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  • 51.
    Roback, Kerstin
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Evidensgraderingssystemet GRADE: Ett sätt att granska vetenskaplig kunskap om metoder och arbetssätt i hälso- och sjukvården2009Report (Other academic)
    Abstract [en]

    Decision on the introduction of new treatments and practices in healthcare are always characterized by uncertainty. The studies carried out to evaluate the pros and cons of a new method can be of different quality and thus provide more or less certain results. When the use of systematic literature reviews on health technologies took off in the 1980s, decision makers began to ask for guidance documents, which also took into account individual study quality. This initiated the development of several systems for grading of evidence.

    Grading of evidence means that the overall decision material is assigned a strength of evidence, based primarily on quality, quantity and consistency between ifferent studies. The quality of individual studies are assessed and their decision values are weighted together with additional information to obtain an overall decision making material.

    GRADE (Grading of Recommendations Assessment, Development and Evaluation) is an approach developed internationally. It started as an informal collaboration between different groups interested in how to assess the value of different studies and the credibility of the overall decision basis for deciding on the introduction of new medical technologies.

    GRADE was first presented in 2004 in the British Medical Journal (BMJ), and is today the most widespread system for grading of evidence. Several international organizations, and assessment units in Europe, North America and Asia are using GRADE and in Sweden, the Swedish Council on Technology Assessment in Health Care (SBU) and the National Board of Health and Welfare have studied the system and integrated parts of the approach in their work. In addition to assessment of evidence quality the GRADE approach also covers development and presentation of recommendations to use or not to use the assessed methods that, based on the scientific basis, also describe the degree of confidence with which a recommendation can be given.

    At the Centre for Medical Technology Assessment (CMT), several systems of evidence-grading have been studied. However, as the systems under study clearly converged towards the GRADE approach, a sharper focus was set on a detailed study of this system and to develop a discussion paper in Swedish in order to highlight the issue of how GRADE can be used in the Swedish context for evaluation and priority setting, locally, regionally and nationally. Target groups for the report are policy makers, healthcare professionals and academic researchers with an interest in issues of evaluation and implementation of health technologies.

    The report begins with the historical background behind the development of GRADE. In Chapter 2 a description of GRADE’s working method and underlying principles is given. Chapter 3 contains a critical review of the system and a discussion of the advantages and disadvantages, and usefulness in a Swedish evaluation perspective. Furthermore, the report contains appendices with GRADE worksheets and numerous examples of assessments using the GRADE approach.

    A GRADE-assessment consists of two parts: an evidence profile for the method in question and a recommendation regarding its use.

    The evidence profile contains a ”Quality assessment” and a ”Summary of findings.” All the important outcomes are shown in the summary and the underlying studies are graded according to design, study quality, etc. The role of the evidence profile is to inform policy and practice but it does only give guidance regarding the clinical efficacy of the interventions.

    Sweden has built a tradition of comprehensive assessment, meaning that methods are examined from a medical, economic, social and ethical perspective. Therefore, GRADE’s evidence profile is not sufficient to inform policy and practice in a Swedish perspective.

    The recommendation on the use of the investigated method is the final step in GRADE. This step is performed by a committee of experts in the healthcare system in which the method is intended to be used. A recommendation to use a method shall reflect the committee's belief that the desired effects outweigh the undesirable effects. The degree of confidence, that the most advantageous behaviour is recommended, shall also be indicated as strong or weak. The approach is structured but leaves room for subjective judgments. The recommendation is based on information in the evidence profile, and beyond that on current norms and preferences in the society, and economic aspects. The latter evaluation criteria will vary greatly depending on the country where the evaluation is made. Among other things, assessment of cost-effectiveness is not explicitly required for decision making in all countries but in reality it is not possible to work out recommendations without an element of priority setting.

    SBU has decided to use GRADE, with some modification, but only to develop an evidence profile. However, SBU attempts to make assessments that analyze all relevant aspects that may be important in decision making and therefore supplements the evidence profile with for example a cost-effectiveness analysis in some cases.

    Explicit recommendations in support of decision making are asked for in many quarters. GRADE’s methodology does not, to any great extent, facilitate the development of such recommendations. While the working method for developing the evidence profile is comprehensive, significant development efforts still remain regarding the recommendation part of the GRADE system.

