Showing papers by "Stockholm County Council published in 2010"
TL;DR: In this article, a cross-cultural study investigated whether subjective religiosity assessed in three dimensions has a protective effect against attempted suicide in four countries: Brazil, Estonia, Iran, Islamic Republic of Iran and Sri Lanka.
Abstract: This cross-cultural study investigates whether religiosity assessed in three dimensions has a protective effect against attempted suicide. Community controls (n = 5484) were more likely than suicide attempters (n = 2819) to report religious denomination in Estonia (OR = 0.5) and subjective religiosity in four countries: Brazil (OR = 0.2), Estonia (OR = 0.5), Islamic Republic of Iran (OR = 0.6), and Sri Lanka (OR = 0.4). In South Africa, the effect was exceptional both for religious denomination (OR = 5.9) and subjective religiosity (OR = 2.7). No effects were found in India and Vietnam. Organizational religiosity gave controversial results. In particular, subjective religiosity (considering him/herself as religious person) may serve as a protective factor against non-fatal suicidal behavior in some cultures.
103 citations
TL;DR: "High consumers" and "sudden increasers" reported higher levels of alcohol consumption, heavy episodic drinking, and alcohol-related problems both at age 14-16 and at age 19.
91 citations
TL;DR: Computer-based quality assurance of specialist eating disorder care is a possible way of meeting demands for evaluating the real-life effectiveness of treatment, in a large-scale, cost-effective and highly structured way.
Abstract: Computer-based quality assurance of specialist eating disorder (ED) care is a possible way of meeting demands for evaluating the real-life effectiveness of treatment, in a large-scale, cost-effective and highly structured way. The Internet-based Stepwise system combines clinical utility for patients and practitioners, and provides research-quality naturalistic data. Stepwise was designed to capture relevant variables concerning EDs and general psychiatric status, and the database can be used for both clinical and research purposes. The system comprises semi-structured diagnostic interviews, clinical ratings and self-ratings, automated follow-up schedules, as well as administrative functions to facilitate registration compliance. As of June 2009, the system is in use at 20 treatment units and comprises 2776 patients. Diagnostic distribution (including subcategories of eating disorder not otherwise specified) and clinical characteristics are presented, as well as data on registration compliance. Obstacles and keys to successful implementation of the Stepwise system are discussed, including possible gains and on-going challenges inherent in large-scale, Internet-based quality assurance.
77 citations
TL;DR: Smokeless tobacco users show symptoms of nicotine dependence at least as frequently as cigarette smokers, and symptoms of withdrawal during quit attempts are particularly frequent in the subgroup of users who combine smokeless tobacco with smoking.
Abstract: Aims To determine whether symptoms of nicotine dependence, addiction and withdrawal symptoms differ between exclusive smokers, exclusive snus (moist snuff) users and dual users. Design A cross-sectional survey of a cohort subsample. Setting County of Stockholm, Sweden. Participants Current exclusive smokers (n = 466), exclusive snus users (n = 209) and dual users (n = 144), mean age 17.6 years. Measurements Self-reported life-time experienceof nicotinedependenceandwithdrawalsymptomsinperiodsof discontinuedtobaccouse.Selecteditemsfromthe modified FagerstomTolerance Questionnaire (mFTQ), the Hooked on Nicotine Checklist (HONC) and theDiagnostic and StatisticalManualof MentalDisorders(DSM-IV).Findings Theoddsratioof endorsingeachof fourmFTQitemsaswell astheHONCiteminvestigatingtheriskof feelingaddictedtotobaccowastwotofive-foldhigherforexclusivesnususers and for dual users compared to exclusive smokers. One DSM-IV item (difficult to refrain from use) was elevated among dual users compared to smokers. Dual users reported the highest prevalence of any withdrawal symptom in contrast to exclusive snus users, who reported a lower risk of withdrawal symptoms compared to exclusive smokers. Conclusions Smokeless tobacco users show symptoms of nicotine dependence at least as frequently as cigarette smokers. Symptoms of nicotine dependence and of withdrawal during quit attempts are particularly frequent in the subgroup of users who combine smokeless tobacco with smoking.
74 citations
TL;DR: The model will be valuable as an early warning system to start developing guidance for new drugs including systems to monitor their effectiveness, safety and cost-effectiveness in clinical practice and the utilisation and expenditure of drugs is difficult to forecast.
