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  • 1.
    Andersson, Henrik
    et al.
    CNRS, UT1C, Toulouse Sch Econ LERNA, F-31015 Toulouse 5, France..
    Hole, Arne Risa
    Univ Sheffield, Sheffield S10 2TN, S Yorkshire, England..
    Svensson, Mikael
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School. Univ Gothenburg, Sahlgrenska Acad, Hlth Metr, Gothenburg, Sweden..
    Valuation of small and multiple health risks: A critical analysis of SP data applied to food and water safety2016In: Journal of Environmental Economics and Management, ISSN 0095-0696, E-ISSN 1096-0449, Vol. 75, p. 41-53Article in journal (Refereed)
  • 2. Asmussen, L.
    et al.
    Nyren, Andersson M.
    Kane, Bridget
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013).
    The Experience of Healthcare Workers Following the Implementation of an IT-System in a Home for the Aged2017In: Irish Journal of Medical Science, ISSN 0021-1265, E-ISSN 1863-4362, Vol. 186, no Suppl.4, p. S161-S161Article in journal (Refereed)
    Abstract [en]

    We report on how health personnel at a home for the aged wereaffected by the introduction of an IT-system to help when nursedocumentation of patient activity and condition. The design of ITsystems for documentation by care-givers in healthcare is topicalbecause of the challenges posed by the need for high levels of safety,confidentiality and ethical responsibility. Health care staff work underextreme time-pressure including emergency situations. It is criticallyimportant to have IT-systems that are easy to use: to find informationand make records.This qualitative study utilises observation and interviews to gaindeep understanding. Observation data guide the interviews. Interviewswith nurses (10) and an IT analyst (1) are reported.Lack of time is a contributing factor as to why health personnel donot have a positive attitude to the use of IT documentation systems.Nurses feel that the lack of time does not afford them the opportunityto learn properly about the IT-system, and many of the staff haveworked with paper for over 20 years. It is also seen as a problem thatthere are many steps (clicks) before one can make a note or findinformation. One of the advantages reported with using IT-systems isthat all information is at one site. Everything is safety copied andconfidentiality is easier to secure.Using IT documentation systems facilitates the use of careplansthat are individualized for patient needs, instead treating all patientswith a particular disease, e.g. dementia, in the same way

  • 3. Asp, M.
    et al.
    Simonsson, B.
    Larm, P.
    Molarius, Anu
    Physical mobility, physical activity, and obesity among elderly: findings from a large population-based Swedish survey2017In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 147, p. 84-91Article in journal (Refereed)
    Abstract [en]

    Objective: To examine how physical activity and physical mobility are related to obesity in the elderly. Study design: A cross-sectional study of 2558 men and women aged 65 years and older who participated in a population survey in 2012 was conducted in mid-Sweden with an overall response rate of 67%. Methods: Obesity (body mass index >= 30 kg/m(2)) was based on self-reported weight and height, and physical activity and physical mobility on questionnaire data. Chi-squared test and multiple logistic regressions were used as statistical analyses. Results: The overall prevalence of obesity was 19% in women and 15% in men and decreased after the age of 75 years. A strong association between both physical activity and obesity, and physical mobility and obesity was found. The odds for obesity were higher for impaired physical mobility (odds ratio [OR] 2.83, 95% confidence interval [CI] 2.14-3.75) than for physical inactivity (OR 1.63, 95% CI 1.28-2.08) when adjusted for gender, age, socio-economic status and fruit and vegetable intake. However, physical activity was associated with obesity only among elderly with physical mobility but not among those with impaired physical mobility. Conclusion: It is important to focus on making it easier for elderly with physical mobility to become or stay physically active, whereas elderly with impaired physical mobility have a higher prevalence of obesity irrespective of physical activity. (C) 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  • 4. Ballangrud, Randi
    et al.
    Husebo, Sissel Eikeland
    Aase, Karina
    Aaberg, Oddveig Reiersdal
    Vifladt, Anne
    Berg, Geir Vegard
    Hall-Lord, Marie Louise
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    "Teamwork in hospitals": a quasi-experimental study protocol applying a human factors approach2017In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 16, article id 34Article in journal (Refereed)
    Abstract [en]

    Background: Effective teamwork and sufficient communication are critical components essential to patient safety in today's specialized and complex healthcare services. Team training is important for an improved efficiency in inter-professional teamwork within hospitals, however the scientific rigor of studies must be strengthen and more research is required to compare studies across samples, settings and countries. The aims of the study are to translate and validate teamwork questionnaires and investigate healthcare personnel's perception of teamwork in hospitals (Part 1). Further to explore the impact of an inter-professional teamwork intervention in a surgical ward on structure, process and outcome (Part 2). Methods: To address the aims, a descriptive, and explorative design (Part 1), and a quasi-experimental interventional design will be applied (Part 2). The study will be carried out in five different hospitals (A-E) in three hospital trusts in Norway. Frontline healthcare personnel in Hospitals A and B, from both acute and non-acute departments, will be invited to respond to three Norwegian translated teamwork questionnaires (Part 1). An inter-professional teamwork intervention in line with the TeamSTEPPS recommend Model of Change will be implemented in a surgical ward at Hospital C. All physicians, registered nurses and assistant nurses in the intervention ward and two control wards (Hospitals D and E) will be invited to to survey their perception of teamwork, team decision making, safety culture and attitude towards teamwork before intervention and after six and 12 months. Adult patients admitted to the intervention surgical unit will be invited to survey their perception of quality of care during their hospital stay before intervention and after six and 12 month. Moreover, anonymous patient registry data from local registers and data from patients' medical records will be collected (Part 2). Discussion: This study will help to understand the impact of an inter-professional teamwork intervention in a surgical ward and contribute to promote healthcare personnel's team competences with an opportunity to achieve changes in work processes and patient safety.

  • 5.
    Bonander, Carl
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences (from 2013). Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety (from 2013).
    Gustavsson, Johanna
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences (from 2013). Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety (from 2013).
    Nilson, Finn
    Can the provision of a home help service for the elderly population reduce the incidence of fall-related injuries?2016In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 22, no Suppl.2, p. A181-A181Article in journal (Refereed)
    Abstract [en]

    Background Fall-related injuries are a global public health problem, especially in elderly populations. In this study, the effect of an intervention aimed at reducing the risk of falls in the homes of community-dwelling elderly persons was evaluated. The intervention, which involves home hazards reduction by providing a minor home help service, is provided in the majority of Swedish municipalities.

