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ABS52: Organisation of asthma and COPD care in primary health care in Mid-Sweden.

https://arctichealth.org/en/permalink/ahliterature76340
Source
Prim Care Respir J. 2006 May 20;
Publication Type
Article
Date
May-20-2006
Author
Karin Lisspers
Bjorn Stallberg
Kristina Broms
Mikael Hasselgren
Gunnar Johansson
Peter Odeback
Mats Arne
Christer Janson
Kurt Svardsudd
Author Affiliation
Department of Public Health and Caring Sciences, Uppsala University, Uppsala Science Park, Uppsala, SE 751 85, Sweden.
Source
Prim Care Respir J. 2006 May 20;
Date
May-20-2006
Language
English
Publication Type
Article
PubMed ID
16716736 View in PubMed
Less detail

The association between longer relative leukocyte telomere length and risk of glioma is independent of the potentially confounding factors allergy, BMI, and smoking.

https://arctichealth.org/en/permalink/ahliterature299110
Source
Cancer Causes Control. 2019 Feb; 30(2):177-185
Publication Type
Journal Article
Date
Feb-2019
Author
Ulrika Andersson
Sofie Degerman
Anna M Dahlin
Carl Wibom
Gunnar Johansson
Melissa L Bondy
Beatrice S Melin
Author Affiliation
Department of Radiation Sciences, Oncology, Umea University, Umea, Sweden. ulrika.l.andersson@umu.se.
Source
Cancer Causes Control. 2019 Feb; 30(2):177-185
Date
Feb-2019
Language
English
Publication Type
Journal Article
Keywords
Adult
Aged
Aged, 80 and over
Body mass index
Brain Neoplasms - epidemiology - genetics
Case-Control Studies
Confounding Factors (Epidemiology)
Female
Glioma - epidemiology - genetics
Humans
Hypersensitivity - epidemiology
Leukocytes
Male
Middle Aged
Phenotype
Risk factors
Smoking - epidemiology
Sweden - epidemiology
Telomere
Abstract
Previous studies have suggested an association between relative leukocyte telomere length (rLTL) and glioma risk. This association may be influenced by several factors, including allergies, BMI, and smoking. Previous studies have shown that individuals with asthma and allergy have shortened relative telomere length, and decreased risk of glioma. Though, the details and the interplay between rLTL, asthma and allergies, and glioma molecular phenotype is largely unknown.
rLTL was measured by qPCR in a Swedish population-based glioma case-control cohort (421 cases and 671 controls). rLTL was related to glioma risk and health parameters associated with asthma and allergy, as well as molecular events in glioma including IDH1 mutation, 1p/19q co-deletion, and EGFR amplification.
Longer rLTL was associated with increased risk of glioma (OR?=?1.16; 95% CI 1.02-1.31). Similar to previous reports, there was an inverse association between allergy and glioma risk. Specific, allergy symptoms including watery eyes was most strongly associated with glioma risk. High body mass index (BMI) a year prior diagnosis was significantly protective against glioma in our population. Adjusting for allergy, asthma, BMI, and smoking did not markedly change the association between longer rLTL and glioma risk. rLTL among cases was not associated with IDH1 mutation, 1p/19q co-deletion, or EGFR amplification, after adjusting for age at diagnosis and sex.
In this Swedish glioma case-control cohort, we identified that long rLTL increases the risk of glioma, an association not confounded by allergy, BMI, or smoking. This highlights the complex interplay of the immune system, rLTL and cancer risk.
PubMed ID
30560391 View in PubMed
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Asthma treatment preference study: a conjoint analysis of preferred drug treatments.

