate, classified as Scheduled Caste/Tribe or Other Backward Castes, living in temporary material housing and who had recently taken a loan. While over three quarters of people with depression (79%) had attended a private or government general medical practitioner in the past 3 months, none had received talking therapy (100% treatment gap) and two people (3.3%) had been prescribed antidepressants.

    CONCLUSIONS: There are clear associations between social, educational and economic disadvantage and depression in this population. Strategies that address the social determinants of depression, such as education, social exclusion, financial protection and affordable housing for all are indicated. To address the large treatment gap in Uttarakhand, we must ensure access to primary and secondary mental health providers who can recognise and appropriately manage depression.

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  • 316.
    Mathiassen, Svend Erik
    et al.
    University of Gävle, Gävle.
    Bolin, Malin
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för humaniora och samhällsvetenskap.
    Olofsdotter, Gunilla
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för humaniora och samhällsvetenskap.
    Johansson, Elin
    University of Gävle, Gävle.
    Equal health at work?: Protocol for an observational study of work organisation, workload and musculoskeletal complaints among women and men in grocery retail2020Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 10, nr 1, artikel-id e032409Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Women generally report more work-related musculoskeletal complaints than men and have higher rates of sickness absence, even within occupations. One likely reason is that work tasks within the occupation are gendered, that is, women and men have different tasks, even when sharing the same job title. Retail is an appealing sector for studying working conditions and work environment in a gender context. The prevalence of work-related complaints is high, physical loads may differ considerably between tasks and the distribution of tasks is likely gendered. The overall aim of this study in retail is to examine factors at the organisational and individual level that may, in a gender perspective, explain working conditions, work tasks, workloads and musculoskeletal health. METHODS AND ANALYSES: Data will be collected in two grocery stores, each with 50-70 workers, at two occasions interspersed by about 1 year. In each of these four waves, data collection will include a web-based questionnaire to all workers addressing, for example, work tasks, psychosocial factors, fatigue and pain; semistructured interviews with managers and approximately 10 workers addressing, for example, competences and decision levels; and technical measurements of postures, movements and heart rate in about 30 workers. The study is novel in combining an organisational gender perspective addressed through qualitative methods with a quantitative analysis of tasks, workload and health. The design allows an examination of both how genders may differ, and why they may differ, as well as analyses of the extent to which gendered working conditions change over time in the two participating stores. ETHICS AND DISSEMINATION: Approval of the study by the Swedish Ethical Review Authority (reference number 2017/404) has been obtained. This work will be disseminated by publication of peer-reviewed papers in scientific journals, presentations at scientific conferences and in meetings with representatives from Swedish retail, including unions and employers' organisations. 

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  • 317.
    Mathiassen, Svend Erik
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbetshälsovetenskap och psykologi, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Bolin, Malin
    Department of Social Sciences, Mid Sweden University, Sundsvall, Sweden.
    Olofsdotter, Gunilla
    Department of Social Sciences, Mid Sweden University, Sundsvall, Sweden.
    Johansson, Elin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbetshälsovetenskap och psykologi, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Equal health at work? Protocol for an observational study of work organisation, workload and musculoskeletal complaints among women and men in grocery retail2020Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 10, nr 1, artikel-id e032409Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction Women generally report more work-related musculoskeletal complaints than men and have higher rates of sickness absence, even within occupations. One likely reason is that work tasks within the occupation are gendered, i.e. women and men have different tasks, even when sharing the same job title. Retail is an appealing sector for studying working conditions and work environment in a gender context. The prevalence of work-related complaints is high, physical loads may differ considerably between tasks, and the distribution of tasks is likely gendered. The overall aim of this study in retail is to examine factors at the organisational and individual level that may, in a gender perspective, explain working conditions, work tasks, workloads, and musculoskeletal health.

    Methods and analyses Data will be collected in two grocery stores, each with 50-70 workers, at two occasions interspersed by about one year. In each of these four waves, data collection will include a web-based questionnaire to all workers addressing, e.g. work tasks, psychosocial factors, fatigue and pain; semi-structured interviews with managers and around 10 workers addressing, e.g. competences and decision levels; and technical measurements of postures, movements and heart rate in about 30 workers. The study is novel in combining an organisational gender perspective addressed through qualitative methods with a quantitative analysis of tasks, workload and health. The design allows an examination of both how genders may differ, and why they may differ, as well as analyses of the extent to which gendered working conditions change over time in the two participating stores.

    Ethics and dissemination Approval of the study by the Swedish Ethical Review Authority (reference number 2017/404) has been obtained. This work will be disseminated by publication of peer-reviewed papers in scientific journals, presentations at scientific conferences, and in meetings with representatives from Swedish retail, including unions and employers’ organisations.

  • 318. Mattick, Karen L.
    et al.
    Kaufhold, Kathrin
    Cardiff University School of Medicine, Cochrane Medical Education Centre, United Kingdom.
    Kelly, Narcy
    Cole, Judith A.
    Scheffler, Grit
    Rees, Charlotte E.
    Bullock, Allison
    Gormely, Gerard J.
    Monrouxe, Lynn V.
    Implications of aligning full registration of doctors with medical school graduation: A qualitative study of stakeholder perspectives2016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 2, artikel-id e010246Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives The Shape of Training report recommended that full registration is aligned with medical school graduation. As part of a General Medical Council-funded study about the preparedness for practice of UK medical graduates, we explored UK stakeholders’ views about this proposal using qualitative interviews (30 group and 87 individual interviews) and Framework Analysis.

    Setting Four UK study sites, one in each country.

    Participants 185 individuals from eight stakeholder groups: (1) foundation year 1 (F1) doctors (n=34); (2) fully registered trainee doctors (n=33); (3) clinical educators (n=32); (4) undergraduate/postgraduate Deans, and Foundation Programme Directors (n=30); (5) other healthcare professionals (n=13); (6) employers (n=7); (7) policy and government (n=11); (8) patient and public representatives (n=25).

    Results We identified four main themes: (1) The F1 year as a safety net: patients were protected by close trainee supervision and ‘sign off’ to prevent errors; trainees were provided with a safe environment for learning on the job; (2) Implications for undergraduate medical education: if the proposal was accepted, a ‘radical review’ of undergraduate curricula would be needed; undergraduate education might need to be longer; (3) Implications for F1 work practice: steps to protect healthcare team integration and ensure that F1 doctors stay within competency limits would be required; (4) Financial, structural and political implications: there would be cost implications for trainees; clarification of responsibilities between undergraduate and postgraduate medical education would be needed. Typically, each theme comprised arguments for and against the proposal.

    Conclusions A policy change to align the timing of full registration with graduation would require considerable planning and preliminary work. These findings will inform policymakers’ decision-making. Regardless of the decision, medical students should take on greater responsibility for patient care as undergraduates, assessment methods in clinical practice and professionalism domains need development, and good practice in postgraduate supervision and support must be shared.

  • 319.
    Mazzocato, Pamela
    et al.
    Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Stockholm, Sweden..
    Stenfors-Hayes, Terese
    Karolinska Inst, Dept Learning Informat Management & Eth, Evaluat Unit, Stockholm, Sweden..
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Stockholm, Sweden..
    Hasson, Henna
    Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Stockholm, Sweden.;Stockholm Cty Council, Ctr Epidemiol & Community Med, Stockholm, Sweden..
    Nystrom, Monica Elisabeth
    Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Stockholm, Sweden.;Umea Univ, Dept Publ Hlth & Clin Med Epidemiol & Global Hlth, Umea, Sweden..
    Kaizen practice in healthcare: a qualitative analysis of hospital employees' suggestions for improvement2016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 7, artikel-id e012256Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Kaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare. Methods: We analysed 186 structured kaizen documents containing improvement suggestions that were produced by 165 employees at a Swedish hospital. Directed content analysis was used to categorise the suggestions into following categories: type of situation (proactive or reactive) triggering an action; type of process addressed (technical/administrative, support and clinical); complexity level (simple or complex); and type of outcomes aimed for (operational or sociotechnical). Compliance to the kaizen template was calculated. Results: 72% of the improvement suggestions were reactions to a perceived problem. Support, technical and administrative, and primary clinical processes were involved in 47%, 38% and 16% of the suggestions, respectively. The majority of the kaizen documents addressed simple situations and focused on operational outcomes. The degree of compliance to the kaizen template was high for several items concerning the identification of problems and the proposed solutions, and low for items related to the test and implementation of solutions. Conclusions: There is a need to combine kaizen practices with improvement and innovation practices that help staff and managers to address complex issues, such as the improvement of clinical care processes. The limited focus on sociotechnical aspects and the partial compliance to kaizen templates may indicate a limited understanding of the entire kaizen process and of how it relates to the overall organisational goals. This in turn can hamper the sustainability of kaizen practices and results.