    Methods Intention-to-treat effect estimates were derived using quasi-experimental time series intervention (ITS) analysis for immediate effects and a difference-in-discontinuity (RD) design for long term effects, and community-level estimates were pooled using meta-analysis. The outcome measure was the incidence of fall-related hospitalizations in the treatment population, the age of which varied by municipality (≥65 years, ≥67 years, ≥70 years or ≥75 years).

    Results We found no statistically significant reductions in injury incidence in the ITS (IRR 1.01 [95% CI: 0.98–1.05]) or RD (IRR 1.00 [95% CI: 0.97–1.03]) analyses. The results are robust to several different model specifications, including segmented panel regression analysis with linear trend change and community fixed effects parameters.

    Conclusions It is unclear whether absence of an effect is due to a low efficacy of the home hazards modifications provided, or a result of low utilisation. Additional studies of the effects on other quality of life measures are recommended before conclusions are drawn regarding the cost-effectiveness of the provision of home help services

  • 6.
    Brorström, Björn
    et al.
    Göteborg University School of Public Administration, Sweden.
    Siverbo, Sven
    Göteborg University School of Public Administration, Sweden.
    Deeply rooted traditions and the will to change: Problematic conflicts in three Swedish health care organizations2004In: Journal of Economic Issues, ISSN 0021-3624, Vol. 38, no 4, p. 939-952Article in journal (Refereed)
  • 7.
    Bruhn, Linnea
    Karlstad University.
    Motiverande samtal -En dynamisk process i arbetet med barn och ungdomar med övervikt: - En kvalitativ studie om professionella inom hälso- och sjukvårdens upplevelser av att använda MI tillsammans med överviktiga barn och ungdomar2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The unhealthy lifestyles such as poor diets and lack of physical activity can lead to overweight and obesity for children and adolescents today. To not have the unhealthy lifestyles lead to future complications it’s important to give them the help and support they need to get motivated to change theirs behavior. Motivational interviewing (MI) is a method to help people change their behavior, this study will focus on a healthy lifestyle changes. A profession in healthcare uses the MI as a method to support the lifestyle change for children and adolescents with obesity. The purpose of this study is to examine what the professions experiences is concerning how the method works with children and adolescents with overweight. This study has used a qualitative method with six interviews. The interviews were recorded and analyzed. The result of this study showed that professions experiences MI as a very positive and useful method, also that the professions needed to use the method continuity to maintain the knowledge. The potential of MI as a method was that the professions often could see a positive change in the patient and the respondent had a positive view in using MI in the future. The author of this study believes that it’s incredibly important to keep working with MI as it probably can "save" money both for society and the work hours for professions in healthcare.

  • 8. Chalmers, J. R.
    et al.
    Thomas, K. S.
    Apfelbacher, C.
    Williams, H. C.
    Prinsen, C. A.
    Spuls, P. I.
    Simpson, E.
    Gerbens, L. A. A.
    Boers, M.
    Barbarot, S.
    Stalder, J. F.
    Abuabara, K.
    Aoki, V.
    Ardeleanu, M.
    Armstrong, J.
    Bang, B.
    Berents, T. L.
    Burton, T.
    Butler, L.
    Chubachi, T.
    Cresswell-Melville, A.
    DeLozier, A.
    Eckert, L.
    Eichenfield, L.
    Flohr, C.
    Futamura, M.
    Gadkari, A.
    Gjerde, E. S.
    van Halewijn, K. F.
    Hawkes, C.
    Howells, L.
    Howie, L.
    Humphreys, R.
    Ishii, H. A.
    Kataoka, Y.
    Katayama, I.
    Kouwenhoven, W.
    Langan, S. M.
    Leshem, Y. A.
    Merhand, S.
    Mina-Osorio, P.
    Murota, H.
    Nakahara, T.
    Nunes, F. P.
    Nygaard, U.
    Nygardas, M.
    Ohya, Y.
    Ono, E.
    Rehbinder, E.
    Rogers, N. K.
    Romeijn, G. L. E.
    Schuttelaar, M. L. A.
    Sears, A. V.
    Simpson, M. A.
    Singh, J. A.
    Srour, J.
    Stuart, B.
    Svensson, A.
    Talmo, G.
    Talmo, H.
    Teixeira, H. D.
    Thyssen, J. P.
    Todd, G.
    Torchet, F.
    Volke, A.
    von Kobyletzki, Laura B.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Weisshaar, E.
    Wollenberg, A.
    Zaniboni, M.
    Report from the fifth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative)2018In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 178, no 5, p. E332-E341Article in journal (Refereed)
    Abstract [en]

    This is the report from the fifth meeting of the Harmonising Outcome Measures for Eczema initiative (HOME V). The meeting was held on 12-14 June 2017 in Nantes, France, with 81 participants. The main aims of the meeting were (i) to achieve consensus over the definition of the core domain of long-term control and how to measure it and (ii) to prioritize future areas of research for the measurement of the core domain of quality of life (QoL) in children. Moderated whole-group and small-group consensus discussions were informed by presentations of qualitative studies, systematic reviews and validation studies. Small-group allocations were performed a priori to ensure that each group included different stakeholders from a variety of geographical regions. Anonymous whole-group voting was carried out using handheld electronic voting pads according to pre-defined consensus rules. It was agreed by consensus that the long-term control domain should include signs, symptoms, quality of life and a patient global instrument. The group agreed that itch intensity should be measured when assessing long-term control of eczema in addition to the frequency of itch captured by the symptoms domain. There was no recommendation of an instrument for the core outcome domain of quality of life in children, but existing instruments were assessed for face validity and feasibility, and future work that will facilitate the recommendation of an instrument was agreed upon.

