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Adjuvant Stereotactic Radiosurgery Reduces Need for Retreatments in Patients with Meningioma Residuals.

https://arctichealth.org/en/permalink/ahliterature275577
Source
World Neurosurg. 2016 Apr;88:475-82
Publication Type
Article
Date
Apr-2016
Author
Arvid Frostell
Ramil Hakim
Ernest Dodoo
Georges Sinclair
Marcus Ohlsson
Petter Förander
Biljana Milovac
Lou Brundin
Mikael Svensson
Source
World Neurosurg. 2016 Apr;88:475-82
Date
Apr-2016
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Aged, 80 and over
Disease-Free Survival
Female
Humans
Male
Meningeal Neoplasms - mortality - pathology - surgery
Meningioma - mortality - pathology - surgery
Middle Aged
Needs Assessment
Neoplasm Recurrence, Local - mortality - prevention & control
Neoplasm, Residual
Neurosurgical Procedures - mortality - utilization
Prevalence
Radiosurgery - mortality - utilization
Radiotherapy, Adjuvant - mortality - utilization
Reoperation - mortality - utilization
Retrospective Studies
Risk factors
Sex Distribution
Survival Rate
Sweden - epidemiology
Treatment Outcome
Young Adult
Abstract
Radical surgical resection of cerebral meningiomas involving the dura mater of venous sinuses is challenging, and tumor residuals are frequently left after surgery. This study sought to evaluate the effect of adjuvant stereotactic radiosurgery (aSRS) on the time to significant growth of meningioma residuals requiring retreatment.
A total of 119 consecutive patients (2004-2013) receiving primary surgical treatment for a meningioma in proximity to a venous structure were included. The patients were assessed retrospectively, with a focus on retreatments and mortality. Radicality of initial tumor surgery was scored using postoperative magnetic resonance imaging. Three subgroups were identified: 1) radical total resection (RTR); 2) near-total resection (NTR), followed by aSRS (NTR + aSRS); and 3) NTR but no aSRS (NTR - aSRS). In the NTR - aSRS group, intervention was initiated after radiologic (magnetic resonance imaging) findings verified growth of residual tumor, in contrast to the NTR + aSRS group, which received aSRS before regrowth. Time to first retreatment, progression-free survival (PFS), and overall survival were analyzed with the log-rank test and multiple-events Cox regression.
RTR was associated with the best prognosis. The patients in the NTR + aSRS group had significantly longer time to first retreatment compared with NTR - aSRS patients (P
PubMed ID
26546994 View in PubMed
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Adolescents alcohol-use and economic conditions: a multilevel analysis of data from a period with big economic changes.

https://arctichealth.org/en/permalink/ahliterature146664
Source
Eur J Health Econ. 2010 Dec;11(6):533-41
Publication Type
Article
Date
Dec-2010
Author
Mikael Svensson
Curt Hagquist
Author Affiliation
Department of Economics, Swedish Business School, Örebro University, Örebro, Sweden. mikael.svensson@oru.se
Source
Eur J Health Econ. 2010 Dec;11(6):533-41
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Age Factors
Alcohol Drinking - economics - epidemiology
Alcoholism - economics - epidemiology
Confidence Intervals
Cross-Sectional Studies
Female
Health Surveys
Humans
Logistic Models
Male
Multivariate Analysis
Odds Ratio
Questionnaires
Regression Analysis
Risk factors
Stress, Psychological - economics
Sweden
Time Factors
Unemployment - psychology - statistics & numerical data
Young Adult
Abstract
This paper examines how the unemployment rate is related to adolescent alcohol use and experience of binge drinking during a time period characterized by big societal changes. The paper uses repeated cross-sectional adolescent survey data from a Swedish region, collected in 1988, 1991, 1995, 1998, 2002 and 2005, and merges this with data on local unemployment rates for the same time periods. Individual level frequency of alcohol use as well as experience of binge drinking is connected to local level unemployment rate to estimate the relationship using multilevel modeling. The model includes municipality effects controlling for time-invariant differences between municipalities as well as year fixed effects controlling for municipality-invariant changes over time in alcohol use. The results show that the unemployment rate is negatively associated with adolescents' alcohol use and the experience of binge drinking. When the unemployment rate increases, more adolescents do not drink at all. Regular drinking (twice per month or more) is, on the other hand, unrelated to the unemployment rate. Examining gender-differences in the relationship, it is shown that the results are driven by behavior in girls, whereas drinking among boys does not show any significant relationship with changes in the unemployment rate.
PubMed ID
20012126 View in PubMed
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Alcohol use and social interactions among adolescents in Sweden: do peer effects exist within and/or between the majority population and immigrants?