  • 320. Mazzocato, Pamela
    et al.
    Stenfors-Hayes, Terese
    von Thiele Schwarz, Ulrica
    Hasson, Henna
    Nyström, Monica Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kaizen practice in healthcare: a qualitative analysis of hospital employees' suggestions for improvement2016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 7, artikel-id e012256Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Kaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare.

    METHODS: We analysed 186 structured kaizen documents containing improvement suggestions that were produced by 165 employees at a Swedish hospital. Directed content analysis was used to categorise the suggestions into following categories: type of situation (proactive or reactive) triggering an action; type of process addressed (technical/administrative, support and clinical); complexity level (simple or complex); and type of outcomes aimed for (operational or sociotechnical). Compliance to the kaizen template was calculated.

    RESULTS: 72% of the improvement suggestions were reactions to a perceived problem. Support, technical and administrative, and primary clinical processes were involved in 47%, 38% and 16% of the suggestions, respectively. The majority of the kaizen documents addressed simple situations and focused on operational outcomes. The degree of compliance to the kaizen template was high for several items concerning the identification of problems and the proposed solutions, and low for items related to the test and implementation of solutions.

    CONCLUSIONS: There is a need to combine kaizen practices with improvement and innovation practices that help staff and managers to address complex issues, such as the improvement of clinical care processes. The limited focus on sociotechnical aspects and the partial compliance to kaizen templates may indicate a limited understanding of the entire kaizen process and of how it relates to the overall organisational goals. This in turn can hamper the sustainability of kaizen practices and results.

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  • 321.
    Melinder, Carren
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Hiyoshi, Ayako
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Stress resilience and the risk of inflammatory bowel disease: a cohort study of men living in Sweden2017Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 1, artikel-id e014315Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To determine if low psychosocial stress resilience in adolescence (increasing chronic stress arousal throughout life) is associated with an increased inflammatory bowel disease (IBD) risk in adulthood. Subclinical Crohn's disease (CD) and ulcerative colitis (UC) can exist over many years and we hypothesise that psychosocial stress may result in conversion to symptomatic disease through its proinflammatory or barrier function effects.

    DESIGN: National register-based cohort study of men followed from late adolescence to middle age.

    SETTING: A general population cohort of men in Sweden.

    PARTICIPANTS: Swedish population-based registers provided information on all men born between 1952 and 1956 who underwent mandatory Swedish military conscription assessment (n=239 591). Men with any gastrointestinal diagnoses (except appendicitis) prior to follow-up were excluded.

    PRIMARY OUTCOME MEASURES: An inpatient or outpatient diagnosis of CD or UC recorded in the Swedish Patient Register (1970-2009).

    RESULTS: A total of 938 men received a diagnosis of CD and 1799 UC. Lower stress resilience in adolescence was associated with increased IBD risk, with unadjusted HRs (95% CIs) of 1.54 (1.26 to 1.88) and 1.24 (1.08 to 1.42), for CD and UC, respectively. After adjustment for potential confounding factors, including markers of subclinical disease activity in adolescence, they are 1.39 (1.13 to 1.71) and 1.19 (1.03 to 1.37).

    CONCLUSIONS: Lower stress resilience may increase the risk of diagnosis of IBD in adulthood, possibly through an influence on inflammation or barrier function.

  • 322.
    Molander, Peter
    et al.
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Nordqvist, Peter
    Öberg, Marie
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Teknisk audiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Öron- näsa- och halskliniken US.
    Lunner, Thomas
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Lyxell, Björn
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Östergötlands Läns Landsting, Sinnescentrum, Öron- näsa- och halskliniken US.
    Andersson, Gerhard
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Stockholm, Sweden.
    Internet-based hearing screening using speech-in-noise: validation and comparisons of self-reported hearing problems, quality of life and phonological representation2013Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, nr 9, s. 3223-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives For the last decade a host of different projects have been launched to allow persons who are concerned about their hearing status to quickly and at a low cost test their hearing ability. Most often, this is carried out without collecting complementary information that could be correlated with hearing impairment. In this two-part study we first, present the development and validation of a novel Internet-based hearing test, and second, report on the associations between this test and phonological representation, quality of life and self-reported hearing difficulties.

    Design Cross-sectional study.

    Setting An opportunity sample of participants was recruited at the Stockholm central station for the first study. All parts of the second study were conducted via the Internet, with testing and self-report forms adapted for online use.

    Participants The first part of the study was carried out in direct contact with the participants, and participants from the second study were recruited by means of advertisements in newspapers and on webpages. The only exclusion criterion was that participants had to be over 18 years old. Most participants were between 60 and 69 years old. There were almost an equal number of men and women (total n=316).

    Outcome measures 48 participants failed the Internet-based hearing screening test. The group failing the test reported more problems on the Amsterdam Inventory of Auditory Disability. In addition, they were found to have diminished phonological representational skills. However, no difference in quality of life was found.

    Conclusions Almost one in five participants was in need of contacting their local hearing clinic. This group had more complaints regarding tinnitus and hyperacusis, rated their own hearing as worse than those who passed, and had a poorer capability of generating accurate phonological representations. This study suggests that it is feasible to screen for hearing status online, and obtain valid data.

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  • 323. Molarius, Anu
    et al.
    Granstrom, Fredrik
    Linköping Universitet.
    Educational differences in psychological distress?: Results from a population-based sample of men and women in Sweden in 20122018Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 4, artikel-id e021007Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Mental health problems are more frequent in socially disadvantaged groups, but the results vary between different studies, different populations and different measures of mental health. This paper investigated the association between educational level, economic difficulties and psychological distress in men and women in Sweden. Methods The study population included 24 510 respondents aged 25-74 years who responded to a survey questionnaire in Mid-Sweden in 2012 (response rate 53%). Psychological distress was measured with the 12-item version of the General Health Questionnaire, and multivariate logistic regression models were used in statistical analyses, adjusting for age, employment status and social support. Results The prevalence of psychological distress was higher in women (16.4%) than in men (11.3%; p<0.001). Persons with low and medium educational level had a lower risk of psychological distress than persons with high educational level after adjustment for confounders. Economic difficulties had a strong association with psychological distress (OR 2.80 (95% CI 2.39 to 3.27) and OR 2.40 (95% CI 2.12 to 3.71) in men and women, respectively) after adjustment for confounders. Conclusion We found a strong association between economic difficulties and psychological distress in this study, but no inverse association between educational level and psychological distress. On the contrary, persons with high education had more psychological distress than persons with low and medium education when age, employment status and social support were taken into account. The findings were similar in men and women.

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  • 324.
    Molarius, Anu
    et al.
    Reg Vastmanland, Sweden; Karlstad Univ, Sweden.
    Granström, Fredrik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Educational differences in psychological distress? Results from a population-based sample of men and women in Sweden in 20122018Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 4, artikel-id e021007Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Mental health problems are more frequent in socially disadvantaged groups, but the results vary between different studies, different populations and different measures of mental health. This paper investigated the association between educational level, economic difficulties and psychological distress in men and women in Sweden. Methods The study population included 24 510 respondents aged 25-74 years who responded to a survey questionnaire in Mid-Sweden in 2012 (response rate 53%). Psychological distress was measured with the 12-item version of the General Health Questionnaire, and multivariate logistic regression models were used in statistical analyses, adjusting for age, employment status and social support. Results The prevalence of psychological distress was higher in women (16.4%) than in men (11.3%; pamp;lt;0.001). Persons with low and medium educational level had a lower risk of psychological distress than persons with high educational level after adjustment for confounders. Economic difficulties had a strong association with psychological distress (OR 2.80 (95% CI 2.39 to 3.27) and OR 2.40 (95% CI 2.12 to 3.71) in men and women, respectively) after adjustment for confounders. Conclusion We found a strong association between economic difficulties and psychological distress in this study, but no inverse association between educational level and psychological distress. On the contrary, persons with high education had more psychological distress than persons with low and medium education when age, employment status and social support were taken into account. The findings were similar in men and women.