https://arctichealth.org/en/permalink/ahliterature15185
Source
Chest. 2004 Mar;125(3):916-23
Publication Type
Article
Date
Mar-2004
Author
Gunnar Johansson
Björn Ställberg
Göran Tornling
Stina Andersson
Göran S Karlsson
Krister Fält
Fredrik Berggren
Author Affiliation
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. gunnar.johansson@lul.se
Source
Chest. 2004 Mar;125(3):916-23
Date
Mar-2004
Language
English
Publication Type
Article
Keywords
Administration, Inhalation
Adolescent
Adrenal Cortex Hormones - therapeutic use
Adult
Anti-Asthmatic Agents - economics - therapeutic use
Asthma - drug therapy
Bronchodilator Agents - therapeutic use
Drug Costs
Female
Humans
Male
Middle Aged
Nebulizers and Vaporizers
Patient satisfaction
Questionnaires
Research Support, Non-U.S. Gov't
Abstract
OBJECTIVE: Assessment of patient preferences for attributes of asthma treatments. METHODS: Two hundred ninety-eight patients (age range, 18 to 60 years) from 15 centers in Sweden completed a questionnaire concerning their asthma, and ranked 18 alternative treatments using conjoint analysis. Patients were receiving treatment with either inhaled corticosteroids (ICS) and short-acting bronchodilator (n = 123) or ICS and long-acting bronchodilator (separate inhalers, n = 87; combination inhaler, n = 88). Attributes analyzed were maintenance treatment, additional reliever, time to onset and duration of reliever, number of symptom-free days (SFDs) per month, and out-of-pocket cost per month. RESULTS: Conjoint analysis showed that the most important aspect of treatment was SFD. Forty percent of the patients had
PubMed ID
15006950 View in PubMed
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Blood pressure levels and risk of cardiovascular events and mortality in type-2 diabetes: cohort study of 34 009 primary care patients.

https://arctichealth.org/en/permalink/ahliterature114320
Source
J Hypertens. 2013 Aug;31(8):1603-10
Publication Type
Article
Date
Aug-2013
Author
Johan Sundström
Reza Sheikhi
Carl J Ostgren
Bodil Svennblad
Johan Bodegård
Peter M Nilsson
Gunnar Johansson
Author Affiliation
Department of Medical Sciences, Uppsala University Hospital, SE-75185 Uppsala, Sweden. johan.sundstrom@medsci.uu.se
Source
J Hypertens. 2013 Aug;31(8):1603-10
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antihypertensive Agents - chemistry
Blood pressure
Blood Pressure Determination
Cardiovascular Diseases - mortality - physiopathology
Cohort Studies
Diabetes Complications - diagnosis
Diabetes Mellitus, Type 2 - diagnosis - physiopathology
Female
Follow-Up Studies
Humans
Hypertension - complications - physiopathology
Male
Middle Aged
Multivariate Analysis
Primary Health Care - organization & administration
Registries
Retrospective Studies
Risk
Sweden
Abstract
The optimal blood pressure (BP) in persons with type-2 diabetes is debated. We investigated shapes of the associations of SBP and DBP levels with risk of cardiovascular events and mortality in a large primary care-based sample of diabetic patients.
We investigated all 34?009 consecutive cardiovascular disease-free type-2 diabetes patients aged 35 years or older (mean age 64 years) at 84 primary care centers in central Sweden between 1999 and 2008. We followed this cohort until the end of 2009 in national registries for the incidence of major cardiovascular events (a composite endpoint of myocardial infarction, stroke, heart failure, or cardiovascular mortality) or total mortality.
During up to 11 years of follow-up, 6344 patients (18.7%) had a first cardiovascular event, and 6235 died (18.3%). The associations of annually updated SBP and DBP with risk of major cardiovascular events were U-shaped. The lowest risk of cardiovascular events was observed at a SBP of 135-139?mmHg and a DBP of 74-76?mmHg, and the lowest mortality risk at a SBP of 142-150?mmHg and a DBP of 78-79?mmHg, in both antihypertensive drug-untreated and drug-treated persons.
In a large primary care-based sample of patients with type-2 diabetes, associations of SBP and DBP with risk of major cardiovascular events and mortality were U-shaped. This may have implications for risk stratification of persons with diabetes.
Notes
Comment In: J Hypertens. 2013 Aug;31(8):1527-823822923
PubMed ID
23625112 View in PubMed
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Comorbidity and health-related quality of life in patients with severe chronic obstructive pulmonary disease attending Swedish secondary care units.