https://arctichealth.org/en/permalink/ahliterature97679
Source
Soc Sci Med. 2010 Jun;70(11):1858-64
Publication Type
Article
Date
Jun-2010
Author
Mikael Svensson
Author Affiliation
Orebro University, Orebro, Sweden. mikael.svensson@oru.se
Source
Soc Sci Med. 2010 Jun;70(11):1858-64
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adolescent Behavior - psychology
Adolescent Psychology
Alcohol Drinking - epidemiology - ethnology
Emigrants and Immigrants - psychology - statistics & numerical data
Empirical Research
Female
Health Surveys
Humans
Interpersonal Relations
Logistic Models
Male
Multilevel Analysis
Peer Group
Schools
Social Environment
Sweden - epidemiology
Abstract
Are adolescents who attend schools with a high level of alcohol use and binge drinking more likely to use alcohol and binge drink themselves? This paper analyzes peer effects in adolescent drinking based on a survey of 13,070 adolescents conducted in Sweden in 2005. The empirical analysis uses a multi-level logistic model to account for non-observable heterogeneity between the schools and the results show that attending a school with a high level of alcohol use and frequent binge drinking is a strong predictor of alcohol use and binge drinking for the individual. Hardly any significant interaction effects are detected, implying that peer influence is similar across different adolescent sub-groups. Looking at adolescents with different ethnic backgrounds, it is found that the drinking-pattern of the Swedish majority population has a significant effect on drinking by Swedish individuals and immigrants from Nordic and European countries, but no effect on drinking by immigrants from non-European countries.
PubMed ID
20236746 View in PubMed
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Cognitive, physical, and psychological status after intracranial aneurysm rupture: a cross-sectional study of a Stockholm case series 1996 to 1999.

https://arctichealth.org/en/permalink/ahliterature125409
Source
World Neurosurg. 2013 Jan;79(1):130-5
Publication Type
Article
Date
Jan-2013
Author
Ann-Christin von Vogelsang
Mikael Svensson
Yvonne Wengström
Christina Forsberg
Author Affiliation
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. ann-christin.von-vogelsang@ki.se
Source
World Neurosurg. 2013 Jan;79(1):130-5
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Adult
Aged
Aged, 80 and over
Aneurysm, Ruptured - psychology - surgery
Anxiety Disorders - diagnosis - psychology
Cognition - physiology
Cognition Disorders - diagnosis - psychology
Cross-Sectional Studies
Depressive Disorder - diagnosis - psychology
Disability Evaluation
Female
Humans
Intracranial Aneurysm - psychology - surgery
Male
Middle Aged
Postoperative Complications - diagnosis - psychology
Questionnaires
Survivors - psychology
Sweden
Treatment Outcome
Young Adult
Abstract
We sought to (1) describe psychological, physical, and cognitive functions in patients 10 years after intracranial aneurysm rupture and (2) identify any differences in outcome variables between age groups, gender or aneurysm locations.
A consecutive sample of patients (n=217) treated for intracranial aneurysm rupture at a neurosurgical clinic in Stockholm, Sweden, were followed-up in a cross-sectional design 10.1 years after the onset with questionnaires and telephone interviews. The outcome measures were psychological functions in terms of symptoms of anxiety or depression and physical and cognitive functions.
Compared with the reference groups, the aneurysm patients scored greater levels of anxiety and depression than normal values. Patients with aneurysm rupture in the posterior circulation scored significantly more problems with anxiety and depression. Only 2.8% of the patients scored for severe physical disability. On a group level, cognition was lower than normal population levels; 21.7% of respondents scored below the cut-off value, indicating cognitive impairments.
Ten years after aneurysm rupture the majority of patients seem to be well-functioning physically, whereas the psychological and cognitive functions are affected. A screening of the mental health of these patients in connection to radiological follow-up might be helpful to identify which patients need further referral to psychiatric treatment for anxiety and depression disorders.
Notes
Comment In: World Neurosurg. 2013 Jan;79(1):60-122743199
PubMed ID
22484070 View in PubMed
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Copayments and physicians visits: A panel data study of Swedish regions 2003-2012.

