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BMI status in Swedish children and young adults in relation to caries prevalence.

https://arctichealth.org/en/permalink/ahliterature134408
Source
Swed Dent J. 2011;35(1):1-8
Publication Type
Article
Date
2011
Author
Anita Alm
Helen Isaksson
Christina Fåhraeus
Göran Koch
Boel Andersson-Gäre
Mats Nilsson
Dowen Birkhed
Lill-Kari Wendts
Author Affiliation
Department of Paediatric Dentistry, Kärnsjukhuset, Skövde, Sweden. anita.alm@vgregion.se
Source
Swed Dent J. 2011;35(1):1-8
Date
2011
Language
English
Publication Type
Article
Keywords
Adiposity
Adolescent
Body mass index
Child
Child, Preschool
Cohort Studies
Dental Caries - diagnosis - epidemiology - etiology
Humans
Longitudinal Studies
Obesity - complications
Oral Health
Overweight - complications
Prevalence
Sweden - epidemiology
Young Adult
Abstract
Overweight and obesity are increasing as health problems at global level. Dental caries and obesity are both multifactorial diseases and are associated with dietary habits. The aim of the present study was to investigate the relationship between body weight status and caries prevalence in an unselected population followed from pre-school years to young adulthood. The present investigation was designed as a longitudinal analysis of the association between overweight/obesity and dental caries in one population at 3, 6, 15 and 20 years of age. The result shows that adolescents (15 years) and young adults (20 years) who are overweight/obese had a statistically significantly higher caries prevalence than normal-weight young people. At 6 years of age, the odds (OR) of having caries among obese children are 2.5 times higher than the odds for caries among six-year-old children of normal weight (p = 0.04). At 3 years of age, no association between overweight/obesity and caries was found. To conclude, overweight and obese adolescents and young adults had more caries than normal-weight individuals. The present study emphasises the need for multidisciplinary approaches to change the lifestyle factors causing both overweight/obesity and dental caries.
PubMed ID
21591594 View in PubMed
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Collaboratively Improving Diabetes Care in Sweden Using a National Quality Register: Successes and Challenges-A Case Study.

https://arctichealth.org/en/permalink/ahliterature279465
Source
Qual Manag Health Care. 2015 Oct-Dec;24(4):212-21
Publication Type
Article
Author
Anette Peterson
Soffia Gudbjörnsdottir
Ulla-Britt Löfgren
Linus Schiöler
Mats Bojestig
Johan Thor
Boel Andersson Gäre
Source
Qual Manag Health Care. 2015 Oct-Dec;24(4):212-21
Language
English
Publication Type
Article
Keywords
Cooperative Behavior
Diabetes Mellitus - epidemiology - therapy
Guideline Adherence
Humans
Quality Improvement
Registries
Sweden
Abstract
Since 1996, the Swedish National Diabetes Register (NDR) enabled health care providers to monitor their clinical performance over time and compare it with the national average. All health systems of Swedish county councils report data. By 2014, the NDR included data from 360 000 patients. Comparisons among county councils show significant variations in clinical outcomes and in adherence to evidence-based national guidelines. The purpose of this study was to evaluate whether and how a quality improvement collaborative could influence clinical practice and outcomes.
Twenty-three diabetes teams from all over Sweden, both primary care units and internal medicine departments, joined a quality improvement collaborative. The project was inspired by the Breakthrough Collaborative Model and lasted for 20 months. Evaluation data were collected from the teams' final reports and the NDR throughout the study period.
The teams reported improved patient outcomes significantly compared with the national average for systolic blood pressure and low-density lipoprotein levels. In contrast, glycated hemoglobin A1c levels deteriorated in the whole NDR population. Five themes of changes in practice were tested and implemented. Success factors included improved teamwork, with active use of register data, and testing new ideas and learning from others.
PubMed ID
26426323 View in PubMed
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Deficiencies in healthcare prior to suicide and actions to deal with them: a retrospective study of investigations after suicide in Swedish healthcare.