  • 9.
    Englund, Liselotte
    et al.
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Media and Communication Studies. P.
    Michel, Per-Olof
    Researcher and Programme Director at the National Centre for Disaster Psychiatry.
    Riddez, Louis
    Reader and Surgeon at Karolinska University Hospital.
    Örtenwall, Per
    Senior Consultant Surgeon and Chief Emergency Medical Officer for the Västra Götaland region.
    The bomb attack in Oslo and the shootings at Utøya, 2011: Kamedo report 972012Report (Other academic)
    Abstract [en]

    The Kamedo observer reports study the medical, psychological, organizational and social aspects of disasters. This report summaries experiences from the bomb attack in Oslo and the shootings at Utøya, 2011. That may be valuable for the further development of the Swedish disaster preparedness system.

  • 10. Eriksson, Andrea
    et al.
    Orvik, Arne
    Strandmark K, Margaretha
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Nordsteien, Anita
    Torp, Steffen
    Management and leadership approaches to health promotion and sustainable workplaces: A scoping review2017In: Societies, ISSN 1090-9389, E-ISSN 2075-4698, Vol. 7, no 2, article id 14Article in journal (Refereed)
    Abstract [en]

    Whole-system approaches linking workplace health promotion to the development of a sustainable working life have been advocated. The aim of this scoping review was to map out if and how whole-system approaches to workplace health promotion with a focus on management, leadership, and economic efficiency have been used in Nordic health promotion research. In addition, we wanted to investigate, in depth, if and how management and/or leadership approaches related to sustainable workplaces are addressed. Eighty-three articles were included in an analysis of the studies' aims and content, research design, and country. For a further in-depth qualitative content analysis we excluded 63 articles in which management and/or leadership were only one of several factors studied. In the in-depth analysis of the 20 remaining studies, four main categories connected to sustainable workplaces emerged: studies including a whole system understanding; studies examining success factors for the implementation of workplace health promotion; studies using sustainability for framing the study; and studies highlighting health risks with an explicit economic focus. Aspects of sustainability were, in most articles, only included for framing the importance of the studies, and only few studies addressed aspects of sustainable workplaces from the perspective of a whole-system approach. Implications from this scoping review are that future Nordic workplace health promotion research needs to integrate health promotion and economic efficiency to a greater extent, in order to contribute to societal effectiveness and sustainability.

  • 11.
    Grenard, Alain
    Karlstad University, Faculty of Arts and Education.
    Kan kost Påverka koncentrationsförmågan?: Elevernas hälsa på gymnasiet2007Independent thesis Basic level (professional degree), 10 points / 15 hpStudent thesis
    Abstract [en]

    The studies are based on my own experiences in the classroom. My student’s reoccurring behaviour of tiredness and having difficulties concentrating, could well have to do with their bad eating habits, even down to suspected extensive sweet and fizzy drink consumption. Kan dietary habits affect student concentration?

    Through a questionnaire to college students from three different programmes, I have been able to map out their purchasing trends of different food-stuffs in the school cafeteria and, through these results, study if student tiredness and difficulty in keeping their concentration throughout the whole day can be traced back to these causes. Many of the students loose concentration just before lunch, or during the last hours of school. This can lead to a poorer performance level if they are not prepared with fruit or water to keep them going, but just try and “hold out”. It is difficult to show with the questionnaire if student concentration is affected by poor dietary habits, even though half of those who answered gave hunger as the cause of concentration problems. But through the literature in this thesis it has been shown that general sound eating habits lead to better concentration.

  • 12.
    Gustavsson, Anders
    et al.
    I3 Innovus, Stockholm.
    Svensson, Mikael
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Economics and Statistics.
    Jacobi, Frank
    Allgulander, Christer
    Alonso, Jordi
    Beghi, Ettore
    Dodel, Richard
    Ekman, Mattias
    Faravelli, Carlo
    Fratiglioni, Laura
    Gannon, Brenda
    Jones, David Hilton
    Jennum, Poul
    Jordanova, Albena
    Jönsson, Linus
    Karampampa, Korinna
    Knapp, Martin
    Kobelt, Gisela
    Kurth, Tobias
    Lieb, Roselind
    Linde, Mattias
    Ljungcrantz, Christina
    Maercker, Andreas
    Melin, Beatrice
    Moscarelli, Massimo
    Musayev, Amir
    Norwood, Fiona
    Preisig, Martin
    Pugliatti, Maura
    Rehm, Juergen
    Salvador-Carulla, Luis
    Schlehofer, Brigitte
    Simon, Roland
    Steinhausen, Hans-Christoph
    Stovner, Lars Jacob
    Vallat, Jean-Michel
    Van den Bergh, Peter
    den Bergh, Peter Van
    van Os, Jim
    Vos, Pieter
    Xu, Weili
    Wittchen, Hans-Ulrich
    Jönsson, Bengt
    Olesen, Jes
    Cost of disorders of the brain in Europe 2010.2011In: European Neuropsychopharmacology, ISSN 0924-977X, E-ISSN 1873-7862, Vol. 21, no 10, p. 718-79Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The spectrum of disorders of the brain is large, covering hundreds of disorders that are listed in either the mental or neurological disorder chapters of the established international diagnostic classification systems. These disorders have a high prevalence as well as short- and long-term impairments and disabilities. Therefore they are an emotional, financial and social burden to the patients, their families and their social network. In a 2005 landmark study, we estimated for the first time the annual cost of 12 major groups of disorders of the brain in Europe and gave a conservative estimate of €386 billion for the year 2004. This estimate was limited in scope and conservative due to the lack of sufficiently comprehensive epidemiological and/or economic data on several important diagnostic groups. We are now in a position to substantially improve and revise the 2004 estimates. In the present report we cover 19 major groups of disorders, 7 more than previously, of an increased range of age groups and more cost items. We therefore present much improved cost estimates. Our revised estimates also now include the new EU member states, and hence a population of 514 million people.

    AIMS: To estimate the number of persons with defined disorders of the brain in Europe in 2010, the total cost per person related to each disease in terms of direct and indirect costs, and an estimate of the total cost per disorder and country.