https://arctichealth.org/en/permalink/ahliterature266266
Source
Int J Chron Obstruct Pulmon Dis. 2015;10:173-83
Publication Type
Article
Date
2015
Author
Josefin Sundh
Gunnar Johansson
Kjell Larsson
Anders Lindén
Claes-Göran Löfdahl
Christer Janson
Thomas Sandström
Source
Int J Chron Obstruct Pulmon Dis. 2015;10:173-83
Date
2015
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Bronchitis, Chronic - epidemiology - psychology
Comorbidity
Depression - epidemiology - psychology
Female
Forced expiratory volume
Humans
Lung - physiopathology
Male
Middle Aged
Musculoskeletal Diseases - epidemiology - psychology
Osteoporosis - epidemiology - psychology
Predictive value of tests
Pulmonary Disease, Chronic Obstructive - diagnosis - epidemiology - physiopathology - psychology - therapy
Quality of Life
Questionnaires
Risk assessment
Risk factors
Secondary Care Centers
Severity of Illness Index
Sex Factors
Sweden - epidemiology
Abstract
Our understanding of how comorbid diseases influence health-related quality of life (HRQL) in patients with chronic obstructive pulmonary disease (COPD) is limited and in need of improvement. The aim of this study was to examine the associations between comorbidities and HRQL as measured by the instruments EuroQol-5 dimension (EQ-5D) and the COPD Assessment Test (CAT).
Information on patient characteristics, chronic bronchitis, cardiovascular disease, diabetes, renal impairment, musculoskeletal symptoms, osteoporosis, depression, and EQ-5D and CAT questionnaire results was collected from 373 patients with Forced Expiratory Volume in one second (FEV1)
Notes
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PubMed ID
25653516 View in PubMed
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Comorbidity, disease burden and mortality across age groups in a Swedish primary care asthma population: An epidemiological register study (PACEHR).

https://arctichealth.org/en/permalink/ahliterature296644
Source
Respir Med. 2018 03; 136:15-20
Publication Type
Journal Article
Observational Study
Date
03-2018
Author
Karin Lisspers
Christer Janson
Kjell Larsson
Gunnar Johansson
Gunilla Telg
Marcus Thuresson
Björn Ställberg
Author Affiliation
Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden. Electronic address: karin.lisspers@ltdalarna.se.
Source
Respir Med. 2018 03; 136:15-20
Date
03-2018
Language
English
Publication Type
Journal Article
Observational Study
Keywords
Acute Disease
Adolescent
Adult
Age Distribution
Aged
Asthma - mortality - physiopathology
Child
Cohort Studies
Comorbidity
Female
Forced Expiratory Volume - physiology
Hospitalization - statistics & numerical data
Humans
Male
Middle Aged
Patient Acceptance of Health Care - statistics & numerical data
Prognosis
Registries
Risk factors
Sweden - epidemiology
Young Adult
Abstract
Asthma is often associated with other diseases. To identify and manage comorbidities is important, as these conditions may increase the disease burden.
To describe the prevalence of comorbidities, disease burden and mortality across age groups in a large Swedish primary care real-life asthma population.
Observational cohort study of asthma patients, all ages, identified from electronic medical records by ICD-10-CM code, data from 36 primary care centers. Data were linked to national mandatory Swedish health registers. Comorbidities were identified by ICD-10-CM codes and collected from electronic medical records and the National Patient Registers, mortality data from the Cause of Death Register. Exacerbations were defined as hospitalizations due to asthma, and/or emergency visits at hospital and/or prescription claims of oral steroids.
In total 33,468 patients (58% women) were included. The most prevalent comorbidities were acute upper respiratory tract infection (53%), rhinitis (25%), acute lower respiratory tract infection (25%), hypertension (21%), anxiety and depression (20%). The comorbidities associated with highest risk for an exacerbation were COPD OR 1.98 (95%CI: 1.80-2.19), nasal polyps OR 1.75 (95%CI: 1.49-2.05) and rhinitis OR 1.52 (95%CI: 1.41-1.63). All-cause mortality was similar to the Swedish population, 1011 deaths per 100,000 person/year compared with 1058 deaths (standardized risk?=?0.99 [95%CI:0.95-1.04]). The pulmonary related death rate was greater in the study population versus the Swedish population (122 versus 72 per 100,000person/year).
Comorbid disease was frequent in this large real-life asthma population with an impact on exacerbations. To identify and treat comorbidities with impact on asthma outcomes are essential to improve asthma care.
PubMed ID
29501242 View in PubMed
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COPD health care in Sweden - A study in primary and secondary care.