https://arctichealth.org/en/permalink/ahliterature307731
Source
BMJ Open. 2019 12 11; 9(12):e032290
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
12-11-2019
Author
Elin Roos Af Hjelmsäter
Axel Ros
Boel Andersson Gäre
Åsa Westrin
Author Affiliation
Höglandssjukhuset, Region Jönköping, Eksjö, Sweden elin.roos.af.hjelmsater@rjl.se.
Source
BMJ Open. 2019 12 11; 9(12):e032290
Date
12-11-2019
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Delivery of Health Care - methods - standards - statistics & numerical data
Female
Health Knowledge, Attitudes, Practice
Health Personnel - education - psychology - standards
Health Services Needs and Demand - organization & administration
Humans
Male
Middle Aged
Preventive Health Services - organization & administration
Professional-Patient Relations
Quality of Health Care
Risk Assessment - methods - statistics & numerical data
Suicide - prevention & control - statistics & numerical data
Sweden - epidemiology
Abstract
The overall aim of this study was to aggregate the conclusions of all investigations conducted after suicides reported to the supervisory authority in Sweden in 2015, and to identify deficiencies in healthcare found in these investigations; the actions proposed to deal with the deficiencies; the level of the organisational hierarchy (micro-meso-macro) in which the deficiencies and actions were situated; and outcomes of the supervisory authority's decisions.
This is a retrospective study of all reports from Swedish primary and secondary healthcare after suicide to the regulatory authority in Sweden in 2015.
In 55% (n=240) of cases, healthcare providers reported healthcare deficiencies that contributed to suicide; these deficiencies were primarily in 'suicide risk assessment' and 'treatment'. Actions aimed at preventing new suicides were proposed in 80% of cases (n=347). By far, the most frequent actions were 'education and competence', present in 52% of cases (n=227) and did not much correspond with identified deficiencies. Sixty-five per cent of the deficiencies and actions were at microlevel, while the remainders were at mesolevel. In 65% (n=284) of cases, the supervisory authority approved the investigation without further requirements.
The most common identified deficiencies were related to care in the immediate interface between patient and staff. Actions proposed to prevent new suicides were centred on single educational interventions without distinctive sustainable effects in the organisations and usually did not correspond with the identified deficiencies. Future research should examine if application of a framework based on knowledge of the suicide process, suicide prevention strategies and patient safety would enable more sophisticated investigations that could facilitate progress on suicide prevention.
PubMed ID
31831542 View in PubMed
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Design of an online health-promoting community: negotiating user community needs with public health goals and service capabilities.

https://arctichealth.org/en/permalink/ahliterature112480
Source
BMC Health Serv Res. 2013;13:258
Publication Type
Article
Date
2013
Author
Joakim Ekberg
Toomas Timpka
Marianne Angbratt
Linda Frank
Anna-Maria Norén
Lena Hedin
Emelie Andersen
Elin A Gursky
Boel Andersson Gäre
Author Affiliation
Department of Medical and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden. joakim.ekberg@liu.se
Source
BMC Health Serv Res. 2013;13:258
Date
2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Community-Based Participatory Research
Female
Health Knowledge, Attitudes, Practice
Health promotion
Health services needs and demand
Humans
Information Dissemination
Internet
Male
Obesity - prevention & control
Personal Satisfaction
Public Health
Students - statistics & numerical data
Sweden
Young Adult
Abstract
An online health-promoting community (OHPC) has the potential to promote health and advance new means of dialogue between public health representatives and the general public. The aim of this study was to examine what aspects of an OHPC that are critical for satisfying the needs of the user community and public health goals and service capabilities.
Community-based participatory research methods were used for data collection and analysis, and participatory design principles to develop a case study OHPC for adolescents. Qualitative data from adolescents on health appraisals and perspectives on health information were collected in a Swedish health service region and classified into categories of user health information exchange needs. A composite design rationale for the OHPC was completed by linking the identified user needs, user-derived requirements, and technical and organizational systems solutions. Conflicts between end-user requirements and organizational goals and resources were identified.
The most prominent health information needs were associated to food, exercise, and well-being. The assessment of the design rationale document and prototype in light of the regional public health goals and service capabilities showed that compromises were needed to resolve conflicts involving the management of organizational resources and responsibilities. The users wanted to discuss health issues with health experts having little time to set aside to the OHPC and it was unclear who should set the norms for the online discussions.
OHPCs can be designed to satisfy both the needs of user communities and public health goals and service capabilities. Compromises are needed to resolve conflicts between users' needs to discuss health issues with domain experts and the management of resources and responsibilities in public health organizations.
Notes
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PubMed ID
23826944 View in PubMed
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Disease course, outcome, and predictors of outcome in a population-based juvenile chronic arthritis cohort followed for 17 years.