    METHODS: The best available estimates of the prevalence and cost per person for 19 groups of disorders of the brain (covering well over 100 specific disorders) were identified via a systematic review of the published literature. Together with the twelve disorders included in 2004, the following range of mental and neurologic groups of disorders is covered: addictive disorders, affective disorders, anxiety disorders, brain tumor, childhood and adolescent disorders (developmental disorders), dementia, eating disorders, epilepsy, mental retardation, migraine, multiple sclerosis, neuromuscular disorders, Parkinson's disease, personality disorders, psychotic disorders, sleep disorders, somatoform disorders, stroke, and traumatic brain injury. Epidemiologic panels were charged to complete the literature review for each disorder in order to estimate the 12-month prevalence, and health economic panels were charged to estimate best cost-estimates. A cost model was developed to combine the epidemiologic and economic data and estimate the total cost of each disorder in each of 30 European countries (EU27+Iceland, Norway and Switzerland). The cost model was populated with national statistics from Eurostat to adjust all costs to 2010 values, converting all local currencies to Euro, imputing costs for countries where no data were available, and aggregating country estimates to purchasing power parity adjusted estimates for the total cost of disorders of the brain in Europe 2010.

    RESULTS: The total cost of disorders of the brain was estimated at €798 billion in 2010. Direct costs constitute the majority of costs (37% direct healthcare costs and 23% direct non-medical costs) whereas the remaining 40% were indirect costs associated with patients' production losses. On average, the estimated cost per person with a disorder of the brain in Europe ranged between €285 for headache and €30,000 for neuromuscular disorders. The European per capita cost of disorders of the brain was €1550 on average but varied by country. The cost (in billion €PPP 2010) of the disorders of the brain included in this study was as follows: addiction: €65.7; anxiety disorders: €74.4; brain tumor: €5.2; child/adolescent disorders: €21.3; dementia: €105.2; eating disorders: €0.8; epilepsy: €13.8; headache: €43.5; mental retardation: €43.3; mood disorders: €113.4; multiple sclerosis: €14.6; neuromuscular disorders: €7.7; Parkinson's disease: €13.9; personality disorders: €27.3; psychotic disorders: €93.9; sleep disorders: €35.4; somatoform disorder: €21.2; stroke: €64.1; traumatic brain injury: €33.0. It should be noted that the revised estimate of those disorders included in the previous 2004 report constituted €477 billion, by and large confirming our previous study results after considering the inflation and population increase since 2004. Further, our results were consistent with administrative data on the health care expenditure in Europe, and comparable to previous studies on the cost of specific disorders in Europe. Our estimates were lower than comparable estimates from the US.

    DISCUSSION: This study was based on the best currently available data in Europe and our model enabled extrapolation to countries where no data could be found. Still, the scarcity of data is an important source of uncertainty in our estimates and may imply over- or underestimations in some disorders and countries. Even though this review included many disorders, diagnoses, age groups and cost items that were omitted in 2004, there are still remaining disorders that could not be included due to limitations in the available data. We therefore consider our estimate of the total cost of the disorders of the brain in Europe to be conservative. In terms of the health economic burden outlined in this report, disorders of the brain likely constitute the number one economic challenge for European health care, now and in the future. Data presented in this report should be considered by all stakeholder groups, including policy makers, industry and patient advocacy groups, to reconsider the current science, research and public health agenda and define a coordinated plan of action of various levels to address the associated challenges.

    RECOMMENDATIONS: Political action is required in light of the present high cost of disorders of the brain. Funding of brain research must be increased; care for patients with brain disorders as well as teaching at medical schools and other health related educations must be quantitatively and qualitatively improved, including psychological treatments. The current move of the pharmaceutical industry away from brain related indications must be halted and reversed. Continued research into the cost of the many disorders not included in the present study is warranted. It is essential that not only the EU but also the national governments forcefully support these initiatives.

  • 13.
    Gustavsson, Johanna
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Nilson, Finn
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Andersson, Ragnar
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Stötabsorberande golv som fallskadepreventiv åtgärd – resultat efter ett år2012Report (Other academic)
    Abstract [sv]

    I april 2011 lades ett stötabsorberande golv, framtaget för att förhindra skador vid fall, in på ett särskilt boende i Sunne kommun. Sedan 1 oktober 2011 har data om fallhändelser samlats in för att följa upp effekter av golvet. Det som undersöks är konsekvenser av fall på olika golvunderlag samt om risken att ramla påverkas.

    Under den tid som studien pågått (12 mån) har 21 fall registrerats på det stötabsorberande golvet, ingen har skadats sig allvarligt och en har skadats lindrigt som en följd av dessa fall. På övriga golvytor med fler boende har 156 fall registrerats, varav fem lett till fraktur och 30 till lindrig skada. Resultaten hittills tyder på att golvet kan ha den eftersträvade effekten.

    Det stötabsorberande golvet bidrar också till en dämpad ljudnivå vilket personalen upplever som positivt.

  • 14.
    Gåård, Anneli
    Karlstad University, Faculty of Economic Sciences, Communication and IT.
    Möt mig med respekt: En kvalitativ studie om vårdrelationens betydelse ur ett brukarperspektiv2012Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 15.
    Häger, Birgit
    et al.
    Karlstad University, Faculty of Social and Life Sciences, FoU Välfärd Värmland.
    Eriksson, Bengt
    Karlstad University, Faculty of Social and Life Sciences, FoU Välfärd Värmland.
    Salutogen omsorg och vård i praktiken – Omsorg och vård för ett helt liv2012Report (Other academic)
  • 16.
    Jakobsson, Niklas
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School.
    Svensson, Mikael
    Univ Gothenburg, Sahlgrenska Acad, Hlth Metr, S-40530 Gothenburg, Sweden..
    Copayments and physicians visits: A panel data study of Swedish regions 2003-20122016In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 120, no 9, p. 1095-1099Article in journal (Refereed)
    Abstract [en]

    Objective: This paper analyzes how primary care physician visits are affected by the level of copayment in Sweden. Data source: We use data between the years 2003-2012 from 21 Swedish health care regions that have the mandate to set their own level of copayment. The copayment per visit varies between 10 and 20 for these years and regions. Study design: Our strategy to identify the causal effect and deal with unobserved endogeneity of price changes on physician visits is based on a panel data model using fixed effects to control for region and time and regional-variation in time trends. Principal finding: We cannot reject that the copayment has no statistical or economic effect of significance, and we estimate the "zero effect" with very high precision. Conclusion: In a setting with sub-national regions with autonomy to set copayments the results points to that the copayment is not an important predictor for the number of health care visits. The result is in line with some previous studies on European data where the range of copayments used tends to be relatively low. 