    GRADE’s methodology can contribute to a more structured approach in the assessment of new technologies in health care. However, the methodology needs to approach the actual decision making a bit closer through the development of more objective assessments of values and preferences. Further, methods for priority setting are needed, as we live in a reality where resources for healthcare are limited. GRADE can be used as a platform for discussions and development towards a more comprehensive approach. An interesting progression would be to test the system for synthesis of more different types of knowledge, research as well as practitioner-based, which would make the working method useful for the evaluation and introduction of certain non-pharmacological methods where the traditional study design is not always possible to use.

  • 52.
    Roback, Kerstin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Gäddlin, Per-Olof
    Division of Pediatrics, County Hospital Ryhov, Jönköping, Sweden.
    Nelson, Nina
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Adoption of medical devices: Perspectives of professionals in Swedish neonatal intensive care2007In: Technology and Health Care, ISSN 0928-7329, Vol. 15, no 3, p. 157-179Article in journal (Refereed)
    Abstract [en]

    Advances in biomedical engineering enable us to treat increasingly severe conditions. This implies an increased need for regulation and priority setting in healthcare, to ensure appropriate safety cautions and to avoid accelerating expenditures. This interview study investigates the mechanisms behind the adoption and use of medical devices through the subjective experiences of hospital staff working with devices for neonatal intensive care. The adoption was found to be primarily initiated by vendor activities, but professionals preferably sought information about functionality from close colleagues. Full integration of devices was sometimes not achieved, and even though the adopting units had good introduction routines, there was no systematic follow-up of how adopted devices had been integrated in the work practices. Diffusion variations were, however, mainly found for temporarily tested devices and not for permanently available technologies. Three factors were found to be the major explanatory variables of the adoption of medical devices: (1) the subjective expected value of the device, (2) information and learning, and (3) the innovativeness of the adopting unit.

  • 53.
    Roback, Kerstin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Hass, Ursula
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Persson, Jan
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Transfer of health care technology in university-industry research collaboration environment2001In: Engineering in Medicine and Biology Society. Proceedings of the 23rd Annual International Conference of the IEEE, 2001, Vol. 4, p. 3938-3941Conference paper (Refereed)
    Abstract [en]

    The traditional innovation research has focused on the diffusion process and adoption of new technologies. This paper deals with health care technology in the early innovation stages preceding targeted development and marketing. A model of early research processes in the biomedical field and determinants of technology transfer will be presented. The study material is eleven projects in the Competence Center Noninvasive Medical Measurements (NIMED), Linkoping University, which is a collaboration center where academic researchers cooperate with industry and clinical departments. Data collection was made through semi-structured interviews. A qualitative approach has been adopted for data analysis. Research initiatives of the investigated projects do in most cases originate in the academic knowledge base and earlier connections in industry and health care play an important role in the formation of cooperation constellation. A number of internal factors are perceived as positive to project advancement, such as stable economy, proximity to clinical departments, and positive feedback from collaboration partners. Significant negative factors are all related to changes in cooperation structure. Clusters of related projects seem to be beneficial to research work and is an evident external factor which has to be added in a new model of technology transfer.

  • 54.
    Roback, Kerstin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Herzog, Almut
    Linköping University, Department of Computer and Information Science, IISLAB - Laboratory for Intelligent Information Systems. Linköping University, The Institute of Technology.
    Home informatics in healthcare: Assessment guidelines to keep up quality of care and avoid adverse effects2003In: Technology and Health Care - European Society for Engineering and Medicine, ISSN 0928-7329, Vol. 11, no 3, p. 195-206Article in journal (Refereed)
    Abstract [en]

    Due to an ageing population and improved treatment possibilities, a shortage in hospital beds is a fact in many countries. Home healthcare schemes using information technology (IT) are under development as a response to this and with the intention to produce a more cost-effective care. So far it has been shown that home healthcare is beneficial to certain patient groups. The trend is a widening of the criteria for admission to home healthcare, which means treatment in the home of more severe conditions that otherwise would require in-hospital care. Home informatics has the potential to become a means of providing good care at home. In this process, it is important to consider what new risks will be encountered when placing electronic equipment in the home care environment. Continuous assessment and guidance is important in order to achieve a safe and effective care. Based on a review of current knowledge this paper presents an inventory of risks and adverse events specific to this area. It was found that risks and adverse events could stem from technology in itself, from human-technology interaction conditions or from the environment in which the technology is placed. As a result from the risk inventory, this paper proposes guidelines for the planning and assessment of IT-based hospital-at-home schemes . These assessment guidelines are specifically aimed at performance improvement and thus to be considered a complement to the more general guidelines on telehomecare adopted by the American Telemedicine Association (ATA) in October 2002.