https://arctichealth.org/en/permalink/ahliterature116247
Source
J Rheumatol. 2013 May;40(5):715-24
Publication Type
Article
Date
May-2013
Author
Lennart Bertilsson
Boel Andersson-Gäre
Anders Fasth
Ingemar F Petersson
Helena Forsblad-D'elia
Author Affiliation
Department of Rheumatology and Inflammation Research, The Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden. lennart.bertilsson2@comhem.se
Source
J Rheumatol. 2013 May;40(5):715-24
Date
May-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Age of Onset
Antirheumatic Agents - therapeutic use
Arthritis, Juvenile - drug therapy - epidemiology - pathology - physiopathology
Cohort Studies
Female
Health status
Humans
Male
Prognosis
Quality of Life
Recovery of Function
Remission Induction
Sweden - epidemiology
Symptom Assessment
Treatment Outcome
Young Adult
Abstract
To investigate disease course, outcome, and predictors of outcome in an unselected population-based cohort of individuals diagnosed with juvenile chronic arthritis (JCA) followed for 17 years.
The cohort consisted of 132 incidence JCA cases identified 1984-1986 according to EULAR criteria. At 5-year followup, 129 individuals underwent joint assessment, laboratory measurements, radiographic examination, and medication and functional assessment. At 17-year followup, 86 were examined with joint assessment, laboratory measurements, medication assessment, Health Assessment Questionnaire (HAQ), Keitel functional test (KFT), and Medical Outcomes Study Short Form-36 (SF-36).
At 17-year followup, 40% were in remission, 44% changed subgroups, median HAQ score was 0.0 (range 0.0-1.5), and median KFT was 100 (range 54-100). SF-36 scores were significantly lower compared to a reference group. Thirty-nine percent of those in remission at 5-year followup were not in remission at 17-year followup. In multivariate analyses of variables from the 17-year followup: remission was predicted by remission at 5-year followup (OR 4.8); HAQ > 0 by rheumatoid factor (RF)-positivity at 5-year followup (OR 3.6); KFT
PubMed ID
23418376 View in PubMed
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Emergent programme theories of a national quality register - a longitudinal study in Swedish elderly care.

https://arctichealth.org/en/permalink/ahliterature295517
Source
J Eval Clin Pract. 2017 Dec; 23(6):1329-1335
Publication Type
Journal Article
Date
Dec-2017
Author
Annika Nordin
Boel Andersson Gäre
Ann-Christine Andersson
Author Affiliation
Region Jönköping County, Jönköping Academy for improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
Source
J Eval Clin Pract. 2017 Dec; 23(6):1329-1335
Date
Dec-2017
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Evidence-Based Practice
Frail Elderly
Health Personnel - organization & administration - standards
Health Services for the Aged - organization & administration - standards
Humans
Interviews as Topic
Longitudinal Studies
Qualitative Research
Quality of Health Care - organization & administration - standards
Registries
Risk assessment
Sweden
Abstract
This study aimed to explore programme theories of a national quality register. A programme theory is a bundle of assumptions underpinning how and why an improvement initiative functions. The purpose was to examine and establish programme theories of a national quality register widely used in Sweden: Senior alert. The paper reports on how programme theories among change recipients emerge in relation to the established programme theory of the initiator.
A qualitative approach and a longitudinal research design were used. To develop programme theories among change recipients, individual semistructured interviews were conducted. Three sets of interviews were conducted in the period of 2011 to 2013, totalling 22 interviews. In addition, 4 participant observations were made. To develop the initiator's programme theory, an iterative multistage collaboration process between the researchers and the initiator was used. A directed content analysis was used to analyse data.
The initiator and change recipients described similar programme logics, but differing programme theories. With time, change recipients' programme theories emerged. Their programme theories converged and became more like the programme theory of the initiator.
This study has demonstrated the importance of making both the initiator's and change recipients' programme theories explicit. To learn about conditions for improvement initiatives, comparisons between their programme theories are valuable. Differences in programme theories provide information on how initiators can customize support for their improvement initiatives. Similar programme logics can be underpinned by different programme theories, which can be deceptive. Programme theories emerge over time and need to be understood as dynamic phenomena.
Notes
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PubMed ID
28748651 View in PubMed
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Framework for assessing quality of care for inflammatory bowel disease in Sweden.