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  • 325.
    Molin, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindgren, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Does 'Time Together' increase quality of interaction and decrease stress?: A study protocol of a multisite nursing intervention in psychiatric inpatient care, using a mixed method approach2017Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 8, artikel-id e015677Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Despite the long-known significance of the nurse–patient relationship, research in psychiatric inpatient care still reports unfulfilled expectations of, and difficulties in, interactions and relationships between patients and staff. Interventions that create structures to allow quality interactions between patients and staff are needed to solve these problems. The aim of this project is to test effects of the nursing intervention Time Together and to evaluate the intervention process.

    Methods and analysis: This is a multisite study with a single-system experimental design using frequent measures. The primary outcomes are quality interactions for patients and perceived stress for staff. Secondary outcomes are levels of symptoms of anxiety and depression for patients and stress of conscience for staff. A process evaluation is performed to describe contextual factors and experiences. Data are collected using questionnaires, participant observations and semistructured interviews. For analysis of quantitative data, both visual and statistical methods will be used. Qualitative data will be analysed using qualitative content analysis.

    Ethics and dissemination: Ethical approval was granted by the Ethical Review Board in the region (Dnr 2016/339-31). The findings will contribute to the development of nursing interventions in general, but more specifically to the development of the intervention. This is relevant both nationally and internationally as similar interventions are needed but sparse. The findings will be disseminated through conference presentations and peer-reviewed publications.

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  • 326. Monnier, A.
    et al.
    Larsson, H.
    Djupsjobacka, M.
    Brodin, L. A.
    Äng, Björn
    Musculoskeletal pain and limitations in work ability in Swedish marines: a cross-sectional survey of prevalence and associated factors2015Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, nr 10, s. e007943-Artikel i tidskrift (Refereegranskat)
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  • 327. Monnier, Andreas
    et al.
    Larsson, Helena
    Djupsjobacka, Mats
    Brodin, Lars-Åke
    KTH, Skolan för teknik och hälsa (STH), Medicinsk teknik, Medicinsk bildteknik.
    Ang, Bjorn O.
    Musculoskeletal pain and limitations in work ability in Swedish marines: a cross-sectional survey of prevalence and associated factors2015Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, nr 10, artikel-id e007943Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives To estimate the prevalence of self-rated musculoskeletal pain and pain limiting work ability in Swedish Armed Forces (SAF) marines, and to study factors potentially associated with pain limiting work ability for the most prevalent pain regions reported. Design Population-based, cross-sectional survey. Participants There were 272 SAF marines from the main marine battalion in Sweden included in the study. Outcomes Self-assessed musculoskeletal pain and pain limiting the marines' work ability within a 6-month period, as obtained from structured questionnaires. The association of individual, health and work-related factors with musculoskeletal pain limiting work ability was systematically regressed with multiple logistic models, estimating OR and 95% CI. Results Musculoskeletal pain and pain limiting work ability were most common in the back, at 46% and 20%, and lower extremities at 51% and 29%, respectively. Physical training 1day/week (OR 5.3, 95% CI 1.7 to 16.8); body height 1.80m (OR 5.0, 95% CI 1.6 to 15.1) and 1.86m (OR 4.4, 95% CI 1.4 to 14.1); computer work 1/4 of the working day (OR 3.2, 95% CI 1.0 to 10.0) and 1/2 (OR 3.3, 95% CI 1.1 to 10.1) of the working day were independently associated with back pain limiting work ability. None of the studied variables emerged significantly associated with such pain for the lower extremities. Conclusions Our findings show that musculoskeletal pain and resultant limitations in work ability are common in SAF marines. Low frequency of physical training emerged independently associated with back pain limiting work ability. This suggests that marines performing physical training 1day per week or less are suitable candidates for further medical evaluation and secondary preventive actions. While also associated, body height and computer work need further exploration as underlying mechanisms for back pain limiting work ability. Further prospective studies are necessary to clarify the direction of causality.

  • 328.
    Monnier, Andreas
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Stockholm ; Swedish Armed Forces, Regional Medical Service Mälardalen, Berga.
    Larsson, Helena
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Stockholm ; Swedish Armed Forces, HR Centre, Stockholm.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Brodin, Lars-Åke
    Department of Medical Engineering, School of Technology and Health, KTH Royal Institute of Technology, Huddinge.
    Äng, Björn O
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Stockholm ; Centre for Clinical Research Dalarna, Falun ; Karolinska University Hospital, Stockholm.
    Musculoskeletal pain and limitations in work ability in Swedish marines: a cross-sectional survey of prevalence and associated factors2015Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, nr 10, artikel-id e007943Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives To estimate the prevalence of self-rated musculoskeletal pain and pain limiting work ability in Swedish Armed Forces (SAF) marines, and to study factors potentially associated with pain limiting work ability for the most prevalent pain regions reported.

    Design Population-based, cross-sectional survey.

    Participants There were 272 SAF marines from the main marine battalion in Sweden included in the study.

    Outcomes Self-assessed musculoskeletal pain and pain limiting the marines' work ability within a 6-month period, as obtained from structured questionnaires. The association of individual, health and work-related factors with musculoskeletal pain limiting work ability was systematically regressed with multiple logistic models, estimating OR and 95% CI.

    Results Musculoskeletal pain and pain limiting work ability were most common in the back, at 46% and 20%, and lower extremities at 51% and 29%, respectively. Physical training ≤1 day/week (OR 5.3, 95% CI 1.7 to 16.8); body height ≤1.80 m (OR 5.0, 95% CI 1.6 to 15.1) and ≥1.86 m (OR 4.4, 95% CI 1.4 to 14.1); computer work 1/4 of the working day (OR 3.2, 95% CI 1.0 to 10.0) and ≥1/2 (OR 3.3, 95% CI 1.1 to 10.1) of the working day were independently associated with back pain limiting work ability. None of the studied variables emerged significantly associated with such pain for the lower extremities.

    Conclusions Our findings show that musculoskeletal pain and resultant limitations in work ability are common in SAF marines. Low frequency of physical training emerged independently associated with back pain limiting work ability. This suggests that marines performing physical training 1 day per week or less are suitable candidates for further medical evaluation and secondary preventive actions. While also associated, body height and computer work need further exploration as underlying mechanisms for back pain limiting work ability. Further prospective studies are necessary to clarify the direction of causality.

  • 329. Monnier, Andreas
    et al.
    Larsson, Helena
    Nero, Håkan
    Djupsjöbacka, Mats
    Äng, Björn
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Karolinska institutet; Uppsala universitet.
    A longitudinal observational study of back pain incidence, risk factors and occupational physical activity in Swedish marine trainees2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 5, artikel-id e025150Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To evaluate the occurrence of low back pain (LBP) and LBP that limits work ability, to identify their potential early risks and to quantify occupational physical activity in Swedish Armed Forces (SwAF) marines during their basic 4 month marine training course.

    DESIGN: Prospective observational cohort study with weekly follow-ups.

    PARTICIPANTS: Fifty-three SwAF marines entering the training course.

    OUTCOMES: Incident of LBP and its related effect on work-ability and associated early risks. Occupational physical activity, as monitored using accelerometers and self-reports.

    RESULTS: During the training course, 68% of the marines experienced at least one episode of LBP. This yielded a LBP and LBP limiting work ability incidence rate of 13.5 (95% CI 10.4 to 17.8) and 6.3 (95% CI 4.2 to 10.0) episodes per 1000 person-days, respectively. Previous back pain and shorter body height (≤1.80 m) emerged as independent risks for LBP (HR 2.5, 95% CI 1.4 to 4.3; HR 2.0, 95% CI 1.2 to 3.3, respectively), as well as for LBP that limited work ability (HR 3.6, 95% CI 1.4 to 8.9; HR 4.5, 95% CI 2.0 to 10.0, respectively). Furthermore, managing fewer than four pull-ups emerged as a risk for LBP (HR 1.9, 95% CI 1.2 to 3.0), while physical training of fewer than three sessions per week emerged as a risk for LBP that limited work ability (HR 3.0, 95% CI 1.2 to 7.4). More than 80% of the work time measured was spent performing low levels of ambulation, however, combat equipment (≥17.5 kg) was carried for more than half of the work time.

    CONCLUSIONS: Incidents of LBP are common in SwAF marines' early careers. The link between LBP and previous pain as well as low levels of exercise highlights the need for preventive actions early on in a marine's career. The role of body height on LBP needs further investigation, including its relationship with body-worn equipment, before it can effectively contribute to LBP prevention.