  • 17.
    Johansson, N.
    et al.
    Health Metrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Jakobsson, Niklas
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Economics and Statistics. Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013). Norwegian Social Res NOVA, Oslo, Norway.
    Svensson, Mikael
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013). Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Economics and Statistics. Williams Coll, Dept Econ, Williamstown, MA 01267 USA.
    Regional variation in health care utilization in Sweden: The importance of demand-side factors2018In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, no 1, article id 403Article in journal (Refereed)
    Abstract [en]

    Background: Differences in health care utilization across geographical areas are well documented within several countries. If the variation across areas cannot be explained by differences in medical need, it can be a sign of inefficiency or misallocation of public health care resources. Methods: In this observational, longitudinal panel study we use regional level data covering the 21 Swedish regions (county councils) over 13 years and a random effects model to assess to what degree regional variation in outpatient physician visits is explained by observed demand factors such as health, demography and socio-economic factors. Results: The results show that regional mortality, as a proxy for population health, and demography do not explain regional variation in visits to primary care physicians, but explain about 50% of regional variation in visits to outpatient specialists. Adjusting for socio-economic and basic supply-side factors explains 33% of the regional variation in primary physician visits, but adds nothing to explaining the variation in specialist visits. Conclusion: 50-67% of regional variation remains unexplained by a large number of observable regional characteristics, indicating that omitted and possibly unobserved factors contribute substantially to the regional variation. We conclude that variations in health care utilization across regions is not very well explained by underlying medical need and demand, measured by mortality, demographic and socio-economic factors.

  • 18.
    Johansson, Sabina
    Karlstad University, Faculty of Health, Science and Technology (starting 2013).
    Sjuksköterskors syn på Fysisk aktivitet på Recept (FaR): En studie om inställningen till FaR inom primärvården2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Title: Physical activity on Prescription, from nurses' point of view

    Keywords: FaR, Health, Physical activity, Nurse, Treatment method

    Background: Sedentary, unhealthy diets, inactivity, alcohol and tobacco abuse has contributed to

    an increase in chronic diseases. These diseases can be largely reduced by improved living habits.

    Nurses are one of the professionals in health care who have the greatest contact with the patients

    and may affect patients to better health and less risk of disease. There is a treatment method that

    is based on physical activity on prescription. It is not well established and a minority of nurses in

    Sweden are using this method.

    Objectives: The purpose of this study is to examine the opinions on FaR in health care and

    through this information get a better understanding of why only a minority of nurses are using the

    method.

    Method. Qualitative interviews were used in this study. The selection of respondents where

    nurses in primary care in Värmland. 6 nurses who work in different areas were interviewed.

    Result: The categories formed of the results were: Attitude to Physical Activity and FaR,

    Replacement methods for FaR, Opinions of healtcare, the Economic obstacles and opportunities,

    Information and communication, Contact and motivation and Workload. There was a positive

    attitude to FaR among nurses. One of the main reasons why FaR was not prescripted in large

    quantities was because patients do not want to have physical activity as a medicin and that it is

    difficult to motivate them. There were several areas of improvement to increase prescription of

    FaR.

    Discussion: There seem to be differences in how nurses, other health professionals and the

    community looks at what health care should work with. The nurses in this study considered

    healthcare should work preventively but they sometimes feel that this opinion is not shared. FaR

    needs to get more advertising and be used more often is something both previous research and

    this study agrees on.

  • 19.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Groth, Kristina
    Karolinska Univ Hosp, Solna, Sweden.
    Multidisciplinary Work Practices: A Comparison of Three Major European Hospitals2014In: 2014 IEEE 27th International Symposium on Computer-Based Medical Systems, IEEE, 2014, p. 369-375Conference paper (Refereed)
    Abstract [en]

    This paper reviews the practices of multidisciplinary teamwork (MDT) for cancer care in three large teaching hospitals in separate jurisdictions. Ethnographic observations provide the main source of data, which are verified though interviews, and in some cases by surveys and analysis of video recordings. We demonstrate how MDT practices develop among different groups, and in different jurisdictions. Common practices are identified and differences explained. Work practice analysis is an integral part of our research, and this study provides insights into medical teamwork and decision-making. 

  • 20.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Luz, Saturnino
    Expanding the HCI Agenda in Healthcare2014In: 2014 IEEE 27th International Symposium on Computer-Based Medical Systems, IEEE, 2014, p. 382-385Conference paper (Refereed)
    Abstract [en]

    Designing technology for use in healthcare, and its evaluation in the healthcare setting, deserves special attention because of the nature of the special context of use. Biological hazards and the risk of infection, issues of privacy and security, system response times, as well as human factors and patient safety are identified as areas deserving of special attention. We give examples and quote from clinician interviews for illustration, and we argue that increased focus from the HCI community on these areas will bring tangible benefits of health information systems to healthcare staff, and ultimately improve patient services. 

  • 21.
    Kastberg, Gustaf
    et al.
    Department of Service Management, Lund University.
    Siverbo, Sven
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013).
    The design and use of management accounting systems in process oriented health care: an explorative study2013In: Financial Accountability and Management, ISSN 0267-4424, E-ISSN 1468-0408, Vol. 29, no 3, p. 246-270Article in journal (Refereed)
    Abstract [en]

    Process orientation has made its entrance in Health Care Organizations (HCOs). The purpose is to improve patients’ journeys through the health care system. One factor that potentially affects process orientation is the design and use of Management Accounting Systems (MAS). In the literature there are worries that process orientation often is not supported by a well designed and used MAS but, on the contrary, is counteracted by a MAS designed for other purposes than supporting processes. This study contributes to the existing knowledge in that it shows how the introduction of process orientation within health care is accompanied by the development of horizontally oriented MAS (HMAS) which is used in different ways and by different actors. Generally, the use of HMAS for diagnostic control is limited. The main use of HMAS is for the purpose of mastering the events and interactive control, and the main users are the persons connected to the processes. The observation in earlier research that the existence of vertically oriented MAS may be a threat to process orientation is to some extent corroborated in the paper.