Abstract: New pharmacological therapies are challenging the healthcare systems, and there is an increasing need to assess their therapeutic value in relation to existing alternatives as well as their potential budget impact. Consequently, new models to introduce drugs in healthcare are urgently needed. In the metropolitan health region of Stockholm, Sweden, a model has been developed including early warning (horizon scanning), forecasting of drug utilization and expenditure, critical drug evaluation as well as structured programs for the introduction and follow-up of new drugs. The aim of this paper is to present the forecasting model and the predicted growth in all therapeutic areas in 2010 and 2011. Linear regression analysis was applied to aggregate sales data on hospital sales and dispensed drugs in ambulatory care, including both reimbursed expenditure and patient co-payment. The linear regression was applied on each pharmacological group based on four observations 2006-2009, and the crude predictions estimated for the coming two years 2010-2011. The crude predictions were then adjusted for factors likely to increase or decrease future utilization and expenditure, such as patent expiries, new drugs to be launched or new guidelines from national bodies or the regional Drug and Therapeutics Committee. The assessment included a close collaboration with clinical, clinical pharmacological and pharmaceutical experts from the regional Drug and Therapeutics Committee. The annual increase in total expenditure for prescription and hospital drugs was predicted to be 2.0% in 2010 and 4.0% in 2011. Expenditures will increase in most therapeutic areas, but most predominantly for antineoplastic and immune modulating agents as well as drugs for the nervous system, infectious diseases, and blood and blood-forming organs. The utilisation and expenditure of drugs is difficult to forecast due to uncertainties about the rate of adoption of new medicines and various ongoing healthcare reforms and activities to improve the quality and efficiency of prescribing. Nevertheless, we believe our model will be valuable as an early warning system to start developing guidance for new drugs including systems to monitor their effectiveness, safety and cost-effectiveness in clinical practice.
70 citations
TL;DR: The results showed that participation in everyday activities increased when using cognitive assistive devices, and there is a need for more research with clients with intellectual disabilities and further research concerning long-time use of cognitive Assistive devices.
Abstract: The aim of the study was to describe how people with intellectual disabilities experienced their participation in everyday activities when using cognitive assistive devices. The purpose of cognitiv ...
52 citations
TL;DR: The long-term effectiveness of psychoanalytic psychotherapy for young adults was supported, with low therapist-rated alliance implying that the therapists have identified problematic interactions, which might have mobilized their effort to solve the problems.
Abstract: Objectives. The short- and long-term effects of open-ended, long-term psychoanalytic psychotherapy for young adults were investigated. Possible changes during the year and a half follow-up, as well as predictors of change, were explored. Design. Patients aged 18–25 years who accepted the offered psychoanalytic individual or group psychotherapy were included. Patients filled out questionnaires and were interviewed at intake, termination, and follow-up. Alliance data were collected after the second session of psychotherapy proper. Methods. The primary outcome measures were the Symptom Checklist-90 and the Inventory of Interpersonal Problems. The Helping Alliance Questionnaire-II was used to measure alliance. Mixed model ANOVAs were used to analyse changeover time and prediction of change in relation to gender, treatment format, treatment duration, and in individual psychotherapy, therapist- and patient-rated alliance. Results. All outcome measures changed significantly from intake to follow-up. None changed significantly during the follow-up period, but there was a tendency towards recurring symptoms and an improvement in one of the object relational measures during the follow-up. The latter was the only outcome measure that did not change significantly during treatment. Lower therapist-rated alliance was predictive of greater change in psychiatric symptoms for patients with high levels of symptoms at intake. Conclusions. The long-term effectiveness of psychoanalytic psychotherapy for young adults was supported. Low therapist-rated alliance implies that the therapists have identified problematic interactions, which might have mobilized their effort to solve the problems. Further research on cases reporting no gain or even deterioration is needed.
51 citations
TL;DR: The results indicate that much can be gained through focusing on physicians in other types of clinics as well, when planning interventions to improve sickness-certification practice, including primary health care and general practitioners.
