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1999 WHO/ISH Guidelines applied to a 1999 MONICA sample from northern Sweden.

https://arctichealth.org/en/permalink/ahliterature52964
Source
J Hypertens. 2002 Jan;20(1):29-35
Publication Type
Article
Date
Jan-2002
Author
Mats Persson
Bo Carlberg
Tom Mjörndal
Kjell Asplund
Jens Bohlin
Lars Lindholm
Author Affiliation
Family Medicine, Department of Public Health and Clinical Medicine, 901 87 University of Umeå, Sweden. mats.persson@fammed.umu.se
Source
J Hypertens. 2002 Jan;20(1):29-35
Date
Jan-2002
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Antihypertensive Agents - therapeutic use
Blood Pressure - drug effects - physiology
Female
Humans
Hypertension - drug therapy - physiopathology
Male
Middle Aged
Research Support, Non-U.S. Gov't
Risk factors
Sweden - epidemiology
Treatment Outcome
Abstract
BACKGROUND: Treating hypertension with drugs is so far the most cost-effective way to reduce this important risk factor for cardiovascular disease (CVD). It is, however, important to determine absolute risk, and thereby estimate indication for drug treatment, in order to maintain a cost-effective drug treatment. WHO/ISH Hypertension Guidelines from 1999 propose a risk stratification for estimating absolute risk for CVD based on blood pressure and additional risk factors, target organ damage (TOD) and CVD. OBJECTIVES: We studied the consequences of applying the recent WHO/ISH risk stratification scheme to a MONICA sample of 6000 subjects from a geographically defined population in northern Sweden, regarding indications for treatment, target blood pressure and risk distribution. METHODS: We have risk-classified each of these patients using a computer program, according to the WHO/ISH scheme. Data on TOD were not available. RESULTS : In all, 917 (15%) had drug-treated hypertension. Three-quarters (n = 737) were inadequately treated, with blood pressure levels at or above 140 or 90 mmHg. 1773 (30% of 5997) untreated subjects had a blood pressure of 140/90 or above; 16% in the low-, 62% in the medium-, 8% in the high-, and 14% in the very-high-risk group. The corresponding risk-group pattern for the inadequately treated hypertensives (n = 737) was 5.5, 48.3, 11.1 and 35.2%, respectively. If we shifted the target blood pressure from below 140/90 to below 130/85 for drug-treated subjects under 60 (n = 278) the number of inadequately treated subjects increased by 34 (12.2% of 278); 14 in the low-risk group, 15 in the medium-risk group, and only five in the high- or very-high-risk groups. CONCLUSIONS: Only one-fifth of the drug-treated hypertensives were well controlled. Moreover, the incidence of newly detected blood pressure elevation was high. The majority of younger subjects with high blood pressure had low risk, but in those aged 45-54 this had already risen to a medium risk. Changing the target blood pressure to below 130/85, for subjects aged below 60, as recommended by WHO/ISH, affects predominantly low- and medium-risk groups.
PubMed ID
11791023 View in PubMed
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Abdominal massage for people with constipation: a cost utility analysis.

https://arctichealth.org/en/permalink/ahliterature142788
Source
J Adv Nurs. 2010 Aug;66(8):1719-29
Publication Type
Article
Date
Aug-2010
Author
Kristina Lämås
Lars Lindholm
Birgitta Engström
Catrine Jacobsson
Author Affiliation
Department of Nursing, Umeå University, Sweden. kristina.lamas@nurs.umu.se
Source
J Adv Nurs. 2010 Aug;66(8):1719-29
Date
Aug-2010
Language
English
Publication Type
Article
Keywords
Abdomen
Adult
Aged
Aged, 80 and over
Constipation - economics - physiopathology - therapy
Cost-Benefit Analysis
Female
Humans
Laxatives - economics - therapeutic use
Male
Massage - economics - nursing
Middle Aged
Patient Dropouts
Patient Education as Topic
Prospective Studies
Quality of Life
Regression Analysis
Self Care - economics
Sweden
Abstract
This paper is a report of a study conducted to evaluate change in health-related quality of life for people with constipation receiving abdominal massage and to estimate the cost-effectiveness of two alternative scenarios developed from the original trial.