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  • 330.
    Monnier, Andreas
    et al.
    Karolinska Inst, Div Physiotherapy, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden;Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden;Mil Acad Karlberg, Swedish Armed Forces, Stockholm, Sweden.
    Larsson, Helena
    Karolinska Inst, Div Physiotherapy, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden;Swedish Armed Forces, Med Serv, Stockholm, Sweden.
    Nero, Håkan
    Lund Univ, Dept Orthoped, Fac Med, Lund, Sweden.
    Djupsjöbacka, Mats
    Univ Gavle, Dept Occupat Hlth Sci & Psychol, Ctr Musculoskeletal Res, Gavle, Sweden.
    Äng, Björn O.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna. Karolinska Inst, Div Physiotherapy, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden;Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    A longitudinal observational study of back pain incidence, risk factors and occupational physical activity in Swedish marine trainees2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 5, artikel-id e025150Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives To evaluate the occurrence of low back pain (LBP) and LBP that limits work ability, to identify their potential early risks and to quantify occupational physical activity in Swedish Armed Forces (SwAF) marines during their basic 4 month marine training course. Design Prospective observational cohort study with weekly follow-ups. Participants Fifty-three SwAF marines entering the training course. Outcomes Incident of LBP and its related effect on workability and associated early risks. Occupational physical activity, as monitored using accelerometers and self-reports. Results During the training course, 68% of the marines experienced at least one episode of LBP. This yielded a LBP and LBP limiting work ability incidence rate of 13.5 (95% CI 10.4 to 17.8) and 6.3 (95% CI 4.2 to 10.0) episodes per 1000 person-days, respectively. Previous back pain and shorter body height (<= 1.80 m) emerged as independent risks for LBP (HR 2.5, 95% CI 1.4 to 4.3; HR 2.0, 95% CI 1.2 to 3.3, respectively), as well as for LBP that limited work ability (HR 3.6, 95% CI 1.4 to 8.9; HR 4.5, 95% CI 2.0 to 10.0, respectively). Furthermore, managing fewer than four pull-ups emerged as a risk for LBP (HR 1.9, 95% CI 1.2 to 3.0), while physical training of fewer than three sessions per week emerged as a risk for LBP that limited work ability (HR 3.0, 95% CI 1.2 to 7.4). More than 80% of the work time measured was spent performing low levels of ambulation, however, combat equipment (>= 17.5 kg) was carried for more than half of the work time. Conclusions Incidents of LBP are common in SwAF marines' early careers. The link between LBP and previous pain as well as low levels of exercise highlights the need for preventive actions early on in a marine's career. The role of body height on LBP needs further investigation, including its relationship with body-worn equipment, before it can effectively contribute to LBP prevention.

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  • 331.
    Monnier, Andreas
    et al.
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Swedish Armed Forces, Military Academy Karlberg, Stockholm, Sweden.
    Larsson, Helena
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Swedish Armed Forces, Headquarters, Medical Services, Stockholm, Sweden.
    Nero, Håkan
    Department of Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbetshälsovetenskap och psykologi, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Äng, Björn O.
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Center for Clinical Research, Uppsala University, Falun, Sweden.
    A longitudinal observational study of back pain incidence, risk factors and occupational physical activity in Swedish marine trainees2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 5, artikel-id e025150Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To evaluate the occurrence of low back pain (LBP) and LBP that limits work ability, to identify their potential early risks and to quantify occupational physical activity in Swedish Armed Forces (SwAF) marines during their basic 4 month marine training course.

    DESIGN: Prospective observational cohort study with weekly follow-ups.

    PARTICIPANTS: Fifty-three SwAF marines entering the training course.

    OUTCOMES: Incident of LBP and its related effect on work-ability and associated early risks. Occupational physical activity, as monitored using accelerometers and self-reports.

    RESULTS: During the training course, 68% of the marines experienced at least one episode of LBP. This yielded a LBP and LBP limiting work ability incidence rate of 13.5 (95% CI 10.4 to 17.8) and 6.3 (95% CI 4.2 to 10.0) episodes per 1000 person-days, respectively. Previous back pain and shorter body height (≤1.80 m) emerged as independent risks for LBP (HR 2.5, 95% CI 1.4 to 4.3; HR 2.0, 95% CI 1.2 to 3.3, respectively), as well as for LBP that limited work ability (HR 3.6, 95% CI 1.4 to 8.9; HR 4.5, 95% CI 2.0 to 10.0, respectively). Furthermore, managing fewer than four pull-ups emerged as a risk for LBP (HR 1.9, 95% CI 1.2 to 3.0), while physical training of fewer than three sessions per week emerged as a risk for LBP that limited work ability (HR 3.0, 95% CI 1.2 to 7.4). More than 80% of the work time measured was spent performing low levels of ambulation, however, combat equipment (≥17.5 kg) was carried for more than half of the work time.

    CONCLUSIONS: Incidents of LBP are common in SwAF marines' early careers. The link between LBP and previous pain as well as low levels of exercise highlights the need for preventive actions early on in a marine's career. The role of body height on LBP needs further investigation, including its relationship with body-worn equipment, before it can effectively contribute to LBP prevention.

  • 332. Monrouxe, Lynn V.
    et al.
    Bullock, Alison
    Gormely, Gerard
    Kaufhold, Kathrin
    Stockholms universitet, Humanistiska fakulteten, Engelska institutionen.
    Kelly, Narcie
    Roberts, Camille Emilie
    Mattick, Karen
    Rees, Charlotte
    New graduate doctors’ preparedness for practice: a multistakeholder, multicentre narrative study2018Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective While previous studies have begun to explore newly graduated junior doctors’ preparedness for practice, findings are largely based on simplistic survey data or perceptions of newly graduated junior doctors and their clinical supervisors alone. This study explores, in a deeper manner, multiple stakeholders’ conceptualisations of what it means to be prepared for practice and their perceptions about newly graduated junior doctors’ preparedness (or unpreparedness) using innovative qualitative methods.

    Design A multistakeholder, multicentre qualitative study including narrative interviews and longitudinal audio diaries.

    Setting Four UK settings: England, Northern Ireland, Scotland and Wales.

    Participants Eight stakeholder groups comprising n=185 participants engaged in 101 narrative interviews (27 group and 84 individual). Twenty-six junior doctors in their first year postgraduation also provided audio diaries over a 3-month period.

    Results We identified 2186 narratives across all participants (506 classified as ‘prepared’, 663 as ‘unprepared’, 951 as ‘general’). Seven themes were identified; this paper focuses on two themes pertinent to our research questions: (1) explicit conceptualisations of preparedness for practice; and (2) newly graduated junior doctors’ preparedness for the General Medical Council’s (GMC) outcomes for graduates. Stakeholders’ conceptualisations of preparedness for practice included short-term (hitting the ground running) and long-term preparedness, alongside being prepared for practical and emotional aspects. Stakeholders’ perceptions of medical graduates’ preparedness for practice varied across different GMC outcomes for graduates (eg, Doctor as Scholar and Scientist, as Practitioner, as Professional) and across stakeholders (eg, newly graduated doctors sometimes perceived themselves as prepared but others did not).

    Conclusion Our narrative findings highlight the complexities and nuances surrounding new medical graduates’ preparedness for practice. We encourage stakeholders to develop a shared understanding (and realistic expectations) of new medical graduates’ preparedness. We invite medical school leaders to increase the proportion of time that medical students spend participating meaningfully in multiprofessional teams during workplace learning.

  • 333.
    Montgomery, Scott
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Clinical Epidemiology Unit, Karolinska Inst, Stockholm, Sweden ; Dept Epidemiology & Publ Health, University College London (UCL), London, England .
    Bahmanyar, Shahram
    Clinical & Epidemiological Unit, Karolinska Inst, Stockholm, Sweden; Center of Pharmacoepidemiology, Karolinska Institute, Stockholm, Sweden .
    Brus, Ole
    Örebro University Hospital, Örebro, Sweden.
    Hussein, Oula
    Örebro University Hospital, Örebro, Sweden.
    Kosma, Paraskevi
    Dept Woman & Child Health, Karolinska Institute, Stockholm, Sweden; Division of Neonatology, Karolinska Hosp, Stockholm, Sweden.
    Palme-Kilander, Charlotte
    Dept Woman & Child Health, Karolinska Institute, Stockholm, Sweden.
    Respiratory infections in preterm infants and subsequent asthma: a cohort study2013Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, nr 10, artikel-id e004034Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To investigate whether gestational age modifies the association of airway infections that result in hospital admission during the first year after birth, with subsequent asthma risk after age 5years.

    Setting: Hospital inpatients and a general population comparison group in Sweden followed for subsequent diagnoses in primary and secondary care.