Abstract: Background: How physicians handle sickness-certification is essential in the sickness-absence process. Few studies have focused this task of physicians’ daily work. Most previous studies have only included general practitioners. However, a previous study indicated that this is a common task also among other physicians. The aim of this study was to gain detailed knowledge about physicians’ work with sickness-certification and of the problems they experience in this work. Methods: A comprehensive questionnaire regarding sickness-certification practice was sent home to all physicians living and working in Sweden (N = 36,898; response rate: 61%). This study included physicians aged 5 times a week varied between clinical settings; from 3% in dermatology to 79% in orthopaedics; and was 43% in primary health care. The OR for finding sickness-certification tasks problematic was highest among the physicians working in primary health care (OR 3.3; CI 2.9-3.7) and rheumatology clinics (OR 2.6; CI 1.9-3.5). About 60% found it problematic to assess patients’ work capacity and to provide a prognosis regarding the duration of work incapacity. Conclusions: So far, most interventions regarding physicians’ sickness-certification practices have been targeted towards primary health care and general practitioners. Our results indicate that the ORs for finding these tasks problematic were highest in primary health care. Nevertheless, physicians in some other clinical settings more often have such consultations and many of them also find these tasks problematic, e.g. in rheumatology, neurology, psychiatry, and orthopaedic clinics. Thus, the results indicate that much can be gained through focusing on physicians in other types of clinics as well, when planning interventions to improve sickness-certification practice.
49 citations
TL;DR: A review of studies on the prevalence of suicidal behavior in immigrant youth in various countries and possible explanations for suicidal behaviour in immigrants, especially regarding acculturation, is presented in this paper.
Abstract: Objectives:Little research has focused on the relation of immigration and suicidal behaviour in youth. Nevertheless, the impact of migration on the mental health of youth is an issue of increasing societal importance. This review aimed to present studies on the prevalence of suicidal behaviour in immigrant youth in various countries and to provide possible explanations for suicidal behaviour in immigrant youth, especially regarding acculturation.Methods:The review included a literature search to locate articles on the subject of suicidal behaviour in immigrant youth in the context of acculturation.Results:Studies on suicidal behaviour in culturally diverse youth are few and most of the existing research does not differentiate ethnic minorities from immigrants. Studies on epidemiology and on specific risk factors were found regarding various immigrant youth including Hispanics in the United States, Asians in North America and Europe, as well as comparative studies between different immigrant groups in spec...
48 citations
TL;DR: During May and June 2009 an outbreak of Cyclospora cayetanensis infection involving 12 laboratory-confirmed and 6 probable cases was detected in Stockholm County, Sweden.
Abstract: During May and June 2009 an outbreak of Cyclospora cayetanensis infection involving 12 laboratory-confirmed and 6 probable cases was detected in Stockholm County, Sweden. Imported sugar snap peas from Guatemala were the suspected vehicle, based on information obtained from patient questionnaires. This is the first reported outbreak of cyclosporiasis in Sweden and the second in Europe.
44 citations
TL;DR: The understanding of the GP's responsibility for the patient’s drug list varied, which may be a threat to safe patient care and it is proposed that GPs are made aware of variations in understanding responsibility so that health care quality can be improved.
Abstract: PURPOSE Information about the patient's current drug list is a prerequisite for safe drug prescribing. The aim of this study was to explore general practitioners' (GPs) understandings of who is responsible for the patient's drug list so that drugs prescribed by different physicians do not interact negatively or even cause harm. The study also sought to clarify how this responsibility was managed. METHODS We conducted a descriptive qualitative study among 20 Swedish physicians. We recruited the informants purposively and captured their view on responsibility by semistructured interviews. Data were analyzed using a phenomenographic approach. RESULTS We found variation in understandings about who is responsible for the patient's drug list and, in particular, how the GPs use different strategies to manage this responsibility. Five categories emerged: (1) imposed responsibility, (2) responsible for own prescriptions, (3) responsible for all drugs, (4) different but shared responsibility, and (5) patient responsible for transferring drug information. The relation between categories is illustrated in an outcome space, which displays how the GPs reason in relation to managing drug lists. CONCLUSIONS The understanding of the GP's responsibility for the patient's drug list varied, which may be a threat to safe patient care. We propose that GPs are made aware of variations in understanding responsibility so that health care quality can be improved.
TL;DR: The outbreak of gastroenteritis in Stockholm County, Sweden could have been prevented if the food items prepared by the food handler some hours before vomiting had not been served, and Norovirus GI.3 (Desert Shield) was identified in stool samples from three office workers.
Abstract: Over 400 office workers from the same unit of a manufacturing company in Stockholm County, Sweden, fell ill with gastroenteritis. A retrospective cohort study of office workers in the affected unit demonstrated that canteen visitors on one day had an increased risk of illness [risk ratio (RR) 27.1, 95% confidence interval (CI) 15.7-46.8] compared to non-visitors. A second study, investigating canteen visitors' consumption of particular food items, showed that both tomatoes from the salad buffet (RR 5.6, 95% CI 3.2-9.6) and hamburgers (RR 4.9, 95% CI 2.4-9.8) were the most likely vehicles of infection. Norovirus GI.3 (Desert Shield) was identified in stool samples from three office workers and from a food handler who prepared the tomatoes for the salad buffet and hamburger ingredients before vomiting at the workplace on 12 November. The outbreak could have been prevented if the food items prepared by the food handler some hours before vomiting had not been served.