https://arctichealth.org/en/permalink/ahliterature126183
Source
World J Gastroenterol. 2012 Mar 14;18(10):1085-92
Publication Type
Article
Date
Mar-14-2012
Author
Martin Rejler
Jörgen Tholstrup
Mattias Elg
Anna Spångéus
Boel Andersson Gäre
Author Affiliation
Department of Medicine, Highland Hospital, S-57581 Eksjö, Sweden. martin.rejler@lj.se
Source
World J Gastroenterol. 2012 Mar 14;18(10):1085-92
Date
Mar-14-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Ambulatory Care Facilities
Delivery of Health Care
Female
Humans
Inflammatory Bowel Diseases - therapy
Male
Middle Aged
Outcome Assessment (Health Care)
Quality Assurance, Health Care - methods
Sweden
Young Adult
Abstract
To create and apply a framework for quality assessment and improvement in care for inflammatory bowel disease (IBD) patients.
A framework for quality assessment and improvement was created for IBD based on two generally acknowledged quality models. The model of Donabedian (Df) offers a logistical and productive perspective and the Clinical Value Compass (CVC) model adds a management and service perspective. The framework creates a pedagogical tool to understand the balance between the dimensions of clinical care (CVC) and the components of clinical outcome (Df). The merged models create a framework of the care process dimensions as a whole, reflecting important parts of the IBD care delivery system in a local setting. Clinical and organizational quality measures were adopted from clinical experience and the literature and were integrated into the framework. Data were collected at the yearly check-up for 481 IBD patients during 2008. The application of the quality assessment framework was tested and evaluated in a local clinical IBD care setting in Jönköping County, Sweden.
The main outcome was the presentation of how locally-selected clinical quality measures, integrated into two complementary models to develop a framework, could be instrumental in assessing the quality of care delivered to patients with IBD. The selected quality measures of the framework noted less anemia in the population than previously reported, provided information about hospitalization rates and the few surgical procedures reported, and noted good access to the clinic.
The applied local quality framework was feasible and useful for assessing the quality of care delivered to IBD patients in a local setting.
Notes
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PubMed ID
22416183 View in PubMed
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How to minimize children's environmental tobacco smoke exposure: an intervention in a clinical setting in high risk areas.

https://arctichealth.org/en/permalink/ahliterature262277
Source
BMC Pediatr. 2013;13:76
Publication Type
Article
Date
2013
Author
Noomi Carlsson
AnnaKarin Johansson
Agneta Abrahamsson
Boel Andersson Gäre
Source
BMC Pediatr. 2013;13:76
Date
2013
Language
English
Publication Type
Article
Keywords
Child, Preschool
Cotinine - urine
Female
Follow-Up Studies
Humans
Incidence
Infant
Infant, Newborn
Male
Parents
Questionnaires
Retrospective Studies
Risk factors
Smoking - epidemiology - prevention & control - urine
Smoking Cessation - methods
Sweden - epidemiology
Tobacco Smoke Pollution - prevention & control - statistics & numerical data
Abstract
Despite the low prevalence of daily smokers in Sweden, children are still being exposed to environmental tobacco smoke (ETS), primarily by their smoking parents. A prospective intervention study using methods from Quality Improvement was performed in Child Health Care (CHC). The aim was to provide nurses with new methods for motivating and supporting parents in their efforts to protect children from ETS exposure.
Collaborative learning was used to implement and test an intervention bundle. Twenty-two CHC nurses recruited 86 families with small children which had at least one smoking parent. Using a bundle of interventions, nurses met and had dialogues with the parents over a one-year period. A detailed questionnaire on cigarette consumption and smoking policies in the home was answered by the parents at the beginning and at the end of the intervention, when children also took urine tests to determine cotinine levels.
Seventy-two families completed the study. Ten parents (11%) quit smoking. Thirty-two families (44%) decreased their cigarette consumption. Forty-five families (63%) were outdoor smokers at follow up. The proportion of children with urinary cotinine values of >6 ng/ml had decreased.
The intensified tobacco prevention in CHC improved smoking parents' ability to protect their children from ETS exposure.
Notes
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PubMed ID
23672646 View in PubMed
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Improved population-based care: Implementing patient-and demand-directed care for inflammatory bowel disease and evaluating the redesign with a population-based registry.