https://arctichealth.org/en/permalink/ahliterature285757
Source
Health Policy. 2016 Sep;120(9):1095-9
Publication Type
Article
Date
Sep-2016
Author
Niklas Jakobsson
Mikael Svensson
Source
Health Policy. 2016 Sep;120(9):1095-9
Date
Sep-2016
Language
English
Publication Type
Article
Keywords
Aged
Cost Sharing - economics
Health Services Accessibility - economics
Humans
Office Visits - economics - utilization
Physicians
Primary Health Care
Sweden
Abstract
This paper analyzes how primary care physician visits are affected by the level of copayment in Sweden.
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.
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.
We cannot reject that the copayment has no statistical or economic effect of significance, and we estimate the "zero effect" with very high precision.
In a setting with sub-national regions with autonomy to set co-payments 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.
PubMed ID
27477892 View in PubMed
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A cost-effectiveness analysis of lowering residential radon levels in Sweden-Results from a modelling study.

https://arctichealth.org/en/permalink/ahliterature296204
Source
Health Policy. 2018 06; 122(6):687-692
Publication Type
Journal Article
Date
06-2018
Author
Mikael Svensson
Lars Barregård
Gösta Axelsson
Eva Andersson
Author Affiliation
Health Metrics, The Sahlgrenska Academy, University of Gothenburg, Box 414, SE 405 30, Gothenburg, Sweden. Electronic address: mikael.svensson.2@gu.se.
Source
Health Policy. 2018 06; 122(6):687-692
Date
06-2018
Language
English
Publication Type
Journal Article
Keywords
Air Pollution, Indoor - adverse effects - economics - prevention & control
Cost-Benefit Analysis
Housing
Humans
Lung Neoplasms - etiology
Models, Statistical
Quality-Adjusted Life Years
Radon - toxicity
Sweden
Abstract
Residential exposure to radon is considered as the second leading cause of lung cancer after smoking. The purpose of this study was to conduct a cost-effectiveness analysis of reducing the indoor radon levels in Sweden from the current reference level of 200?Bq/m3 to the WHO suggested reference level of maximum 100?Bq/m3.
We constructed a decision-analytic cost-effectiveness model using input data from published literature and administrative records. The model compared the increase in economic costs to the health benefits of lower indoor radon-levels in a Swedish policy context. We estimated the cost per life-year and quality adjusted life year (QALY) gained and assessed the robustness of the results using both deterministic and probabilistic sensitivity analysis.
Including (excluding) costs of added life years the cost per QALY for existing homes was €130,000 (€99,000). For new homes the cost per QALY including (excluding) costs of added life years was €39,000 (€25,000).
The results indicate that it is not cost-effective to reduce indoor radon levels from 200?Bq/m3 to a maximum of 100?Bq/m3 in existing homes, whereas it is cost-effective for new homes.
PubMed ID
29576334 View in PubMed
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The Cost-Effectiveness of the Kiva Antibullying Program: Results from a Decision-Analytic Model.