TL;DR: The psychometric properties of the Swedish version of the OQ-45.2 in a substance abuse sample were satisfactory except for somewhat low internal consistency in the social role subscale.
Abstract: This study described the psychometric properties of the Swedish version of the Outcome Questionnaire (OQ-45.2) in a substance abuse sample (N=227). The test properties were satisfactory except for somewhat low internal consistency in the social role subscale. The results were similar to those obtained in other countries but systematic international comparisons are still lacking.
TL;DR: It is important to be aware of how a country's immigration policies impact on TB control activities among immigrants and to understand this emerging complexity in order to make TB control more effective.
TL;DR: School children with asthma have reductions of spirometric flows when categorized as persistent or transient early onset asthma, even if this latter group of children is completely symptom‐free at school age.
Abstract: Changes in lung function due to childhood asthma have been reported to occur before school age, and to persist throughout life. The aim was to assess the relationship between aspects of lung function and asthma over time in 4,089 children participating in the large population-based birth cohort BAMSE. Questionnaires were administered at 1, 2, 4, and 8 years of age. At 4 and 8 years, children were invited to a clinical examination, in which 2,965 and 2,630 children participated, respectively. The examinations included blood sampling for evaluation of sensitization to airway allergens (n = 2,053), peak expiratory flow (PEF) measurements at 4 and 8 years (n = 1,957), and forced expiratory flows (n = 2,455) at 8 years. Asthma onset before the age of 4 years, but no thereafter, was at 8 years associated with impaired spirometric flows. This was seen irrespective of symptom presence after the age of 4. Reduced PEF growth between the age of 4 and 8 was seen only for the group of children with early onset transient asthma, while an association between sensitization and lung function was only seen in the late-onset asthma group. In conclusion, school children with asthma have reductions of spirometric flows when categorized as persistent or transient early onset asthma, even if this latter group of children is completely symptom-free at school age. Pediatr Pulmonol. 2010; 45:341–348. © 2010 Wiley-Liss, Inc.
TL;DR: A WISC-III profile could not be used to discriminate between the different PDDs, and there was a clear and significant difference in level between children with Asperger's disorder and children with either autistic disorder or PDD-NOS.
Abstract: WISC-III (Wechsler, 1991) index score profiles and their characteristics were examined with traditional statistics in a large Swedish sample consisting of children with autistic disorder (n = 85), Asperger's disorder (n = 341), or pervasive developmental disorders not otherwise specified (PDD-NOS; n = 94). There was a clear and significant difference in level between children with Asperger's disorder, who performed in the average range according to the Swedish standardization, and children with either autistic disorder or PDD-NOS, who performed below the average range (almost 2 standard deviations below the mean), but few other differences between the diagnostic groups were found. The variation in this sample, compared with the Swedish standardization, was generally larger in regard to the size of standard deviations and to the proportion of individuals who exhibited significant differences between indices. The result implied that a WISC-III profile could not be used to discriminate between the different PDDs.
TL;DR: The number of patients and their utilisation of hospital services remained constant and showed a marked decrease in women over 65 years of age and Comparisons with national statistics indicate that the results can be generalised to Sweden.
Abstract: Aim: The objectives were to show how utilisation of hospital care among hip fracture patients has changed in Stockholm during 1998—2007 and to explore changes in some demographic and clinical characteristics as well as surgical treatment of the patients. Methods: The Stockholm County Patient Care Register covers all public healthcare services in the region. All patients from 1998 to 2007 who had a hospital stay due to a hip fracture (ICD-10 codes S72.0, S72.1, S72.2) and had undergone hip surgery (NCSP codes NFB09-99 and NFJ39-99) were identified. Number of hospital stays, surgical procedures, deaths, and length of hospital stay were categorised according to age and sex, and presented as absolute and relative numbers year by year. Age- and sex-standardised annual incidence figures were calculated. Results: A total of 28,528 patients (72.2% women, 27.8% men) were hospitalised due to a hip fracture. The annual numbers decreased during the study period in all age groups except men 85 years and older. The age...