Constipation is a common problem and is associated with decrease in quality of life. Abdominal massage appears to decrease the severity of gastrointestinal symptoms, but its impact on health-related quality of life has not been assessed.
A randomized controlled trial including 60 participants was conducted in Sweden between 2005 and 2007. The control group continued using laxatives as before and the intervention group received additional abdominal massage. Health-related quality of life was assessed using the EQ-5D and analyzed with linear regression. Two scenarios were outlined to conduct a cost utility analysis. In the self-massage scenario patients learned to give self-massage, and in the professional massage scenario patients in hospital received abdominal massage from an Enrolled Nurse.
Linear regression analysis showed that health-related quality of life was statistically significantly increased after 8 weeks of abdominal massage. About 40% were estimated to receive good effect. For 'self-massage', the cost per quality adjusted life year was euro75,000 for the first 16 weeks. For every additional week of abdominal massage, the average dropped and eventually approached euro8300. For 'professional massage', the cost per quality adjusted life year was euro60,000 and eventually dropped to euro28,000.
Abdominal massage may be cost-effective in the long-term and it is relevant to consider it when managing constipation. A crucial aspect will be to identify those who will benefit.
PubMed ID
20557387 View in PubMed
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Can the impact of gender equality on health be measured? A cross-sectional study comparing measures based on register data with individual survey-based data.

https://arctichealth.org/en/permalink/ahliterature120640
Source
BMC Public Health. 2012;12:795
Publication Type
Article
Date
2012
Author
Ann Sörlin
Ann Öhman
Nawi Ng
Lars Lindholm
Author Affiliation
Department of Public Health and Clinical Medicine, Centre for Global Health Research, Umeå University, S-901 87 Umeå, Sweden. ann.sorlin@epiph.umu.se
Source
BMC Public Health. 2012;12:795
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Cross-Sectional Studies
Employment - organization & administration
Female
Health Policy
Health status
Health Surveys
Humans
Male
Middle Aged
Registries
Reproducibility of Results
Sex Factors
Sweden
Abstract
The aim of this study was to investigate potential associations between gender equality at work and self-rated health.
2861 employees in 21 companies were invited to participate in a survey. The mean response rate was 49.2%. The questionnaire contained 65 questions, mainly on gender equality and health. Two logistic regression analyses were conducted to assess associations between (i) self-rated health and a register-based company gender equality index (OGGI), and (ii) self-rated health and self-rated gender equality at work.
Even though no association was found between the OGGI and health, women who rated their company as "completely equal" or "quite equal" had higher odds of reporting "good health" compared to women who perceived their company as "not equal" (OR = 2.8, 95% confidence interval = 1.4 - 5.5 and OR = 2.73, 95% CI = 1.6-4.6). Although not statistically significant, we observed the same trends in men. The results were adjusted for age, highest education level, income, full or part-time employment, and type of company based on the OGGI.
No association was found between gender equality in companies, measured by register-based index (OGGI), and health. However, perceived gender equality at work positively affected women's self-rated health but not men's. Further investigations are necessary to determine whether the results are fully credible given the contemporary health patterns and positions in the labour market of women and men or whether the results are driven by selection patterns.
Notes
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PubMed ID
22985388 View in PubMed
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Colonoscopic surveillance - a cost-effective method to prevent hereditary and familial colorectal cancer.

https://arctichealth.org/en/permalink/ahliterature291610
Source
Scand J Gastroenterol. 2017 Sep; 52(9):1002-1007
Publication Type
Comparative Study
Journal Article
Date
Sep-2017
Author
Olle Sjöström
Lars Lindholm
Beatrice Melin
Author Affiliation
a Department of Radiation Sciences, Oncology , Umeå University , Umeå , Sweden.