  • 22.
    Larsson, Kristina
    Karlstad University.
    Motivation till livsstilsförändring: En kvantitativ studie om motivation till livsstilsförändring via gruppverksamhet2007Independent thesis Basic level (degree of Bachelor), 10 points / 15 hpStudent thesis
    Abstract [en]

    Länsförsäkringar in Värmland, Sweden, had during the year 2003 a total level of 6.1 percent of people on the sick-list, which was higher than average in the business (4,5%) and for salaried employees in the private sector (3,3%). The average age of those put on sick-list was 47 years, whish is four years higher than the average for the whole LF-group. The cost for the total amount of people being on sick-list at LF-company (6,1%) was estimated to 1 500 kkr, according to a calculation model coming from Försäkringskassan. For every percent the sick level could be reduced, the company would save 239 kkr. To map out the state of health of each and every collaborator in LF, the company offered all employees to make a health profile at the company's health service, Clarahälsan AB. This health control was accomplished during May 2004 to August 2004, and almost every employee participated (99%). The purpose of this study was to find out if the stress and lifestyle handling course at Clarahälsan AB, which was offered those considered in need for it after the health control,could influence the motivation of the participants to change lifestyle in order to prevent long time sick leave. A quantitative method was used to evaluate goals for life style changes after accomplishment of the course by quastionnaire. Three women and six men participated in the study. The result shows that six out of seven (two drop-outs) had been influenced in a positive way towards a chang in lifestyle including exercise, stress management, sleep and work situation. All seven had a postive change considering food habits.

  • 23.
    Lexomboon, Duangjai
    et al.
    Department of Community Dentistry, Mahidol University.
    Punyasingh, Komson
    Department of Community Dentistry, Mahidol University.
    Supply projections for dentists, Thailand (2000-2030).2000In: Human Resource for Health Development Journal, Vol. 4, no 2, p. 94-105Article in journal (Refereed)
    Abstract [en]

    Abstract In the1970s, dental manpower in Thailand was found to be in short supply. In responseto this shortage, both the Ministry of University Affairs (MoUA) and the Office of NationalEducation Council (ONEC) proposed production plans to expand the supply of dentists. As aconsequence, the production of dentists has been increasing dramatically over the past 20 years.Experience from many countries has shown that such a rapid expansion of supply for dentists, ifnot periodically evaluated, could lead to a state of oversupply. This paper projects the supply of dentists in Thailand for the next 30 years, using theproposed first year enrollment plans of MoUA and ONEC, in order to compare future supplywith the projected requirements. WHO models for projecting workforce supply andrequirements and cohort retention rate method were used in this study. The student dropout rateused in this study was found to be approximately 2%, equal to the one used in MoUA plan.Estimated quinquennial retention rates for the dental workforce declined from 99% to 75% overthe first 34 years following completion of training, with a maximum working life of 50 years. The supply projections for dentists under the production plans of MoUA and the ONECshow that the population per dentist will decrease from 10,350 in the year 2000 to 6,072 and to3,082 in 2030. The MoUA production plan projects a supply similar to the projectedrequirement in the next 15 years but the ONEC production plan projects an oversupply state.The current economic crisis of the country coupled with health care reform, support anincreased emphasis of preventive care, which can be effectively rendered by dental nurses.Future production planning, therefore, should take into consideration the future use of auxiliarypersonnel and changes in dental health care provision.

  • 24.
    Nilsson, Jan
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Masud Rana, AKM
    Huy Loung, Duong
    Winblad, Bengt
    Nahar Kabir, Zarina
    Health-Related Quality of Life in Old Age: A Comparison Between Rural Areas in Bangladesh and Vietnam2012In: Asia Pacific Journal of Public Health, ISSN 1010-5395, Vol. 24, no 4, p. 610-619Article in journal (Refereed)
    Abstract [en]

    This study compares health-related quality of life (HRQoL) and its determinants among older people (≥60 years) in rural Bangladesh and Vietnam. Cross-sectional studies among older people were conducted in Bangladesh (n = 1031) and Vietnam (n = 870). Data on HRQoL were collected using an instrument that includes 24 items distributed into 6 dimensions. Older people in Vietnam reported more favorable HRQoL outcomes than those in Bangladesh, reporting better HRQoL on physical, psychological, social, and financial dimensions. Hierarchical linear regression analyses show that advanced age, being a woman, belonging to a poor household, and reporting poor health were significantly associated with lower HRQoL scores in both Bangladesh and Vietnam. In Bangladesh, being illiterate was additionally associated with lower HRQoL scores. The results of this explorative study underline the importance of a cross-cultural understanding of HRQoL of older people and the influence of the socioecological context.

  • 25.
    Persson, Mattias
    et al.
    School of Business, Örebro University, Sweden.
    Wennberg, Linn
    Department of Public Health & Community Medicine, University of Gothenburg, Sweden.
    Beckman, Linda
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Salmivalli, Christina
    Department of Psychology, University of Turku, Finland.
    Svensson, Mikael
    Health Metrics, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    The Cost-Effectiveness of the Kiva Antibullying Program: Results from a Decision-Analytic Model2018In: Prevention Science, ISSN 1389-4986, E-ISSN 1573-6695, Vol. 19, no 6, p. 728-737Article in journal (Refereed)
    Abstract [en]

    Bullying causes substantial suffering for children and adolescents. A number of bullying prevention programs have been advocated as effective methods for counteracting school bullying. However, there is a lack of economic evaluations of bullying prevention programs assessing the “value for money.” The aim of this study was to assess the cost-effectiveness of the Finnish bullying prevention program KiVa in comparison to “status quo” (treatment as usual) in a Swedish elementary school setting (grades 1 to 9). The cost-effectiveness analysis was carried out using a payer perspective based on a Markov cohort model. The costs of the program were measured in Swedish kronor and Euros, and the benefits were measured using two different metrics: (1) the number of victim-free years and (2) the number of quality adjusted life years (QALYs). Data on costs, probability transitions, and health-related quality of life measures were retrieved from published literature. Deterministic and probabilistic sensitivity analyses were carried out to establish the uncertainty of the cost-effectiveness results. The base-case analysis indicated that KiVa leads to an increased cost of €829 for a gain of 0.47 victim-free years per student. In terms of the cost per gained QALY, the results indicated a base-case estimate of €13,823, which may be seen as cost-effective given that it is lower than the typically accepted threshold value in Swedish health policy of around €50,000. Further research is needed to confirm the conclusions of this study, especially regarding the treatment effects of KiVa in different school contexts