TL;DR: In order to ensure a uniform, transparent and reproducible assessment characterized by limited subjectivity (fewest possible variations among reviewers and in the different assessments of one reviewer), review templates were specifically developed for various study designs.
TL;DR: The Chlamydia Monday has been demonstrated by this study to be a cost-effective intervention and should be considered a wise use of society’s resources.
Abstract: Aims: The study was undertaken to assess the cost-effectiveness of the Chlamydia Monday, 2007. This is a community-based intervention aimed at reducing the prevalence of chlamydia by information and increased availability of testing, treatment and contact tracing in Stockholm. The aim was to analyze the cost-effectiveness by estimating costs, savings and effects on health associated with the intervention, and to determine if cost-effectiveness varies between men and women. Methods: A societal perspective was adopted, meaning all significant costs and consequences were taken into consideration, regardless of who experienced them. A cost-effectiveness model was constructed including costs of the intervention, savings due to avoiding potential costs associated with medical sequels of chlamydia infection, and health gains measured as quality adjusted life years (QALY). Sensitivity analyses were done to explore model and result uncertainty. Results: Total costs were calculated to be €66,787.21; total savings to €30,370.14; and total health gains to 9.852324 QALYs (undiscounted figures). The discounted cost per QALY was €8,346.05 (€10,810.77/QALY for women and €6,085.35/QALY for men). Sensitivity analyses included changes in effectiveness, variation of prevalence, reduced risk of sequel progression, inclusion of prevented future production loss and shortened duration for chronic conditions. The cost per QALY was consistently less than €50,000, which is often regarded as cost-effective in a Swedish context. Conclusions: The Chlamydia Monday has been demonstrated by this study to be a cost-effective intervention and should be considered a wise use of society's resources.
TL;DR: Cat sensitization identified by recombinant Fel d 1 several years before symptoms – results from the bamse cohort are published.
Abstract: Saarne T, Gronlund H, Kull I, Almqvist C, Wickman M, van Hage M. Cat sensitization identified by recombinant Fel d 1 several years before symptoms – results from the bamse cohort. Pediatr Allergy Immunol 2010: 21: 277–283. © 2009 John Wiley & Sons A/S
Exposure to cat is one of the most important causes of allergic disease. The objective of this study was to investigate IgE reactivity to the recombinant major cat allergen, rFel d 1, as an early marker of cat sensitization. Based on questionnaires, 144 children with allergic symptoms due to cat, or where such symptoms were suspected, were selected from the birth cohort BAMSE and allocated into three study groups. Blood samples taken at age 4 and 8 yrs were analysed for IgE to rFel d 1 and cat dander extract (CDE) by quantitative ELISA (cut-off limit 0.037 kUA/l) and the ImmunoCAP™ System (cut-off limit 0.35 kUA/l), respectively. At 4 yrs, 25/33 children with certain allergic symptoms to cat had IgE to both rFel d 1 and CDE, while 14/42 of those suspecting symptoms at 4 had IgE to rFel d 1 and 9/42 to CDE. In a group developing symptoms after 4 yrs, 60/69 had IgE to rFel d 1 and 57/69 to CDE at 8, while 33/69 had IgE to rFel d 1 already at 4 and 26/69 to CDE. This was the only one of the three study groups where a significant increase in the IgE levels to rFel d 1 was found from 4 to 8 yrs (p < 0.001), even when only children with IgE to rFel d 1 already at 4 were included (p < 0.001). We show that the single major cat allergen rFel d 1 is at least as good as CDE in the diagnosis of cat allergy in childhood. With a sensitive rFel d 1 assay cat sensitization can be detected several years before symptoms to cat are reported.
01 Jan 2010
TL;DR: The European Commission launched, in November 2001, a proposal for a new directive on medicinal products for human use within the community, in accordance with the EU process for co-decision, the proposal was submitted to Parliament for reading, and a suggestion was raised in Parliament that the Commission should develop an environmental classification system for human medicinal products.
Abstract: The European Commission launched, in November 2001, a proposal for a new directive on medicinal products for human use within the community. In accordance with the EU process for co-decision, the proposal was submitted to Parliament for reading. In that process a suggestion was raised in Parliament that the Commission should develop an environmental classification system for human medicinal products. The rationale behind the suggestion was the emerging evidence that used human medicinal products often reach the aquatic environment, after normal use or after disposal of unused or expired medicines. The suggestion from Parliament on environmental classification of human medicines was not accepted by the Commission at that time, but the rejection was considered “soft”, i.e. a door was kept open that such a system might be considered later.