https://arctichealth.org/en/permalink/ahliterature302649
Source
Prev Sci. 2018 08; 19(6):728-737
Publication Type
Evaluation Study
Journal Article
Date
08-2018
Author
Mattias Persson
Linn Wennberg
Linda Beckman
Christina Salmivalli
Mikael Svensson
Author Affiliation
Department of Economics, School of Business, Örebro University, 701 82, Orebro, Sweden. mattias.persson@oru.se.
Source
Prev Sci. 2018 08; 19(6):728-737
Date
08-2018
Language
English
Publication Type
Evaluation Study
Journal Article
Keywords
Adolescent
Bullying - prevention & control
Child
Cost-Benefit Analysis
Decision Support Techniques
Finland
Humans
Program Evaluation - economics
Abstract
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.
PubMed ID
29728796 View in PubMed
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The cost-effectiveness of the Olweus Bullying Prevention Program: Results from a modelling study.

https://arctichealth.org/en/permalink/ahliterature277050
Source
J Adolesc. 2015 Dec;45:127-37
Publication Type
Article
Date
Dec-2015
Author
Linda Beckman
Mikael Svensson
Source
J Adolesc. 2015 Dec;45:127-37
Date
Dec-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Bullying - prevention & control
Child
Cost-Benefit Analysis
Female
Health Promotion - economics
Humans
Male
School Health Services - economics
Students - psychology
Surveys and Questionnaires
Sweden
Abstract
Exposure to bullying affects around 3-5 percent of adolescents in secondary school and is related to various mental health problems. Many different anti-bullying programmes are currently available, but economic evaluations are lacking. The aim of this study is to identify the cost effectiveness of the Olweus Bullying Prevention Program (OBPP). We constructed a decision-tree model for a Swedish secondary school, using a public payer perspective, and retrieved data on costs and effects from the published literature. Probabilistic sensitivity analysis to reflect the uncertainty in the model was conducted. The base-case analysis showed that using the OBPP to reduce the number of victims of bullying costs 131,250 Swedish kronor (€14,470) per victim spared. Compared to a relevant threshold of the societal value of bullying reduction, this indicates that the programme is cost-effective. Using a relevant willingness-to-pay threshold shows that the OBPP is a cost-effective intervention.
PubMed ID
26433734 View in PubMed
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Descriptive epidemiology in relation to gender differences and treatment modalities 10 years after intracranial aneurysm rupture in the Stockholm cohort 1996-1999.

https://arctichealth.org/en/permalink/ahliterature121553
Source
World Neurosurg. 2013 Sep-Oct;80(3-4):328-34
Publication Type
Article
Author
Ann-Christin von Vogelsang
Yvonne Wengström
Mikael Svensson
Christina Forsberg
Author Affiliation
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Red Cross University College, Stockholm, Sweden. Electronic address: ann-christin.von-vogelsang@ki.se.
Source
World Neurosurg. 2013 Sep-Oct;80(3-4):328-34
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Aneurysm, Ruptured - epidemiology - mortality - surgery
Cause of Death
Cohort Studies
Data Interpretation, Statistical
Female
Follow-Up Studies
Glasgow Outcome Scale
Humans
Intracranial Aneurysm - epidemiology - mortality - surgery
Kaplan-Meier Estimate
Male
Middle Aged
Neurosurgical Procedures - statistics & numerical data
Sex Factors
Subarachnoid Hemorrhage - epidemiology - surgery
Surgical Instruments
Survival Analysis
Sweden - epidemiology
Young Adult
Abstract
To describe epidemiology in relation to gender differences and treatment modalities 10 years after intracranial aneurysm rupture in the Stockholm cohort 1996-1999.
A total of 468 consecutive patients with aneurysmal subarachnoid hemorrhage were followed-up in a retrospective cohort design 10 years after rupture. Information on medical history, clinical variables, and treatments were obtained from patient records. Causes of death were obtained from patient records and The Swedish Cause of Death Register. Incidence of ruptured aneurysms per 100,000 people were calculated from male, female, and overall population data per year from 1996-1999.
Ten years after aneurysm rupture 63.9% (n = 296) of patients were still alive. The overall 28-day case fatality was 19.4%; most often deaths were due to the initial hemorrhage. There were no significant differences in survival time between patients treated with clipping (8.4 years, 95% confidence interval 8.1-8.8), compared with endovascularly treated patients (8.2 years, 95% confidence interval 7.4-9.1) (log rank P = 0.550). The female incidence was higher than that of men, and women were significantly older at the onset of aneurysm rupture (55.7 vs. 52.8 years, P = 0.027).
Ten years after rupture, most treated patients were still alive. The mortality was highest in the first month after rupture, due to the initial hemorrhage. Gender differences were apparent in incidence, but 10 years after the rupture mortality rates and survival times were equal between men and women. Survival time was equal between patients within active treatment modalities.
Notes
Comment In: World Neurosurg. 2013 Sep-Oct;80(3-4):264-523111207
PubMed ID
22898030 View in PubMed
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Economic costs of antidepressant use: a population-based study in Sweden.