https://arctichealth.org/en/permalink/ahliterature146912
Source
Respir Med. 2010 Mar;104(3):404-11
Publication Type
Article
Date
Mar-2010
Author
Claes-Göran Löfdahl
Björn Tilling
Tommy Ekström
Leif Jörgensen
Gunnar Johansson
Kjell Larsson
Author Affiliation
Department of Respiratory Medicine and Allergology, Lund University Hospital, SE-222 41 Lund, Sweden. claes-goran.lofdahl@med.lu.se
Source
Respir Med. 2010 Mar;104(3):404-11
Date
Mar-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Guideline Adherence - economics
Humans
Male
Middle Aged
Practice Guidelines as Topic
Process Assessment (Health Care)
Pulmonary Disease, Chronic Obstructive - economics - nursing - therapy
Quality Indicators, Health Care
Quality of Life
Questionnaires
Respiratory Function Tests
Retrospective Studies
Spirometry - economics
Sweden
Treatment Outcome
Abstract
To map out-patients with Chronic Obstructive Pulmonary Disease (COPD) with special reference to patients suffering from acute exacerbations, and to describe COPD health care structure and process in Swedish clinical practice in a real life setting.
Retrospective, non-interventional, epidemiological survey.
141 hospital based out patient clinics (OPC, n=30) and primary health care clinics (PC, n=111) were included in the structure evaluation.
1004 COPD diagnosed patients from 100 of the centres (OPC, n=26) participated in the process evaluation.
All Swedish OPC (n=40) and a random sample of 180 PC were asked to answer a questionnaire regarding COPD care. In addition, data from 10 randomly selected patients with a documented COPD disease were analysed from the centres.
Spirometers were available at all OPCs and at 99% of the PCs. Spirometry had been performed in 52% of PC-patients and in 89% of OPC-patients during the last 2 years prior to the study. More severe patients, as judged by investigator and lung function data, were treated at OPCs than at PCs. Physiotherapists, occupational therapists and dieticians were available at >80% of centres. Exacerbation rate was higher at PCs without a specialized nurse, 2.2/year versus 0.9/year at centres with a specialized nurse.
Special attention to COPD, marked by a specialised nurse in primary care improves the quality, as assessed by a lower number of exacerbations. The structure of COPD care in Sweden for diagnosed individuals seems satisfactory, but could be improved mainly through higher availability and educational activities.
PubMed ID
19963361 View in PubMed
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Cultural adaptation and validation of the Swedish VEINES-QOL/Sym in patients with venous insufficiency.

https://arctichealth.org/en/permalink/ahliterature296027
Source
Phlebology. 2018 Sep; 33(8):540-546
Publication Type
Journal Article
Date
Sep-2018
Author
Helen Sinabulya
Gunnar Bergström
Jan Hagberg
Gunnar Johansson
Lena Blomgren
Author Affiliation
1 Department of Molecular Medicine and Surgery, Division of Vascular Surgery, Karolinska Institutet, Stockholm, Sweden.
Source
Phlebology. 2018 Sep; 33(8):540-546
Date
Sep-2018
Language
English
Publication Type
Journal Article
Keywords
Adaptation, Psychological
Adult
Aged
Aged, 80 and over
Cohort Studies
Female
Humans
Male
Middle Aged
Surveys and Questionnaires
Sweden - epidemiology
Venous Insufficiency - epidemiology - psychology
Abstract
Objectives To translate and evaluate the psychometric properties of the Venous Insufficiency Epidemiological and Economic Studies (VEINES) questionnaire, divided into two subscales; symptoms (VEINES-Sym) and quality of life (VEINES-QOL), in a Swedish cohort of patients with venous disease. Methods The original questionnaire was translated into Swedish with forward-backward translation and administered to 112 patients who were consecutively recruited and had varying degrees of chronic venous disease. Mean age was 54.5?±?15.2 years (range: 19-83) and 75% of the participants were female. All patients completed the RAND 36-item health survey and the VEINES-QOL/Sym. Results The results showed excellent internal consistency for both VEINES-QOL (Cronbach's alpha (a)?=?0.93) and VEINES-Sym (a?=?0.89). Both the VEINES-QOL and VEINES-Sym correlated well to all the RAND-36 domains, demonstrating good construct validity. Exploratory factor analysis confirmed both subscales of the VEINES-QOL/Sym. Conclusions The Swedish VEINES-QOL/Sym is a valid health-related quality of life instrument for chronic venous disease, both for research purposes and for clinical evaluation.
PubMed ID
28954585 View in PubMed
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Dietary advice on prescription: experiences with a weight reduction programme.