https://arctichealth.org/en/permalink/ahliterature165568
Source
Qual Manag Health Care. 2007 Jan-Mar;16(1):38-50
Publication Type
Article
Author
Martin Rejler
Anna Spångéus
Jörgen Tholstrup
Boel Andersson-Gäre
Author Affiliation
Department of Medicine, Höglands Hospital in Eksjö, Sweden. martin.rejler@lj.se
Source
Qual Manag Health Care. 2007 Jan-Mar;16(1):38-50
Language
English
Publication Type
Article
Keywords
Chronic Disease
Health Services Accessibility - organization & administration
Health services needs and demand
Humans
Inflammatory Bowel Diseases - therapy
Quality of Health Care - organization & administration
Registries
State Medicine
Sweden
Abstract
The gastroenterology unit at the Höglands Hospital in Eksjö is responsible for the care of all 466 patients with inflammatory bowel disease (IBD) in a geographic area including approximately 115,000 inhabitants. In 2000, the frustration over an inadequate traditional outpatient clinic inspired us to redesign our outpatient unit to become more patient and demand directed. The redesign included the following: A direct telephone line for patients to a specialized nurse, available during working hours; appointments were scheduled in accordance with expected needs, and emergency appointments were available daily; traditional follow-ups of IBD patients were replaced by an annual telephone contact with a specialized nurse; the team agreed on a patient-centered value base for its work, and the redesign was monitored using clinical outcome measures reflecting 4 dimensions (see parentheses below) of the care in a "Value compass"; quality of life (functional) and routine blood samples (clinical) were followed yearly and collected in a computerized IBD registry together with basic information about the patients; access and waiting lists together with patient satisfaction (satisfaction) are followed regularly; and ward utilization (financial) was registered. Our study shows that the new design offers a more efficient outpatient clinic in which waiting lists are markedly reduced although production rates remains the same. Utilization data show a significant decrease in comparison with national data, showing that the new care is economically favorable. The clinical results regarding anemia frequency in the IBD population are highly comparable with or even better than those found in the literature. We also show good results regarding quality of life where more than 88% of patients achieve set goals. In conclusion, our new patient- and demand-directed care seems to be more efficient and with clinical and quality-of-life results remaining on a high standard.
PubMed ID
17235250 View in PubMed
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Improved results in paediatric diabetes care using a quality registry in an improvement collaborative: a case study in Sweden.

https://arctichealth.org/en/permalink/ahliterature268561
Source
PLoS One. 2014;9(5):e97875
Publication Type
Article
Date
2014
Author
Anette Peterson
Lena Hanberger
Karin Akesson
Mats Bojestig
Boel Andersson Gäre
Ulf Samuelsson
Source
PLoS One. 2014;9(5):e97875
Date
2014
Language
English
Publication Type
Article
Keywords
Adolescent
Child
Child, Preschool
Cooperative Behavior
Diabetes Mellitus, Type 1 - prevention & control
Female
Hemoglobin A, Glycosylated - analysis
Humans
Infant
Infant, Newborn
Male
Patient-Centered Care
Pediatrics
Quality of Health Care
Registries
Sweden
Abstract
Several studies show that good metabolic control is important for children and adolescents with type 1 diabetes. In Sweden, there are large differences in mean haemoglobin A1c (HbA1c) in different hospitals and difficulties implementing national guidelines in everyday practice. This study shows how the participation in an improvement collaborative could facilitate improvements in the quality of care by paediatric diabetes teams. The Swedish paediatric diabetes quality registry, SWEDIABKIDS was used as a tool and resource for feedback and outcome measures.
Twelve teams at paediatric diabetes centres, caring for 30% (2302/7660) of patients in Sweden, participated in an 18-month quality improvement program. Each team defined treatment targets, areas needing improvement, and action plans. The main outcome was the centre patients' mean HbA1c levels, but other clinical variables and change concepts were also studied. Data from the previous six months were compared with the first six months after starting the program, and the long-term follow up after another eleven months.
All centres reduced mean HbA1c during the second and third periods compared with the first. The mean reduction for all was 3·7 mmol/mol (p
Notes
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PubMed ID
24867418 View in PubMed
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