  • 26.
    Punyasingh, Komson
    et al.
    Department of Community Dentistry, Mahidol University.
    Udompanich, Suwit
    Department of Community Dentistry, Khon Kaen University.
    Lexomboon, Duangjai
    Department of Community Dentistry, Mahidol University .
    Baseline projection of requirements for dental health manpower in Thailand (1995-2015 AD.)1997In: Human Resource for Health Development Journal, Vol. 1, no 1, p. 24-34Article in journal (Refereed)
    Abstract [en]

    This study is intended to compare the dental health personnel supply to the requirement in each 5-year interval from 1995 to 2015. The dental health personnel supply was calculated by subtracting the annual personnel loss from the current active personnel plus the annual personnel production. The results show that there will be 10,100 dentists and 7,718 dental nurses in supply in the year 2015. The personnel requirement was calculated using 3 different techniques; the population ratio technique, the FDI/WHO technique, and the system dynamics technique. The dental personnel to population ratio of 1:5,000 was used to calculate the personnel requirement in the population ratio technique. The FDI/WHO and the system dynamics techniques calculated the personnel requirement by converting the need for service into the need for personnel. While the FDI/WHO technique calculated the need for service based on the lifetime of care for each age cohort, the system dynamics technique calculated the need for service which changed with the alternations in the input factors such as the socioeconomics of the population, the trend of oral diseases, and the structure of health care system. From these three techniques, the requirement for dentists ranges from 8,920 to 9,748 and for dental nurses ranges from 3,046 to 10,974. The results show that in the year 2015, the supply of dentists exceeds the requirement regardless of what technique is used. Similarly, the supply of dental nurses is higher than the requirement when the calculations are done using the population ratio technique and the system dynamics technique. However, the dental nurses will be in shortage according to the FDI/WHO technique. The reason for this different outcome is that dental nurses in the FDI/WHO technique provide health promotion and health education services as well as preventive and simple curative services; while in the other two techniques they provide only preventive and simple curative treatment.

  • 27.
    Rahm, GullBritt
    et al.
    Karlstad University, Faculty of Social and Life Sciences.
    Rystedt, Ingrid
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Strandmark K, Margaretha
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Workplace bullying in the health and social caresystems in Sweden: A descriptive study2012Conference paper (Refereed)
    Abstract [en]

    Abstract 

    Workplace bullying in the health and social care systems in Sweden. A descriptive study.

    Aims

    This study aims to map and describe the problem of bullying within the health and social care systems as a foundation for an intervention. In this presentation we will present the study and preliminary results concerning negative acts and work-place health in Sweden.   

    Methods

    Baseline data for this quantitative study was collected at nursing wards at five hospitals and five wards for eldercare in municipalities. Questionnaires were sent by post to 2810 employees.  Response-rate was 55% (n=1550).

    Bullying was measured both with an operationalized and a self-labelling method. The instrument used in the former were The Negative Acts Questionnaire, NAQ-R, and bullying was assessed according to the operational criterion suggested  by Leyman (1996) “exposure to at least one negative act/week during six months” and a stricter criterion by Mikkelsen & Einarsen, (2001)  suggesting 2 negative acts/week during six months.  

    As for the self-labelling of bullying a definition of bullying was presented and questions were asked whether the person had been bullied or had witnessed bullying the last 6 months. A further question was asked regarding previous life-time experiences of bullying.

    To assess work-place environment the Nordic Questionnaire for Psychological and Social Factors at work, QPSNordic34+ was utilized. In addition a questionnaire made for this study concerning demographic information and specific workplace related questions were included.

    Primarily descriptive statistics was used.

    Results

    Bullying measured by NAQ-R, using the operational criterion, reported results of bullying at 18,5 % (Leyman) and for the stricter criterion 6.8% (Mikkelsen & Einarsen). Four percent (4 %) reported bullying relating to the self-labelling question. A higher proportion, 22%, had witnessed bullying and an even higher proportion, 38%, reported having experienced bullying earlier in life.

     An association was shown between having been bullied earlier in life and experiencing bullying at the work-place at the present time. Also work-place environment, age, where you were born, living in a relationship, education and length of employment were, respectively, associated to more negative acts in the workplace.

    Conclusion

    The operationalized method yields a higher percent of bullying compared to the self-labelling method. This is also shown in earlier studies and might be due to bullying being stigmatizing and shameful and therefore difficult to express in a straight-forward way.

    A significant relationship was observed between being bullied earlier in life-time and current exposure. As far as we know this represents new knowledge and should be further investigated.

  • 28.
    Rystedt, Ingrid
    Högskolan i Borås.
    Samverkan mellan patienter och hälso- och sjukvårdssystemet: Centrala begrepp, geografiska variationer och verktyg för stöd2011In: Brukarens roll i välfärdsforskning och utvecklingsarbete / [ed] Lars Rönnmark, Borås: Högskolan i Borås , 2011, p. 107-124Chapter in book (Other academic)
  • 29.
    Ränk, Daniel
    Karlstad University.
    Idrott och hälsa, inlärning och koncentration: En enkätstudie om hur elever på högstadiet upplever att deras inlärning och koncentration påverkas av ämnet Idrott och hälsa2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 30.
    Sund, Björn
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013).
    Svensson, Mikael
    Göteborgs universitet.
    Estimating a constant WTP for a QALY-a mission impossible?2017In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Economic evaluations are an important input to decision-making and priority-setting in the health care sector. Measuring preferences for health improvements, as the demand-side value (willingness to pay) of gaining a quality-adjusted life year (QALY), is one relevant component in the interpretation of the results from health economic evaluations. Our article addresses whether willingness to pay for a QALY (WTP-Q) is sensitive to the size of the health differences and the probability for improvement. We use data from a contingent valuation survey based on 1400 respondents conducted in the spring of 2014. The results show that the expectation of sensitivity to scope, or higher WTP to the larger expected quality of life improvement, is not supported. We find WTP-Q values that conform reasonably well to previous studies in Sweden.