    Participants: National registers identified 42334 children admitted to hospital for respiratory infection in their first year after birth during 1981-1995, individually matched with 211594 children not admitted to hospital for infection during their first year.

    Primary outcome Asthma diagnoses and prescribed asthma treatments after the age of 5years identified through registers.

    Results: Cox regression was used to identify a HR (and 95% CI) of 1.51 (1.47 to 1.51) for the association of respiratory infection before 1year of age with asthma after age 5years, after adjustment for sex, gestational age, chronic lung disease, maternal asthma and maternal smoking. When stratified by gestational age (and with additional adjustment for birth weight), there is statistically significant effect modification by gestational age, with the highest magnitude asthma risk among those born with a gestational age of less than 28 weeks, producing an adjusted HR of 2.22 (1.59 to 3.09). This higher magnitude asthma risk persisted until after age 10years, but differences in risk by gestational age were less pronounced for asthma after age 16years.

    Conclusions: Extremely preterm infants are most likely to have chronic respiratory sequelae following respiratory infections in early life.

  • 334.
    Montgomery, Scott
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Karolinska Institutet, Stockholm, Sweden .
    Hassan, Ahmad
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Bahmanyar, Shahram
    Karolinska Institutet, Stockholm, Sweden; Golestan University of Medical Sciences, Gorgan, Iran .
    Brus, Ole
    Örebro University Hospital, Örebro, Sweden.
    Hussein, Oula
    Örebro University Hospital, Örebro, Sweden.
    Hiyoshi, Ayako
    Region Örebro län.
    Hillert, Jan
    Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden .
    Olsson, Tomas
    Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden .
    Fall, Katja
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Örebro University Hospital, Örebro, Sweden.
    Mortality following a brain tumour diagnosis in patients with multiple sclerosis2013Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, nr 11, artikel-id e003622Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: As brain tumours and their treatment may theoretically have a poorer prognosis in inflammatory central nervous system diseases such as multiple sclerosis (MS), all-cause mortality following a brain tumour diagnosis was compared between patients with and without MS. The potential role of age at tumour diagnosis was also examined.

    Setting: Hospital inpatients in Sweden with assessment of mortality in hospital or following discharge.

    Participants: Swedish national registers identified 20 543 patients with an MS diagnosis (1969–2005) and they were matched individually to produce a comparison cohort of 204 163 members of the general population without MS. Everyone with a primary brain tumour diagnosis was selected for this study: 111 with MS and 907 without MS.

    Primary and secondary outcome measures: 5-year mortality risk following brain tumour diagnosis and age at brain tumour diagnosis.

    Results: A non-statistically significant lower mortality risk among patients with MS (lower for those with tumours of high-grade and uncertain-grade malignancy and no notable difference for low-grade tumours) produced an unadjusted HR (and 95% CI) of 0.75 (0.56 to 1.02). After adjustment for age at diagnosis, grade of malignancy, sex, region of residence and socioeconomic index, the HR is 0.91 (0.67–1.24). The change in estimate was largely due to adjustment for age at brain tumour diagnosis, as patients with MS were on average 4.7 years younger at brain tumour diagnosis than those in the comparison cohort (p<0.001).

    Conclusions: Younger age at tumour diagnosis may contribute to mortality reduction in those with highgrade and uncertain-grade brain tumours. Survival following a brain tumour is not worse in patients with MS; even after age at brain tumour diagnosis and grade of malignancy are taken into account.

  • 335. Montgomery, Scott
    et al.
    Udumyan, Ruzan
    Magnuson, Anders
    Osika, Walter
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Sundin, Per-Ola
    Blane, David
    Mortality following unemployment during an economic downturn: Swedish register-based cohort study2013Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, nr 7, s. e003031-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To investigate if unemployment during an economic downturn is associated with mortality, even among men with markers of better health (higher cognitive function scores and qualifications), and to assess whether the associations vary by age at unemployment. Design Longitudinal register-based cohort study. Setting Study entry was in 1990 and 2001 when Sweden was entering periods of significant economic contraction. Participants A representative sample of men from the general population (n=234782) born between 1952 and 1956 who participated in military conscription examinations. Men in receipt of disability or sickness benefit at study entry were excluded. Main outcome measure All-cause mortality. Results Unemployment compared with employment in 1991 (ages 34-38years) produced adjusted HRs (with 95% CIs) for all-cause mortality (3651 deaths) during follow-up to 2001 and after stratification by education of 2.35 (1.99 to 2.76) for compulsory education, 2.25 (1.97 to 2.58) for up to 3years postcompulsory education and 1.90 (1.40 to 2.57) for more than 3years postcompulsory education. When unemployment was compared with employment in 2001 (ages 45-49years) with follow-up to 2010, the pattern of mortality risk (4271 deaths) stratified by education was reversed, producing adjusted HRs of 2.81 (2.47 to 3.21) for compulsory education, 2.87 (2.58 to 3.19) for up to 3years postcompulsory education and 3.44 (2.78 to 4.25) for more than 3years postcompulsory education. Interaction testing confirmed effect modification by age/period (p=0.003). The degree of gradient reversal was slightly less pronounced after stratification by cognitive function but produced a similar pattern of results (p=0.004). Conclusions Unemployment at older ages is associated with greater mortality risk than at younger ages, with the greatest relative increase in risk among men with markers of better health, suggesting the greater vulnerability of all older workers to unemployment-associated exposures.

  • 336.
    Montgomery, Scott
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Karolinska Institutet, Stockholm, Sweden .
    Udumyan, Ruzan
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Örebro University Hospital, Örebro, Sweden.
    Magnuson, Anders
    Örebro University Hospital, Örebro, Sweden.
    Osika, Walter
    Stockholm University, Stockholm, Sweden.
    Sundin, Per-Ola
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Örebro University Hospital, Örebro, Sweden.
    Blane, David
    School of Public Health, Imperial College London, London, UK .
    Mortality following unemployment during an economic downturn: Swedish register-based cohort study2013Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, nr 7, s. e003031-Artikel i tidskrift (Refereegranskat)
  • 337. Mortensen, Laust H.
    et al.
    Rehnberg, Johan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS). Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Dahl, Espen
    Diderichsen, Finn
    Elstad, Jon Ivar
    Martikainen, Pekka
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Rehkopf, David
    Tarkiainen, Lasse
    Fritzell, Johan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Shape of the association between income and mortality: a cohort study of Denmark, Finland, Norway and Sweden in 1995 and 20032016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 12, artikel-id e010974Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Prior work has examined the shape of the income-mortality association, but work has not compared gradients between countries. In this study, we focus on changes over time in the shape of income-mortality gradients for 4 Nordic countries during a period of rising income inequality. Context and time differentials in shape imply that the relationship between income and mortality is not fixed. Setting: Population-based cohort study of Denmark, Finland, Norway and Sweden. Participants: We collected data on individuals aged 25 or more in 1995 (n=12.98 million individuals, 0.84 million deaths) and 2003 (n=13.08 million individuals, 0.90 million deaths). We then examined the household size equivalised disposable income at the baseline year in relation to the rate of mortality in the following 5 years. Results: A steep income gradient in mortality in men and women across all age groups except the oldest old in Denmark, Finland, Norway and Sweden. From the 1990s to 2000s mortality dropped, but generally more so in the upper part of the income distribution than in the lower part. As a consequence, the shape of the income gradient in mortality changed. The shift in the shape of the association was similar in all 4 countries. Conclusions: A non-linear gradient exists between income and mortality in most cases and because of a more rapid mortality decline among those with high income the income gradient has become steeper over time.

  • 338.
    Mosson, R.
    et al.
    Department of Learning Informatics, Management and Ethics, Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Department of Learning Informatics, Management and Ethics, Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Hasson, H.
    Unit for Implementation and Evaluation, Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden.
    Lundmark, R.
    Department of Learning Informatics, Management and Ethics, Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Richter, A.
    Department of Learning Informatics, Management and Ethics, Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    How do iLead?: Validation of a scale measuring active and passive implementation leadership in Swedish healthcare2018Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 6, artikel-id e021992Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives This study aims to describe the creation of a scale-the iLead scale-through adaptations of existing domain-specific scales that measure active and passive implementation leadership, and to describe the psychometric properties of this scale. Methods Data collected from a leadership intervention were used in this validation study. Respondents were 336 healthcare professionals (90% female and 10% male; mean age 47 years) whose first-line and second-line managers participated in the intervention. The data were collected in the Stockholm regional healthcare organisation that offer primary, psychiatric, rehabilitation and acute hospital care, among other areas. The items for measuring implementation leadership were based on existent research and the full-range leadership model. Confirmatory factor analysis was performed to evaluate the dimensionality of the scale, followed by tests for reliability and convergent, discriminant and criterion-related validity using correlations and multilevel regression analyses. Results The final scale consists of 16 items clustered into four subscales representing active implementation leadership, and one scale signifying passive implementation leadership. Findings showed that the hypothesised model had an acceptable model fit (Ï ‡ 2 (99) =382.864∗∗, Comparative Fit Index=0.935, Tucker-Lewis Index=0.911, root mean square error of approximation=0.059). The internal consistency and convergent, discriminant and criterion-related validity were all satisfactory. Conclusions The iLead scale is a valid measure of implementation leadership and is a tool for understanding how active and passive leader behaviours influence an implementation process. This brief scale may be particularly valuable to apply in training focusing on facilitating implementation, and in evaluating leader training. Moreover, the scale can be useful in evaluating various leader behaviours associated with implementation success or failure.