https://arctichealth.org/en/permalink/ahliterature281161
Source
J Clin Nurs. 2017 Mar;26(5-6):795-804
Publication Type
Article
Date
Mar-2017
Author
Marie Bräutigam-Ewe
Marie Lydell
Jörgen Månsson
Gunnar Johansson
Cathrine Hildingh
Source
J Clin Nurs. 2017 Mar;26(5-6):795-804
Date
Mar-2017
Language
English
Publication Type
Article
Keywords
Adult
Counseling
Feeding Behavior - psychology
Female
Health Behavior
Health education
Humans
Male
Middle Aged
Nurse's Role
Obesity - nursing
Overweight - nursing
Primary Health Care - methods
Sweden
Weight Reduction Programs
Abstract
To describe overweight persons' experiences with weight reduction and participation in the dietary advice on prescription.
Approximately 20% of overweight individuals are able to successfully lose weight. Experiences from earlier weight reduction programmes indicate that those who succeed typically manage to avoid overeating to handle stress and have high motivation to lose weight. Those who fail have low self-control and engage in negative health behaviours such as eating when experiencing negative emotions and stress.
The study used a descriptive qualitative design and was conducted at a Primary Health Care Centre in south-west Sweden.
The first nineteen study participants who completed the weight reduction programme in two years responded in writing to five open questions about their experiences with the programme. Data were analysed using inductive content analysis.
The participants appreciated the face-to-face meetings with the nurse because they felt seen and listened to during these sessions. They also felt their life situations and self-discipline had an impact on how well they were able to follow the programme. Dietary advice on prescription advice was considered to be helpful for achieving behavioural changes and losing weight. People who succeeded in sustainably losing weight described the importance of support from partners or close friends.
To achieve sustainable weight reduction, it is important to individualise the programme in order to address each person's life situation and the unique difficulties they may encounter.
Motivational interviewing appears to be a good technique for developing a successful relationship between the nurse and the patient. The dietary advice on prescription advice was perceived to be a good way to improve food habits and can easily be used at many Primary Health Care Centres. Patient's partners should also be offered the opportunity to participate in the programme.
PubMed ID
27549032 View in PubMed
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Economic burden of COPD in a Swedish cohort: the ARCTIC study.

https://arctichealth.org/en/permalink/ahliterature295005
Source
Int J Chron Obstruct Pulmon Dis. 2018; 13:275-285
Publication Type
Journal Article
Observational Study
Date
2018
Author
Karin Lisspers
Kjell Larsson
Gunnar Johansson
Christer Janson
Madlaina Costa-Scharplatz
Jean-Bernard Gruenberger
Milica Uhde
Leif Jorgensen
Florian S Gutzwiller
Björn Ställberg
Author Affiliation
Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala.
Source
Int J Chron Obstruct Pulmon Dis. 2018; 13:275-285
Date
2018
Language
English
Publication Type
Journal Article
Observational Study
Keywords
Absenteeism
Age Factors
Aged
Cost of Illness
Female
Health Care Costs - trends
Health Expenditures - trends
Humans
Income
Male
Middle Aged
Models, Economic
Primary Health Care - economics - trends
Pulmonary Disease, Chronic Obstructive - diagnosis - economics - epidemiology - therapy
Registries
Retrospective Studies
Sick Leave - economics
Sweden
Time Factors
Treatment Outcome
Abstract
We assessed direct and indirect costs associated with COPD in Sweden and examined how these costs vary across time, age, and disease stage in a cohort of patients with COPD and matched controls in a real-world, primary care (PC) setting.
Data from electronic medical records linked to the mandatory national health registers were collected for COPD patients and a matched reference population in 52 PC centers from 2000 to 2014. Direct health care costs (drug, outpatient or inpatient, PC, both COPD related and not COPD related) and indirect health care costs (loss of income, absenteeism, loss of productivity) were assessed.
A total of 17,479 patients with COPD and 84,514 reference controls were analyzed. During 2013, direct costs were considerably higher among the COPD patient population (€13,179) versus the reference population (€2,716), largely due to hospital nights unrelated to COPD. Direct costs increased with increasing disease severity and increasing age and were driven by higher respiratory drug costs and non-COPD-related hospital nights. Indirect costs (~€28,000 per patient) were the largest economic burden in COPD patients of working age during 2013.
As non-COPD-related hospital nights represent the largest direct cost, management of comorbidities in COPD would offer clinical benefits and relieve the financial burden of disease.
Notes
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PubMed ID
29391785 View in PubMed
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39 records – page 1 of 4.