  • 55.
    Roback, Kerstin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Johansson, M
    Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Norrköping.
    Starkhammar, A
    Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Norrköping.
    Feasibility of a Thermographic Method for Early Detection of Foot Disorders in Diabetes2009In: DIABETES TECHNOLOGY and THERAPEUTICS, ISSN 1520-9156, Vol. 11, no 10, p. 663-667Article in journal (Refereed)
    Abstract [en]

    Background: Foot complications due to diabetes impose a major economic burden to society and loss of health-related quality of life for the patients. Early diagnosis and intensified preventive measures have proved useful to limit the incidence of foot ulcers and lower limb amputations in diabetes, and the development of new tools for early diagnosis has therefore become an attractive option. This article covers a feasibility study of the SpectraSole (Linkoping, Sweden) Pro 1000 foot indicator, an innovation based on liquid crystal thermography. The technology identifies increases in temperature, a known indicator of inflammation. Methods: Sixty-five patients with diagnosed diabetes were examined with the foot indicator immediately after their ordinary foot examinations according to current practice, and findings from the two investigations were compared. Results: Sixty-nine examinations were performed. The foot indicator identified increased temperature in 31 cases, of which six had not been detected in the preceding ordinary examinations. The instrument was perceived as easy to use, and the thermographs could be used to visualize problem areas of the foot, which might contribute to better compliance with therapeutic advice. Conclusions: The foot indicator detected a relatively high share of the different types of complications but not all. It can be used as a complement to current practices for foot examination. The instrument provides rapid imaging of the foot temperature, and the study indicates that it yields valuable diagnostic information in early stages of foot disease.

  • 56.
    Roback, Kerstin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Johansson, Marie
    Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Norrköping. Östergötlands Läns Landsting.
    Starkhammar, Anders
    Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Norrköping. Östergötlands Läns Landsting.
    A new thermographic method for early detection of foot complications in diabetes: A feasability study. Abstract no. 2752009In: International Conference on Advanced Technologies & Treatments for Diabetes (ATTD), Athens, 2009Conference paper (Other academic)
  • 57.
    Roback, Kerstin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Nelson, Nina
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Johansson, Anders
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Hass, Ursula
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Strömberg, Tomas
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology.
    A New Fiberoptical Respiratory Rate Monitor for the Neonatal Intensive Care Unit2005In: Pediatric Pulmonology, ISSN 8755-6863, Vol. 39, no 2, p. 120-126Article in journal (Refereed)
    Abstract [en]

    A new technique for respiratory rate measurement in the neonatal intensive care unit, fiberoptic respirometry (FORE), was tested using a specially designed nasal adapter. The aim was to investigate the system's accuracy and compare it to the transthoracic impedance (TTI) method and manual counting (MC). Further, the relationship between accuracy and degree of body movement was investigated. Seventeen neonates of median gestational age 35 weeks were included in the study. Video recordings (synchronized with data recordings) were used for classification of body movement. Breaths per minute data were obtained for 23-32-min periods per child, and a subset of these included MC performed by experienced nurses. A Bland-Altman analysis showed low accuracy of both FORE and TTI. A >20% deviation from MC was found in 22.7% and 23.8% of observations for the two methods, respectively. Both methods had accuracy problems during body movement. FORE tended to underestimate respiratory rate due to probe displacement, while TTI overestimated due to motion artefacts. The accuracy was also strongly subject-dependent. The neonates were undisturbed by the FORE device. In some cases, though, it was difficult to keep the adapter positioned in the airway. Further development should, therefore, focus on FORE adapter improvements to maintain probe position over time.