  • 339. Mosson, Rebecca
    et al.
    von Thiele Schwarz, Ulrica
    Hasson, Henna
    Lundmark, Robert
    Department of Learning, Informatics, Management and Ethics, Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Richter, Anne
    How do iLead? Validation of a scale measuring active and passive implementation leadership in Swedish healthcare2018Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 6, artikel-id e021992Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: This study aims to describe the creation of a scale-the iLead scale-through adaptations of existing domain-specific scales that measure active and passive implementation leadership, and to describe the psychometric properties of this scale.

    METHODS: Data collected from a leadership intervention were used in this validation study. Respondents were 336 healthcare professionals (90% female and 10% male; mean age 47 years) whose first-line and second-line managers participated in the intervention. The data were collected in the Stockholm regional healthcare organisation that offer primary, psychiatric, rehabilitation and acute hospital care, among other areas. The items for measuring implementation leadership were based on existent research and the full-range leadership model. Confirmatory factor analysis was performed to evaluate the dimensionality of the scale, followed by tests for reliability and convergent, discriminant and criterion-related validity using correlations and multilevel regression analyses.

    RESULTS: The final scale consists of 16 items clustered into four subscales representing active implementation leadership, and one scale signifying passive implementation leadership. Findings showed that the hypothesised model had an acceptable model fit (χ2(99)=382.864**, Comparative Fit Index=0.935, Tucker-Lewis Index=0.911, root mean square error of approximation=0.059). The internal consistency and convergent, discriminant and criterion-related validity were all satisfactory.

    CONCLUSIONS: The iLead scale is a valid measure of implementation leadership and is a tool for understanding how active and passive leader behaviours influence an implementation process. This brief scale may be particularly valuable to apply in training focusing on facilitating implementation, and in evaluating leader training. Moreover, the scale can be useful in evaluating various leader behaviours associated with implementation success or failure.

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  • 340.
    Moula, Alireza
    et al.
    Karlstads universitet, Fakulteten för humaniora och samhällsvetenskap (from 2013), Institutionen för sociala och psykologiska studier (from 2013).
    Addelyan Rasi, Hamideh
    Can a psychosocial intervention programme teaching coping strategies improve the quality of life of Iranian women? A non-randomised quasi-experimental study2013Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3Artikel i tidskrift (Refereegranskat)
  • 341.
    Mubanga, Mwenya
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Molekylär epidemiologi. Uppsala universitet, Science for Life Laboratory, SciLifeLab.
    Byberg, Liisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Egenvall, Agneta
    Department of Clinical Sciences, Division of Ruminant Medicine and Veterinary Epidemiology, Swedish University of Agricultural Sciences.
    Sundström, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk epidemiologi.
    Magnusson, Patrik K
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm.
    Ingelsson, Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Molekylär epidemiologi. Uppsala universitet, Science for Life Laboratory, SciLifeLab. Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA..
    Fall, Tove
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Molekylär epidemiologi. Uppsala universitet, Science for Life Laboratory, SciLifeLab.
    Dog ownership and Cardiovascular Risk Factors: a nationwide prospective register-based cohort study2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, artikel-id 23447Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To study the association between dog ownership and cardiovascular risk factors.

    Design A nationwide register–based cohort study and a cross-sectional study in a subset.

    Setting A cohort of 2 026 865 participants was identified from the Register of the Total Population and linked to national registers for information on dog ownership, prescribed medication, hospital admissions, education level, income and country of birth. Participants were followed from 1 October, 2006, to the end of the study on 31 December, 2012, assessing medication for a cardiovascular risk factor, emigration and death. Cross-sectional associations were further assessed in 10 110 individuals from the TwinGene study with additional adjustment for professional level, employment status, Charlson comorbidity index, disability and tobacco use.

    Participants All Swedish residents aged 45–80 years on 1 October, 2006.

    Main outcome measures Initiation of medication for hypertension, dyslipidaemia and diabetes mellitus.

    Results After adjustment for confounders, the results indicated slightly higher likelihood of initiating antihypertensive (HR, 1.02; 95% CI, 1.01 to 1.03) and lipid-lowering treatment (HR, 1.02; 95% CI, 1.01 to 1.04) in dog owners than in non-owners, particularly among those aged 45–60 years and in those owning mixed breed or companion/toy breed dogs. No association of dog ownership with initiation of treatment for diabetes was found in the overall analysis (HR, 0.98; 95% CI, 0.95 to 1.01). Sensitivity analyses in the TwinGene cohort indicated confounding of the association between dog ownership and prevalent treatment for hypertension, dyslipidaemia and diabetes mellitus, respectively, from factors not available in the national cohort, such as employment status and non cardiovascularchronic disease status.

    Conclusions In this large cohort study, dog ownership was associated with a minimally higher risk of initiation of treatment for hypertension and dyslipidaemia implying that the previously reported lower risk of cardiovascular mortality among dog owners in this cohort is not explained by reduced hypertension and dyslipidaemia. These observations may suffer from residual confounding despite access to multiple important covariates, and future studies may add valuable information.

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  • 342.
    Murley, Chantelle
    et al.
    Karolinska Institutet.
    Mogard, Olof
    Karolinska Institutet.
    Wiberg, Michael
    Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Karampampa, Korinna
    Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet.
    Trajectories of disposable income among people of working ages diagnosed with multiple sclerosis: a nationwide register-based cohort study in Sweden 7 years before to 4 years after diagnosis with a population-based reference group2018Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 5, artikel-id e020392Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To describe how disposable income (DI) and three main components changed, and analyse whether DI development differed from working-aged people with multiple sclerosis (MS) to a reference group from 7 years before to 4 years after diagnosis in Sweden.

    DESIGN: Population-based cohort study, 12-year follow-up (7 years before to 4 years after diagnosis).

    SETTING: Swedish working-age population with microdata linked from two nationwide registers.

    PARTICIPANTS: Residents diagnosed with MS in 2009 aged 25-59 years (n=785), and references without MS (n=7847) randomly selected with stratified matching (sex, age, education and country of birth).

    PRIMARY AND SECONDARY OUTCOME MEASURES: DI was defined as the annual after tax sum of incomes (earnings and benefits) to measure individual economic welfare. Three main components of DI were analysed as annual sums: earnings, sickness absence benefits and disability pension benefits.

    RESULTS: We found no differences in mean annual DI between people with and without MS by independent t-tests (p values between 0.15 and 0.96). Differences were found for all studied components of DI from diagnosis year by independent t-tests, for example, in the final study year (2013): earnings (-64 867 Swedish Krona (SEK); 95% CI-79 203 to -50 528); sickness absence benefits (13 330 SEK; 95% CI 10 042 to 16 500); and disability pension benefits (21 360 SEK; 95% CI 17 380 to 25 350). A generalised estimating equation evaluated DI trajectory development between people with and without MS to find both trajectories developed in parallel, both before (-4039 SEK; 95% CI -10 536 to 2458) and after (-781 SEK; 95% CI -6988 to 5360) diagnosis.

    CONCLUSIONS: The key finding of parallel DI trajectory development between working-aged MS and references suggests minimal economic impact within the first 4 years of diagnosis. The Swedish welfare system was responsive to the observed reductions in earnings around MS diagnosis through balancing DI with morbidity-related benefits. Future decreases in economic welfare may be experienced as the disease progresses, although thorough investigation with future studies of modern cohorts are required.