https://arctichealth.org/en/permalink/ahliterature306918
Source
J Ment Health Policy Econ. 2019 Dec 01; 22(4):125-130
Publication Type
Journal Article
Date
Dec-01-2019
Author
Linda Beckman
Laura von Kobyletzki
Mikael Svensson
Author Affiliation
Department of Public Health, Karlstad University, Universitetsgatan 2, 65188, Karlstad. Sweden, E-mail: linda.beckman@kau.se.
Source
J Ment Health Policy Econ. 2019 Dec 01; 22(4):125-130
Date
Dec-01-2019
Language
English
Publication Type
Journal Article
Keywords
Adolescent
Aged
Antidepressive Agents - economics - therapeutic use
Cost of Illness
Depressive Disorder - drug therapy - economics - epidemiology
Female
Health Care Costs - statistics & numerical data
Health Expenditures - statistics & numerical data
Humans
Mental Health Services - economics - statistics & numerical data
Population Surveillance - methods
Sweden - epidemiology
Abstract
Prescription of antidepressant drugs (ADs) has increased in recent decades, with rising costs for patients as well as for the health care system. There is sparse evidence of which factors explain the high economic costs and financial burden for the general population.
The aim was to assess individual-level determinants of out-of-pocket and total health care costs of AD use in the Swedish general population.
We randomly sampled 400,000 individuals aged 18+ from Statistics Sweden's population register from 2010 to 2013. Two-part regression models were used for our two primary outcome variables: (i) total health care costs for AD use per year and individual, and (ii) total out-of-pocket costs of AD use per year and individual.
Women, the unemployed, unmarried people and residents of big cities have both higher use of ADs and higher associated total health care and out-of-pocket costs. Today, ADs are relatively inexpensive and average cost differences among all groups are therefore minor. The elderly have higher use of ADs, but are more commonly low-volume users and do not have higher total health care or out-of-pocket costs.
Groups with relatively low socioeconomic status are at risk of higher costs for antidepressant use. However, given the Swedish system of drug subsidies, differences in financial burden for individuals are minor. The limitations of this study included that we lacked data on diagnosis and could therefore not categorize the reasons for AD consumption. Furthermore, our results may not be generalized to other countries with a lower AD prevalence then Sweden's, since our estimates are dependent on the point prevalence of antidepressant use in the population.
Groups with higher AD consumption and economic costs may suffer from more severe depression owing to more risk factors and less social support in their surroundings, and may be in greater need of additional treatment and support than other groups.
Our results offer insight at an aggregate level, and more information on the underlying causes of higher costs is needed to discern the policy implications.
PubMed ID
32058977 View in PubMed
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29 records – page 1 of 3.