Source
Scand J Gastroenterol. 2017 Sep; 52(9):1002-1007
Date
Sep-2017
Language
English
Publication Type
Comparative Study
Journal Article
Keywords
Adult
Colonoscopy - economics
Colorectal Neoplasms - diagnosis - prevention & control
Cost-Benefit Analysis
Early Detection of Cancer
Female
Health Care Costs - statistics & numerical data
Humans
Male
Mass Screening
Middle Aged
Quality-Adjusted Life Years
Registries
Sweden
Abstract
Approximately 20-30% of all colorectal cancer (CRC) cases may have a familial contribution. The family history of CRC can be prominent (e.g., hereditary colorectal cancer (HCRC)) or more moderate (e.g., familial colorectal cancer (FCRC)). For family members at risk, colonoscopic surveillance is a well-established method to prevent both HCRC and FCRC, although the evidence for the exact procedures of the surveillance is limited. Surveillance can come at a high price if individuals are frequently examined, as this may result in unnecessary colonoscopies in relation to actual risk for CRC. This study analyses the cost-effectiveness of a surveillance programme implemented in the Northern Sweden Health Care Region.
The study includes 259 individuals prospectively recorded in the colonoscopic surveillance programme registry at the Cancer Prevention Clinic, Umeå University Hospital. We performed a cost-utility analysis with a contrafactual design: we compared observed costs and loss of quality-adjusted life years (QALYs) due to CRC with the surveillance programme to an expected outcome without surveillance. The main measure was the incremental cost-effectiveness ratio (ICER) between surveillance and non-surveillance. Scenario analysis was used to explore uncertainty.
The ICER between surveillance and non-surveillance in the base model was 3596€/QALY. The ICER varied from -4620€ in the best-case scenario to 33,779€ in the worst-case scenario.
Colonoscopic surveillance is a very cost-effective method to prevent HCRC and FCRC compared to current thresholds for cost-effectiveness and other cancer preventive interventions.
PubMed ID
28587529 View in PubMed
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Colonoscopic surveillance - a cost-effective method to prevent hereditary and familial colorectal cancer.

https://arctichealth.org/en/permalink/ahliterature283134
Source
Scand J Gastroenterol. 2017 Jun 06;:1-6
Publication Type
Article
Date
Jun-06-2017
Author
Olle Sjöström
Lars Lindholm
Beatrice Melin
Source
Scand J Gastroenterol. 2017 Jun 06;:1-6
Date
Jun-06-2017
Language
English
Publication Type
Article
Abstract
Approximately 20-30% of all colorectal cancer (CRC) cases may have a familial contribution. The family history of CRC can be prominent (e.g., hereditary colorectal cancer (HCRC)) or more moderate (e.g., familial colorectal cancer (FCRC)). For family members at risk, colonoscopic surveillance is a well-established method to prevent both HCRC and FCRC, although the evidence for the exact procedures of the surveillance is limited. Surveillance can come at a high price if individuals are frequently examined, as this may result in unnecessary colonoscopies in relation to actual risk for CRC. This study analyses the cost-effectiveness of a surveillance programme implemented in the Northern Sweden Health Care Region.
The study includes 259 individuals prospectively recorded in the colonoscopic surveillance programme registry at the Cancer Prevention Clinic, Umeå University Hospital. We performed a cost-utility analysis with a contrafactual design: we compared observed costs and loss of quality-adjusted life years (QALYs) due to CRC with the surveillance programme to an expected outcome without surveillance. The main measure was the incremental cost-effectiveness ratio (ICER) between surveillance and non-surveillance. Scenario analysis was used to explore uncertainty.
The ICER between surveillance and non-surveillance in the base model was 3596€/QALY. The ICER varied from -4620€ in the best-case scenario to 33,779€ in the worst-case scenario.