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  • 343.
    Murphy, Patrick J.
    et al.
    NUI Galway, Ireland.
    Mc Sharry, Jenny
    NUI Galway, Ireland.
    Casey, Dympna
    NUI Galway, Ireland.
    Doherty, Sally
    Royal Coll Surgeons Ireland, Ireland.
    Gillespie, Paddy
    NUI Galway, Ireland.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Murphy, Andrew W.
    NUI Galway, Ireland.
    Newell, John
    NUI Galway, Ireland.
    ODonnell, Martin
    NUI Galway, Ireland.
    Steinke, Elaine E.
    Wichita State University, KS 67260 USA.
    Toomey, Elaine
    University of Coll Dublin, Ireland.
    Byrne, Molly
    NUI Galway, Ireland.
    Sexual counselling for patients with cardiovascular disease: protocol for a pilot study of the CHARMS sexual counselling intervention2016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 6, artikel-id e011219Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction Sexual problems are common with cardiovascular disease, and can negatively impact quality of life. To address sexual problems, guidelines have identified the importance of sexual counselling during cardiac rehabilitation, yet this is rarely provided. The Cardiac Health and Relationship Management and Sexuality (CHARMS) intervention aims to improve the provision of sexual counselling in cardiac rehabilitation in Ireland. Methods and analysis This is a multicentre pilot study for the CHARMS intervention, a complex, multilevel intervention delivered within hospital-based cardiac rehabilitation programmes. The intervention includes (1) training in sexual counselling for staff, (2) a staff-led patient education and support intervention embedded within the cardiac rehabilitation programme, (3) a patient information booklet and (4) an awareness raising poster. The intervention will be delivered in two randomly selected cardiac rehabilitation centres. In each centre 30 patients will be recruited, and partners will also be invited to participate. Data will be collected from staff and patients/partners at T1 (study entry), T2 (3-month follow-up) and T3 (6-month follow-up). The primary outcome for patients/partners will be scores on the Sexual Self-Perception and Adjustment Questionnaire. Secondary outcomes for patients/partners will include relationship satisfaction; satisfaction with and barriers to sexual counselling in services; sexual activity, functioning and knowledge; physical and psychological well-being. Secondary outcomes for staff will include sexuality-related practice; barriers to sexual counselling; self-ratings of capability, opportunity and motivation; sexual attitudes and beliefs; knowledge of cardiovascular disease and sex. Fidelity of intervention delivery will be assessed using trainer self-reports, researcher-coded audio recordings and exit interviews. Longitudinal feasibility data will be gathered from patients/partners and staff via questionnaires and interviews. Ethics and dissemination This study is approved by the Research Ethics Committee (REC) of the National University of Ireland, Galway. Findings will be disseminated to cardiac rehabilitation staff, patients/partners and relevant policymakers via appropriate publications and presentations.

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  • 344.
    Muzrif, Munas M.
    et al.
    Univ Sri Jayawardenapura, Sri Lanka.
    Perera, Dinusha
    Univ Sri Jayawardenapura, Sri Lanka.
    Wijewardena, Kumudu
    Univ Sri Jayawardenapura, Sri Lanka.
    Schei, Berit
    Norwegian Univ Sci & Technol NTNU, Norway;Trondheim Reg & Univ Hosp, Norway.
    Swahnberg, Katarina
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Domestic violence: a cross-sectional study among pregnant women in different regions of Sri Lanka2018Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 2, artikel-id e017745Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives The aims of this study were to assess the regional differences in domestic violence among pregnant women in the capital district and in the tea plantation sector of Sri Lanka, to explore potential contributory factors and to assess whether healthcare workers addressed domestic violence and disclosure among survivors. Design A cross-sectional study was carried out using interviewer-administered Abuse Assessment Screen. Setting Fifty-seven antenatal clinic centres in the capital district and 30 in the tea plantation sector. Participants Pregnant women between 6 and 40 weeks of gestational age. In the capital district, 1375 women were recruited from antenatal clinic centres in the urban (n= 25) and in the rural areas (n= 32), and 800 women from 30 centres in the tea plantation sector. The response rate in the capital district was 95.6% and 96.7% in the tea plantation sector. Results Among the total sample of pregnant women (n= 2088), the prevalence of 'ever abused' was 38.6%, and the prevalence of 'currently abused' was 15.9%. 'Ever abused' (31.5% vs 50.8%) and 'currently abused' (10% vs 25.8%) were significantly higher (P< 0.001) among the women living in the tea plantation sector. 'Ever abused' was associated with living in the tea plantation sector, being employed, living far from gender-based violence care centre and of Muslim ethnicity, after adjusting for age, education and family income. Only 38.8% of all participants had been asked by healthcare workers about abuse. Living in the tea plantation sector and lower level of education were associated with not being asked. Among those who reported 'ever abused', only 8.7% had disclosed the experience to a healthcare worker. Conclusion Domestic violence was prevalent and highest among women in the tea plantation sector compared with the capital district. The capacity of healthcare workers in addressing domestic violence should be increased.

  • 345.
    Nelander, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Cnattingius, S
    Åkerud, Helena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Wikström, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Pedersen, N L
    Wikström, Anna-Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Pregnancy hypertensive disease and risk of dementia and cardiovascular disease in women aged 65 years or older: a cohort study2016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 1, artikel-id e009880Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The primary aim was to study pregnancy hypertensive disease and subsequent risk of dementia. The second aim was to study if the increased risks of cardiovascular disease (CVD) and stroke after pregnancy hypertensive disease persist in an elderly population.

    DESIGN: Cohort study.

    SETTING: Sweden.

    POPULATION OR SAMPLE: 3232 women 65 years or older (mean 71 years) at inclusion.

    METHODS: Cox proportional hazards regression analyses were used to calculate risks of dementia, CVD and/or stroke for women exposed to pregnancy hypertensive disease. Exposure data were collected from an interview at inclusion during the years 1998-2002. Outcome data were collected from the National Patient Register and Cause of Death Register from the year of inclusion until the end of 2010. Age at inclusion was set as a time-dependent variable, and adjustments were made for body mass index, education and smoking.

    MAIN OUTCOME MEASURES: Dementia, CVD, stroke.

    RESULTS: During the years of follow-up, 7.6% of the women exposed to pregnancy hypertensive disease received a diagnosis of dementia, compared with 7.4% among unexposed women (HR 1.19; 95% CI 0.79 to 1.73). The corresponding rates for CVD were 22.9% for exposed women and 19.0% for unexposed women (HR 1.29; 95% CI 1.02 to 1.61), and for stroke 13.4% for exposed women and 10.7% for unexposed women (HR 1.36; 95% CI 1.00 to 1.81).

    CONCLUSIONS: There was no increased risk of dementia after self-reported pregnancy hypertensive disease in our cohort. We found that the previously reported increased risk of CVD and stroke after pregnancy hypertensive disease persists in an older population.

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  • 346.
    Nilsson, Anders
    et al.
    Karolinska Institute, Sweden.
    Magnusson, Kristoffer
    Karolinska Institute, Sweden.
    Carlbring, Per
    Stockholm University, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Sweden.
    Hellner Gumpert, Clara
    Karolinska Institute, Sweden.
    Effects of added involvement from concerned significant others in internet-delivered CBT treatments for problem gambling: study protocol for a randomised controlled trial2016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 9, artikel-id e011974Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Problem gambling is a public health concern affecting similar to 2.3% of the Swedish population. Problem gambling also severely affects concerned significant others (CSOs). Several studies have investigated the effect of individual treatments based on cognitive-behavioural therapy (CBT), but less is known of the effect of involving CSOs in treatment. This study aims to compare an intervention based on behavioural couples therapy (BCT), involving a CSO, with an individual CBT treatment to determine their relative efficacy. BCT has shown promising results in working with substance abuse, but this is the first time it is used as an intervention for problem gambling. Both interventions will be internet-delivered, and participants will receive written support and telephone support. Methods and analysis: A sample of 120 couples will be randomised to either the BCT condition, involving the gambler and the CSO, or the CBT condition, involving the gambler alone. Measures will be conducted weekly and at 3, 6 and 12 months follow-up. The primary outcome measure is gambling behaviour, as measured by Timeline Followback for Gambling. This article describes the outline of the research methods, interventions and outcome measures used to evaluate gambling behaviour, mechanisms of change and relationship satisfaction. This study will be the first study on BCT for problem gambling. Ethics and dissemination: This study has been given ethical approval from the regional ethics board of Stockholm, Sweden. It will add to the body of knowledge as to how to treat problem gambling and how to involve CSOs in treatment. The findings of this study will be published in peer-reviewed journals and published at international and national conferences.