  • 31.
    Svensson, Henrik
    Karlstad University, Faculty of Social and Life Sciences.
    Sjukvårdens professioner och evidensbaserad vård2008Independent thesis Advanced level (degree of Magister), 20 points / 30 hpStudent thesis
    Abstract [en]

    A study based on the tension between different professional groups in health care in relation to developing care and introducing new work procedures. The purpose of the project has been to enhance the knowledge regarding professional identities and how they affect development of new work procedures in health care organizations.

    The following issues have been looked into:

    • Are there differences, and if so, what differences, in the view and practice of evidence based knowledge based on the clinical manager´s primary profession?

    • How do clinical managers with different primary profession (nurses and physicians) experience their roll in developing new work procedures, and in applying evidence based knowledge?

    This has been investigated quantitatively, by questionnaires to employed general practitioners and nurses at ten primary care unit within the County council of Örebro, in the middle of Sweden. To perceive a qualitative dimension, the clinical managers of the same units have been interviewed.

    The study has not been able to show significant divergences in the views of the employees on the basis of the clinical manager´s primary profession. On the other hand, it is shown that the

    system is not neutral regarding the clincal manager´s primary profession and that the professional groups have different views in significant aspects. This veryfies that the professional groups of employees are of crucial importance for the development of health care.

  • 32.
    Trosic, Branka
    Karlstad University. Karlstad University, Faculty of Social and Life Sciences.
    Att tolka dementa: Vårdpersonalens egna berättelser2009Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Tidigare forskning pekar på försämrad kommunikationsförmåga som ett av de mest uppmärksammade symtomen vid demenssjukdom. För att förmedla ett budskap till sin omgivning använder dementa som alla andra människor både verbala och icke-verbala signaler. Med tiden försämras deras verbala uttrycksätt och de börjar istället att i allt högre grad använda sig av de icke-verbala signalerna, som till exempel ansiktsuttryck, kroppsspråk, gester, paraspråk och liknande. Eftersom dementas olika kommunikativa uttryckssätt ibland kan vara väldigt svåra att tolka av andra i deras närhet, är det av stor betydelse att ta reda på de förutsättningar som påverkar detta. Syftet med denna studie är att utifrån vårdpersonalens berättelser belysa vilka faktorer som påverkar deras tolkning av dementas olika kommunikativa uttryckssätt under omvårdnadsmötet. För att svara på detta syfte har jag använt mig av fokusgruppsintervjuer som metod för att samla in data, vilken sedan analyserades med hjälp av kvalitativ innehållsanalys. Resultatet visar att de faktorer som påverkar vårdpersonalens tolkning av dementas olika kommunikativa uttryckssätt är (1) kunskap, (2) yrkeskompetens och (3) institutionella aspekter som psykosocial miljö och tid. Den föreliggande studiens resultat kommer förhoppningsvis att bidra till en bättre kommunikation mellan dementa och vårdpersonal.

  • 33. Wittchen, H U
    et al.
    Jacobi, F
    Rehm, J
    Gustavsson, A
    Svensson, Mikael
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Economics and Statistics.
    Jönsson, B
    Olesen, J
    Allgulander, C
    Alonso, J
    Faravelli, C
    Fratiglioni, L
    Jennum, P
    Lieb, R
    Maercker, A
    van Os, J
    Preisig, M
    Salvador-Carulla, L
    Simon, R
    Steinhausen, H-C
    The size and burden of mental disorders and other disorders of the brain in Europe 2010.2011In: European Neuropsychopharmacology, ISSN 0924-977X, E-ISSN 1873-7862, Vol. 21, no 9, p. 655-79Article in journal (Refereed)
    Abstract [en]

    AIMS: To provide 12-month prevalence and disability burden estimates of a broad range of mental and neurological disorders in the European Union (EU) and to compare these findings to previous estimates. Referring to our previous 2005 review, improved up-to-date data for the enlarged EU on a broader range of disorders than previously covered are needed for basic, clinical and public health research and policy decisions and to inform about the estimated number of persons affected in the EU.

    METHOD: Stepwise multi-method approach, consisting of systematic literature reviews, reanalyses of existing data sets, national surveys and expert consultations. Studies and data from all member states of the European Union (EU-27) plus Switzerland, Iceland and Norway were included. Supplementary information about neurological disorders is provided, although methodological constraints prohibited the derivation of overall prevalence estimates for mental and neurological disorders. Disease burden was measured by disability adjusted life years (DALY).

    RESULTS: Prevalence: It is estimated that each year 38.2% of the EU population suffers from a mental disorder. Adjusted for age and comorbidity, this corresponds to 164.8million persons affected. Compared to 2005 (27.4%) this higher estimate is entirely due to the inclusion of 14 new disorders also covering childhood/adolescence as well as the elderly. The estimated higher number of persons affected (2011: 165m vs. 2005: 82m) is due to coverage of childhood and old age populations, new disorders and of new EU membership states. The most frequent disorders are anxiety disorders (14.0%), insomnia (7.0%), major depression (6.9%), somatoform (6.3%), alcohol and drug dependence (>4%), ADHD (5%) in the young, and dementia (1-30%, depending on age). Except for substance use disorders and mental retardation, there were no substantial cultural or country variations. Although many sources, including national health insurance programs, reveal increases in sick leave, early retirement and treatment rates due to mental disorders, rates in the community have not increased with a few exceptions (i.e. dementia). There were also no consistent indications of improvements with regard to low treatment rates, delayed treatment provision and grossly inadequate treatment. Disability: Disorders of the brain and mental disorders in particular, contribute 26.6% of the total all cause burden, thus a greater proportion as compared to other regions of the world. The rank order of the most disabling diseases differs markedly by gender and age group; overall, the four most disabling single conditions were: depression, dementias, alcohol use disorders and stroke.

    CONCLUSION: In every year over a third of the total EU population suffers from mental disorders. The true size of "disorders of the brain" including neurological disorders is even considerably larger. Disorders of the brain are the largest contributor to the all cause morbidity burden as measured by DALY in the EU. No indications for increasing overall rates of mental disorders were found nor of improved care and treatment since 2005; less than one third of all cases receive any treatment, suggesting a considerable level of unmet needs. We conclude that the true size and burden of disorders of the brain in the EU was significantly underestimated in the past. Concerted priority action is needed at all levels, including substantially increased funding for basic, clinical and public health research in order to identify better strategies for improved prevention and treatment for disorders of the brain as the core health challenge of the 21st century.

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