Colonoscopic surveillance is a very cost-effective method to prevent HCRC and FCRC compared to current thresholds for cost-effectiveness and other cancer preventive interventions.
PubMed ID
28587529 View in PubMed
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The cost-effectiveness of interventions targeting lifestyle change for the prevention of diabetes in a Swedish primary care and community based prevention program.

https://arctichealth.org/en/permalink/ahliterature291772
Source
Eur J Health Econ. 2017 Sep; 18(7):905-919
Publication Type
Journal Article
Date
Sep-2017
Author
Anne Neumann
Lars Lindholm
Margareta Norberg
Olaf Schoffer
Stefanie J Klug
Fredrik Norström
Author Affiliation
Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden. Anne.Neumann@uniklinikum-dresden.de.
Source
Eur J Health Econ. 2017 Sep; 18(7):905-919
Date
Sep-2017
Language
English
Publication Type
Journal Article
Keywords
Adult
Aged
Cost-Benefit Analysis
Diabetes Mellitus, Type 2 - prevention & control
Exercise
Female
Health Promotion - economics - organization & administration
Healthy Diet
Healthy Lifestyle
Humans
Male
Markov Chains
Middle Aged
Primary Health Care - economics - organization & administration
Quality-Adjusted Life Years
Sweden
Weight Loss
Abstract
Policymakers need to know the cost-effectiveness of interventions to prevent type 2 diabetes (T2D). The objective of this study was to estimate the cost-effectiveness of a T2D prevention initiative targeting weight reduction, increased physical activity and healthier diet in persons in pre-diabetic states by comparing a hypothetical intervention versus no intervention in a Swedish setting.
A Markov model was used to study the cost-effectiveness of a T2D prevention program based on lifestyle change versus a control group where no prevention was applied. Analyses were done deterministically and probabilistically based on Monte Carlo simulation for six different scenarios defined by sex and age groups (30, 50, 70 years). Cost and quality adjusted life year (QALY) differences between no intervention and intervention and incremental cost-effectiveness ratios (ICERs) were estimated and visualized in cost-effectiveness planes (CE planes) and cost-effectiveness acceptability curves (CEA curves).
All ICERs were cost-effective and ranged from 3833 €/QALY gained (women, 30 years) to 9215 €/QALY gained (men, 70 years). The CEA curves showed that the probability of the intervention being cost-effective at the threshold value of 50,000 € per QALY gained was very high for all scenarios ranging from 85.0 to 91.1%.
The prevention or the delay of the onset of T2D is feasible and cost-effective. A small investment in healthy lifestyle with change in physical activity and diet together with weight loss are very likely to be cost-effective.
Notes
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PubMed ID
27913943 View in PubMed
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Decentralized colonoscopic surveillance with high patient compliance prevents hereditary and familial colorectal cancer.

https://arctichealth.org/en/permalink/ahliterature270727
Source
Fam Cancer. 2016 Mar 2;
Publication Type
Article
Date
Mar-2-2016
Author
Olle Sjöström
Lars Lindholm
Björn Tavelin
Beatrice Melin
Source
Fam Cancer. 2016 Mar 2;
Date
Mar-2-2016
Language
English
Publication Type
Article
Abstract
Although colonoscopic surveillance is recommended both for individuals with known hereditary colorectal cancer (HCRC) syndromes and those with a more moderate familial colorectal cancer (FCRC) history, the evidence for the benefits of surveillance is limited and surveillance practices vary. This study evaluates the preventive effect for individuals with a family history of CRC of decentralized colonoscopic surveillance with the guidance of a cancer prevention clinic. We performed a population based prospective study of 261 patients with HCRC or FCRC, recorded in the colonoscopic surveillance registry at the Cancer genetics clinic, University Hospital of Umeå, Sweden. Colonoscopic surveillance was conducted every second (HCRC) or fifth (FCRC) year at local hospitals in Northern Sweden. Main outcome measures were findings of high-risk adenomas (HRA) or CRC, and patient compliance to surveillance. Estimations of the expected numbers of CRC without surveillance were made. During a total of 1256 person years of follow-up, one case of CRC was found. The expected numbers of cancers in the absence of surveillance was between 9.5 and 10.5, resulting in a standardized incidence ratio, observed versus expected cases of CRC, between 0.10 (CI 95 % 0.0012-0.5299) and 0.11 (CI 95 % 0.0014-0.5857). No CRC mortality was reported, but three patients needed surgical intervention. HRA were found in 5.9 % (14/237) of the initial and in 3.4 % (12/356) of the follow-up colonoscopies. Patient compliance to the surveillance program was 90 % as 597 of the planned 662 colonoscopies were performed. The study concludes that colonoscopic surveillance with high patient compliance to the program is effective in preventing CRC when using a decentralized method for colonoscopy surveillance with the guidance of a cancer prevention clinic.