  • 58.
    Roback, Kerstin
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment.
    Persson, Jan
    Linköping University, The Institute of Technology. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment.
    Evidensbaserad sjukvård och kommersialisering av idéer2008In: Medicinteknikdagarna 2008. Svensk förening för medicinsk teknik och fysik,2008, 2008, p. 78-78Conference paper (Refereed)
    Abstract [sv]

       

  • 59.
    Schmidt, Andrea
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Samhällsekonomiska kostnader för reumatiska sjukdomar2003Report (Other academic)
    Abstract [en]

    Reumatiska sjukdomar drabbar många människor och är förknippade med såväl lidande som stora belastningar på samhällsekonomin.

    Syftet med denna studie har varit att skatta bördan av reumatiska sjukdomar på samhällsekonomin i Sverige. Detta med avseende på såväl konsumtion av sjukvård (direkta kostnader) som produktionsbortfall till följd av arbetsoförmåga (indirekta kostnader). En redovisning görs även av kvinnors och mäns respektive andelar av kostnaderna.

    Studien är en sjukdomskostnadskalkyl (cost of illness analysis). Kostnader för sjukvårdskonsumtion har beräknats med hjälp av Socialstyrelsens nationella patientregister vad gäller slutenvård samt Apotekets Diagnos-Recept undersökning gällande läkemedel och öppenvård. Beräkningar av kostnader för produktionsbortfall i form av sjukskrivningar och förtidspensioner/sjukbidrag har baserats på Riksförsäkringsverkets diagnosklassificerade urvalsstatistik.

    De totala kostnaderna för reumatiska sjukdomar i Sverige år 2001 beräknades till ca 36,4 miljarder kronor. Av dessa bestod 31,3 miljarder kronor (86%) av indirekta kostnader (produktionsbortfall), medan direkta kostnader (vård och läkemedel) uppgick till 5,1 miljarder kronor (14%). Kvinnornas andel av kostnaderna var ca 2/3 (för såväl direkta som indirekta och totala kostnader). Försäkringskassans utgifter förknippade med reumatiska sjukdomar uppgick till totalt ca 12,5 miljarder kronor. Detta var ca 16% av de totala utgifterna för samtliga diagnoser.

    Sammanfattningsvis är den samhällsekonomiska bördan av reumatiska sjukdomar i Sverige mycket omfattande. Relationen mellan direkta och indirekta kostnader gör det rimligt att benämna reumatisk sjukdom (de diagnoser som ingår däri) en socialförsäkringssjukdom, vilket också visar sig i stora utgifter för Försäkringskassan. I förhållande till kostnadernas totala omfattning konsumerar dessa patienter relativt begränsad mängd sjukvårdsresurser.

  • 60.
    Söderlin, Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rheumatology . Linköping University, Faculty of Health Sciences.
    Kautianen, Hannu
    Rheumatism Foundation Hospital, Heinola, Finland.
    Jonsson, Dick
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Skogh, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Rheumatology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Rheumatology in Östergötland.
    Leirisalo-Repo, Marjatta
    Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Huch, Finland.
    The costs of early inflammatory joint disease: a population-based study in southern Sweden2003In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, Vol. 32, no 4, p. 216-224Article in journal (Refereed)
    Abstract [en]

    Objective: To study the costs and use of healthcare for patients during the first months with early joint inflammation, in a population-based prospective referral study in Southern Sweden.

    Methods: Adult patients with arthritis for <3 months and with onset of symptoms between 1 May 1999 and 1 May 2000 were referred from primary health centres to rheumatologists. Four clinical assessments were performed during a 6-month follow-up period. The direct medical costs for inpatient stays, outpatient visits, visits to general practitioners, and visits to health professionals, as well as costs for medication, radiographs, and laboratory tests were recorded from the onset of the disease up to 6 months of follow-up. Indirect costs for sick leave were also recorded.

    Results: Fifty-six of 71 referred patients agreed to participate. Thirteen (23%) had RA, 21 (38%) had reactive arthritis (ReA), 14 (25%) had undifferentiated arthritis, and eight (14%) had other arthritides. The median cost per patient in the entire group was USD 3362. The median cost per patient in the RA group was USD 4385, and USD 4085 in the ReA group. There was no statistically significant difference in the median costs per patient in the different diagnostic groups. Sick leave accounted for 44% of the total costs in the entire group, and 46% and 47%, respectively, in the RA and ReA groups.