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  • 347. Nilsson, Anders
    et al.
    Magnusson, Kristoffer
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Hellner Gumpert, Clara
    Effects of added involvement from concerned significant others in internet-delivered CBT treatments for problem gambling: Study protocol for a randomised controlled trial2016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 9, artikel-id e011974Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Problem gambling is a public health concern affecting ∼2.3% of the Swedish population. Problem gambling also severely affects concerned significant others (CSOs). Several studies have investigated the effect of individual treatments based on cognitive–behavioural therapy (CBT), but less is known of the effect of involving CSOs in treatment. This study aims to compare an intervention based on behavioural couples therapy (BCT), involving a CSO, with an individual CBT treatment to determine their relative efficacy. BCT has shown promising results in working with substance abuse, but this is the first time it is used as an intervention for problem gambling. Both interventions will be internet-delivered, and participants will receive written support and telephone support.

    Methods and analysis: A sample of 120 couples will be randomised to either the BCT condition, involving the gambler and the CSO, or the CBT condition, involving the gambler alone. Measures will be conducted weekly and at 3, 6 and 12 months follow-up. The primary outcome measure is gambling behaviour, as measured by Timeline Followback for Gambling. This article describes the outline of the research methods, interventions and outcome measures used to evaluate gambling behaviour, mechanisms of change and relationship satisfaction. This study will be the first study on BCT for problem gambling.

    Ethics and dissemination: This study has been given ethical approval from the regional ethics board of Stockholm, Sweden. It will add to the body of knowledge as to how to treat problem gambling and how to involve CSOs in treatment. The findings of this study will be published in peer-reviewed journals and published at international and national conferences.

  • 348.
    Nilsson, Göran
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Hedberg, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Öhrvik, John
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Survival of the fattest: unexpected findings about hyperglycaemia and obesity in a population based study of 75-year-olds2011Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 1, nr 1, artikel-id e000012Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To study the relationship between body mass index (BMI) and mortality among 75-year-olds with and without diabetes mellitus type 2 (DM) or impaired fasting glucose (IFG).

    DESIGN: Prospective population-based cohort study with a 10-year follow-up.

    PARTICIPANTS: A random sample of 618 of the 1100 inhabitants born in 1922 and living in the city of Västerås in 1997 were invited to participate in a cardiovascular health survey; 70% of those invited agreed to participate (432 individuals: 210 men, 222 women).

    OUTCOME MEASURES: All-cause and cardiovascular mortality.

    RESULTS: 163 of 432 (38%) participants died during the 10-year follow-up period. The prevalence of DM or IFG was 41% (35% among survivors, 48% among non-survivors). The prevalence of obesity/overweight/normal weight/underweight according to WHO definitions was 12/45/42/1% (14/43/42/1% among survivors, 9/47/42/2% among non-survivors). The hazard rate for death decreased by 10% for every kg/m(2) increase in BMI in individuals with DM/IFG (HR 0.91, 95% CI 0.86 to 0.97; p=0.003). After adjustment for sex, current smoking, diagnosed hypertension, diagnosed angina pectoris, previous myocardial infarction and previous stroke/transient ischaemic attack, the corresponding decrease in mortality was 9% (HR 0.92, 95% CI 0.86 to 0.99; p=0.017). These findings remained after exclusion of individuals with BMI<20 or those who died within 2-year follow-up. In individuals without DM/IFG, BMI had no effect on mortality (HR 1.01, 95% CI 0.95 to 1.07; p=0.811). The HR for BMI differed significantly between individuals with and without DM/IFG (p interaction=0.025). The increased all-cause mortality in individuals with DM/IFG in combination with lower BMI was driven by cardiovascular death.

    CONCLUSION: High all-cause and cardiovascular mortality was associated with lower BMI in 75-year-olds with DM/IFG but not in those without DM/IFG. Further studies on the combined effect of obesity/overweight and DM/IFG are needed in order to assess the appropriateness of current guideline recommendations for weight reduction in older people with DM/IFG.

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  • 349. Nilsson, Hanna
    et al.
    Angerås, Ulf
    Bock, David
    Börjesson, Mats
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms och Mats Börjessons forskningsgrupp.
    Onerup, Aron
    Fagevik Olsen, Monika
    Gellerstedt, Martin
    Haglind, Eva
    Angenete, Eva
    Is preoperative physical activity related to post-surgery recovery? A cohort study of patients with breast cancer.2016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 1, artikel-id e007997Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The aim of our study is to assess the association between preoperative level of activity and recovery after breast cancer surgery measured as hospital stay, length of sick leave and self-assessed physical and mental recovery.

    DESIGN: A prospective cohort study.

    SETTING: Patients included were those scheduled to undergo breast cancer surgery, between February and November 2013, at two participating hospitals in the Western Region of Sweden.

    PARTICIPANTS: Patients planned for breast cancer surgery filled out a questionnaire before, as well as at 3 and 6 weeks after the operation. The preoperative level of activity was self-assessed and categorised into four categories by the participants using the 4-level Saltin-Grimby Physical Activity Level Scale (SGPALS).

    MAIN OUTCOME MEASURE: Our main outcome was postoperative recovery measured as length of sick leave, in-hospital stay and self-assessed physical and mental recovery.

    RESULTS: 220 patients were included. Preoperatively, 14% (31/220) of participants assessed themselves to be physically inactive, 61% (135/220) to exert some light physical activity (PA) and 20% (43/220) to be more active (level 3+4). Patients operated with mastectomy versus partial mastectomy and axillary lymph node dissection versus sentinel node biopsy were less likely to have a short hospital stay, relative risk (RR) 0.88 (0.78 to 1.00) and 0.82 (0.70 to 0.96). More active participants (level 3 or 4) had an 85% increased chance of feeling physically recovered at 3 weeks after the operation, RR 1.85 (1.20 to 2.85). No difference was seen after 6 weeks.

    CONCLUSIONS: The above study shows that a higher preoperative level of PA is associated with a faster physical recovery as reported by the patients 3 weeks post breast cancer surgery. After 6 weeks, most patients felt physically recovered, diminishing the association above. No difference was seen in length of sick leave or self-assessed mental recovery between inactive or more active patients.

  • 350.
    Nilsson, Hanna
    et al.
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG—Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Angerås, Ulf
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG—Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Bock, David
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG—Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Börjesson, Mats
    Swedish School of Sport and Health Sciences and Karolinska University Hospital, Stockholm, Sweden.
    Onerup, Aron
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG—Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Fagevik Olsen, Monika
    Department of Gastrosurgical Research and Education, Gothenburg, Sweden.
    Gellerstedt, Martin
    Högskolan Väst, Institutionen för ekonomi och it, Avd för juridik, ekonomi, statistik och politik. Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG—Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Haglind, Eva
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG—Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Angenete, Eva
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG—Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Is preoperative physical activity related to post-surgery recovery?: A cohort study of patients with breast cancer2016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 1, artikel-id e007997Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The aim of our study is to assess the association between preoperative level of activity and recovery after breast cancer surgery measured as hospital stay, length of sick leave and self-assessed physical and mental recovery. Design: A prospective cohort study. Setting: Patients included were those scheduled to undergo breast cancer surgery, between February and November 2013, at two participating hospitals in the Western Region of Sweden. Participants: Patients planned for breast cancer surgery filled out a questionnaire before, as well as at 3 and 6 weeks after the operation. The preoperative level of activity was self-assessed and categorised into four categories by the participants using the 4-level SaltinGrimby Physical Activity Level Scale (SGPALS). Main outcome measure: Our main outcome was postoperative recovery measured as length of sick leave, in-hospital stay and self-assessed physical and mental recovery. Results: 220 patients were included. Preoperatively, 14% (31/220) of participants assessed themselves to be physically inactive, 61% (135/220) to exert some light physical activity (PA) and 20% (43/220) to be more active (level 3+4). Patients operated with mastectomy versus partial mastectomy and axillary lymph node dissection versus sentinel node biopsy were less likely to have a short hospital stay, relative risk (RR) 0.88 (0.78 to 1.00) and 0.82 (0.70 to 0.96). More active participants (level 3 or 4) had an 85% increased chance of feeling physically recovered at 3 weeks after the operation, RR 1.85 (1.20 to 2.85). No difference was seen after 6 weeks. Conclusions: The above study shows that a higher preoperative level of PA is associated with a faster physical recovery as reported by the patients 3 weeks post breast cancer surgery. After 6 weeks, most patients felt physically recovered, diminishing the association above. No difference was seen in length of sick leave or self-assessed mental recovery between inactive or more active patients.

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