PubMed ID
26935832 View in PubMed
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Delay to celiac disease diagnosis and its implications for health-related quality of life.

https://arctichealth.org/en/permalink/ahliterature129841
Source
BMC Gastroenterol. 2011;11:118
Publication Type
Article
Date
2011
Author
Fredrik Norström
Lars Lindholm
Olof Sandström
Katrina Nordyke
Anneli Ivarsson
Author Affiliation
Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden. fredrik.norstrom@epiph.umu.se
Source
BMC Gastroenterol. 2011;11:118
Date
2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anxiety - psychology
Celiac Disease - diagnosis - psychology - therapy
Cross-Sectional Studies
Delayed Diagnosis
Depression - psychology
Female
Health status
Humans
Male
Middle Aged
Pain Measurement
Quality of Life - psychology
Quality-Adjusted Life Years
Questionnaires
Sweden
Young Adult
Abstract
To determine how the delay in diagnosing celiac disease (CD) has developed during recent decades and how this affects the burden of disease in terms of health-related quality of life (HRQoL), and also to consider differences with respect to sex and age.
In collaboration with the Swedish Society for Coeliacs, a questionnaire was sent to 1,560 randomly selected members, divided in equal-sized age- and sex strata, and 1,031 (66%) responded. HRQoL was measured with the EQ-5D descriptive system and was then translated to quality-adjusted life year (QALY) scores. A general population survey was used as comparison.
The mean delay to diagnosis from the first symptoms was 9.7 years, and from the first doctor visit it was 5.8 years. The delay has been reduced over time for some age groups, but is still quite long. The mean QALY score during the year prior to initiated treatment was 0.66; it improved after diagnosis and treatment to 0.86, and was then better than that of a general population (0.79).
The delay from first symptoms to CD diagnosis is unacceptably long for many persons. Untreated CD results in poor HRQoL, which improves to the level of the general population if diagnosed and treated. By shortening the diagnostic delay it is possible to reduce this unnecessary burden of disease. Increased awareness of CD as a common health problem is needed, and active case finding should be intensified. Mass screening for CD might be an option in the future.
Notes
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PubMed ID
22060243 View in PubMed
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Does unemployment contribute to poorer health-related quality of life among Swedish adults?

https://arctichealth.org/en/permalink/ahliterature301729
Source
BMC Public Health. 2019 Apr 29; 19(1):457
Publication Type
Journal Article
Date
Apr-29-2019
Author
Fredrik Norström
Anna-Karin Waenerlund
Lars Lindholm
Rebecka Nygren
Klas-Göran Sahlén
Anna Brydsten
Author Affiliation
Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden. fredrik.norstrom@umu.se.