    Conclusion: The costs of early arthritis are already considerable during the first months of the disease following the onset of the symptoms. The indirect costs due to sick leave accounted for nearly half of the costs.

  • 61.
    Wåhlin, Charlotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Association between clinical and work-related interventions and return to work for patients with musculoskeletal or mental disorders2012In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 4, p. 355-362Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to explore what characterizes patients receiving clinical interventions vs combined clinical and work-related interventions in a cohort of sick-listed subjects with musculoskeletal or mental disorders. Factors associated with return-to-work were also analysed.

    Design: A prospective cohort study.

    Methods: A total of 699 newly sick-listed patients responded to a questionnaire on sociodemographics, measures of health, functioning, work ability, self-efficacy, social support, work conditions, and expectations. The 3-month follow-up questionnaire included patients' self-reported measures of return-to-work, work ability and type of interventions. The most frequent International Classification of Diseases-10 diagnoses for patients' musculoskeletal disorders were dorsopathies (M50-54) and soft tissue disorders (M70-79), and for patients with mental disorders, depression (F32-39) and stress reactions (F43).

    Results: Patients with mental disorders who received combined interventions returned to work to a higher degree than those who received only clinical intervention. The prevalence of work-related interventions was higher for those who were younger and more highly educated. For patients with musculoskeletal disorders better health, work ability and positive expectations of return-to-work were associated with return-to-work. However, combined interventions did not affect return-to-work in this group.

    Conclusion: Receiving combined interventions increased the probability of return-to-work for patients with mental disorders, but not for patients with musculoskeletal disorders. Better health, positive expectations of return-to-work and better work ability were associated with return-to-work for patients with musculoskeletal disorders.

  • 62.
    Wåhlin, Charlotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Evaluation of self-reported work ability and usefulness of interventions among sick-listed patients2013In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 23, no 1, p. 32-43Article in journal (Refereed)
    Abstract [en]

    Aim To describe the types of intervention offered, to investigate the relationship between the type of intervention given, patient-reported usefulness of interventions and the effect on self-reported work ability in a cohort of sick-listed patients with musculoskeletal disorders (MSD) or mental disorders (MD).

    Methods A prospective cohort study was performed including 810 newly sick-listed patients (MSD 62 % and MD 38 %). The baseline questionnaire included sociodemographic characteristics and measures of work ability. The 3-month follow-up questionnaire included measures of work ability, type of intervention received, and judgment of usefulness.

    Results Twenty-five percent received medical intervention modalities (MI) only, 45 % received a combination of medical and rehabilitative intervention modalities (CRI) and 31 % received work-related interventions combined with medical or rehabilitative intervention modalities (WI). Behavioural treatments were more common for patients with MD compared with MSD and exercise therapy were more common for patients with MSD. The most prevalent workplace interventions were adjustment of work tasks or the work environment. Among patients with MD, WI was found to be useful and improved work ability significantly more compared with only MI or CRI. For patients with MSD, no significant differences in improved work ability were found between interventions.

    Conclusions Patients with MD who received a combination of work-related and clinical interventions reported best usefulness and best improvement in work ability. There was no difference in improvements in work ability between rehabilitation methods in the MSD group. There seems to be a gap between scientific evidence and praxis behaviour in the rehabilitation process. Unimodal rehabilitation was widely applied in the early rehabilitation process, a multimodal treatment approach was rare and only one-third received work-related interventions. It remains a challenge to understand who needs what type of intervention.