Source
BMC Public Health. 2019 Apr 29; 19(1):457
Date
Apr-29-2019
Language
English
Publication Type
Journal Article
Keywords
Adult
Cross-Sectional Studies
Depression
Female
Health status
Humans
Male
Middle Aged
Quality of Life
Quality-Adjusted Life Years
Sex Factors
Socioeconomic Factors
Sweden - epidemiology
Unemployment - statistics & numerical data
Young Adult
Abstract
Previous studies have shown that unemployment has negative impacts on various aspects of health. However, little is known about the effect of unemployment on health-related quality of life. Our aim was to examine how unemployment impacts upon health-related quality of life among Swedish adults, and to investigate these effects on population subgroups defined by education level, marital status, previous health, and gender.
As part of a cross-sectional study, a questionnaire was sent to 2500 randomly selected individuals aged 20 to 64?years living in Sweden in 2016. The questionnaire included the EuroQol 5 dimensions (EQ-5D) instrument and was answered by 967 individuals (39%). Quality-adjusted life year (QALY) scores were derived from the EQ-5D responses. Of the respondents, 113 were unemployed and 724 were employed. We used inverse probability-weighted propensity scores in our analyses to estimate a risk difference. Gender, age, education level, marital status, and previous health were used as covariates in our analyses.
There was a statistically significant lower QALY score by 0.096 points for the unemployed compared to the employed. There were also statistically significant more problems due to unemployment for usual activities (6.6% more), anxiety/depression (23.6% more), and EQ-5D's Visual Analogue Scale (7.5 point lower score). Grouped analyses indicated a larger negative health effect from becoming unemployed for men, those who are married, and young individuals.
In our study, we show that the health deterioration from unemployment is likely to be large, as our estimated effect implies an almost 10% worse health (in absolute terms) from being unemployed compared to being employed. This further highlights that unemployment is a public health problem that needs more focus. Our study also raises further demands for determining for whom unemployment has the most negative effects and thus suggesting groups of individuals who are in greatest need for labor market measures.
PubMed ID
31035994 View in PubMed
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A gluten-free diet effectively reduces symptoms and health care consumption in a Swedish celiac disease population.

https://arctichealth.org/en/permalink/ahliterature120646
Source
BMC Gastroenterol. 2012;12:125
Publication Type
Article
Date
2012
Author
Fredrik Norström
Olof Sandström
Lars Lindholm
Anneli Ivarsson
Author Affiliation
Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden. fredrik.norstrom@epiph.umu.se
Source
BMC Gastroenterol. 2012;12:125
Date
2012
Language
English
Publication Type
Article
Keywords
Absenteeism
Adult
Aged
Arthralgia - diagnosis - diet therapy
Autoimmune Diseases - diagnosis
Celiac Disease - diet therapy
Cross-Sectional Studies
Delivery of Health Care - utilization
Diet, Gluten-Free
Female
Health Care Surveys
Humans
Length of Stay
Male
Middle Aged
Questionnaires
Self Report
Sweden
Young Adult
Abstract
A gluten-free diet is the only available treatment for celiac disease. Our aim was to investigate the effect of a gluten-free diet on celiac disease related symptoms, health care consumption, and the risk of developing associated immune-mediated diseases.
A questionnaire was sent to 1,560 randomly selected members of the Swedish Society for Coeliacs, divided into equal-sized age- and sex strata; 1,031 (66%) responded. Self-reported symptoms, health care consumption (measured by health care visits and hospitalization days), and missed working days were reported both for the year prior to diagnosis (normal diet) and the year prior to receiving the questionnaire while undergoing treatment with a gluten-free diet. Associated immune-mediated diseases (diabetes mellitus type 1, rheumatic disease, thyroid disease, vitiligo, alopecia areata and inflammatory bowel disease) were self-reported including the year of diagnosis.
All investigated symptoms except joint pain improved after diagnosis and initiated gluten-free diet. Both health care consumption and missed working days decreased. Associated immune-mediated diseases were diagnosed equally often before and after celiac disease diagnosis.
Initiated treatment with a gluten-free diet improves the situation for celiac disease patients in terms of reduced symptoms and health care consumption. An earlier celiac disease diagnosis is therefore of great importance.
Notes
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PubMed ID
22984893 View in PubMed
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