  • 63.
    Zhu, Ying
    et al.
    Karolinska Institute.
    Dalal, Koustuv
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    CHILDHOOD EXPOSURE TO DOMESTIC VIOLENCE AND ATTITUDE TOWARDS WIFE BEATING IN ADULT LIFE: A STUDY OF MEN IN INDIA2010In: JOURNAL OF BIOSOCIAL SCIENCE, ISSN 0021-9320, Vol. 42, no 2, p. 255-269Article in journal (Refereed)
    Abstract [en]

    This study examined mens justification of wife beating in relation to their perceived rights and autonomy using a nationally representative sample of 18,047 men in India with childhood exposure to parental violence. Five reasons for wife beating justification, four items of mens perceived rights, and five items of household autonomy were analysed using chi(2) test and logistic regression. Among 18,047 participants, 67% justified wife beating. Low education, economic stress and being unmarried were generally more associated with justifying wife beating for all five reasons. Wifes refusal of sex and husbands final say on household autonomy are risk factors. Joint autonomy on household decision making and wifes autonomy on managing her own earnings are protective factors. Perceived relationship rights and autonomy are highly predictive of wife-beating justification for the men who have been exposed to parental violence during childhood. The study has significant implications for public health planners and education strategies.

  • 64.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    School of Nursing University of California Los Angeles USA.
    Davidson, Thomas
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    The influence of chronic heart failure in patient-partner dyads: a comparative study addressing issues of health-related quality of life2011In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 26, no 1, p. 65-73Article in journal (Refereed)
    Abstract [en]

    Background: Patients with chronic heart failure (HF) and their partners face many challenges associated with heart disease. High social support in a close relationship has been found to improve survival in patients with HF. However, caring for a patient with HF may have negative effects on the health-related quality of life (HRQOL) of the partner responsible for the care. The main focus in health care is still on improving the patients’ HRQOL, but the awareness of partners’ and families’ role and situation is increasing. Therefore further studies are needed to clarify these issues and the importance of partners in relation to HRQOL of patients with HF.

    Objectives: To describe and compare HRQOL, quality-adjusted life year (QALY) weights, symptoms of depression, perceived control and knowledge in patients with chronic HF and their partners and to compare HRQOL and QALY weights in the partners with an age- and gender-matched group.

    Methods: Data was collected from 135 patient-partner dyads at two Swedish hospitals. Data on the reference group was collected from the same region.

    Results: Patients had lower HRQOL in all dimensions (p < 0.001) except in the mental health domain and lower QALY weights compared to their partners (p < 0.001). Mental health scores were lower in partners compared to the age and gender-matched references (p < 0.001). All other HRQOL scores and the QALY weights were comparable between partners and reference group. Patients had more depressive symptoms than their partners (p < 0.001). There was no difference in the level of perceived control or knowledge about chronic HF between patients and partners.

    Conclusion: Being a partner to a patient with chronic HF markedly affects the mental aspect of HRQOL. Interventions focusing on education and psychosocial support may potentially promote effective coping in partners and enhance their ability to support the patient.

  • 65.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    School of Nursing, University of California, Los Angeles, USA.
    Davidsson, Thomas
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    The influence of chronic heart failure in patient-partner dyads - a comparative study addressing issues of health-related quality of life2009Conference paper (Other academic)
    Abstract [en]

    Background: Patients with chronic heart failure (HF) and their partners face many challenges associated with heart disease. High social support in a close relationship has been found to improve survival in patients with HF. However, caring for a patient with HF may have negative effects on the health-related quality of life (HRQOL) of the partner responsible for the care. The main focus in health care is still on improving the patients’ HRQOL, but the awareness of partners’ and families’ role and situation is increasing. Therefore further studies are needed to clarify these issues and the importance of partners in relation to HRQOL of patients with HF.

    Objectives: To describe and compare HRQOL, quality-adjusted life year (QALY) weights, symptoms of depression, perceived control and knowledge in patients with chronic HF and their partners and to compare HRQOL and QALY weights in the partners with an age- and gender-matched group.

    Methods: Data was collected from 135 patient-partner dyads at two Swedish hospitals. Data on the reference group was collected from the same region.

    Results: Patients had lower HRQOL in all dimensions (p < 0.001) except in the mental health domain and lower QALY weights compared to their partners (p < 0.001). Mental health scores were lower in partners compared to the age and gender-matched references (p < 0.001). All other HRQOL scores and the QALY weights were comparable between partners and reference group. Patients had more depressive symptoms than their partners (p < 0.001). There was no difference in the level of perceived control or knowledge about chronic HF between patients and partners.

    Conclusion: Being a partner to a patient with chronic HF markedly affects the mental aspect of HRQOL. Interventions focusing on education and psychosocial support may potentially promote effective coping in partners and enhance their ability to support the patient.

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