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Search Results: 1 - 10 of 208298 matches for " Curt L?fgren "
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Cost-effectiveness of three malaria treatment strategies in rural Tigray, Ethiopia where both Plasmodium falciparum and Plasmodium vivax co-dominate
Hailemariam Lemma, Miguel San Sebastian, Curt Lfgren, GebreAb Barnabas
Cost Effectiveness and Resource Allocation , 2011, DOI: 10.1186/1478-7547-9-2
Abstract: The study was conducted under a routine health service delivery following the national malaria diagnosis and treatment guideline. Every suspected malaria case, who presented to a health extension worker either at a village or health post, was included. Costing, from the provider's perspective, only included diagnosis and antimalarial drugs. Effectiveness was measured by the number of correctly treated cases (CTC) and average and incremental cost-effectiveness calculated. One-way and two-way sensitivity analyses were conducted for selected parameters.In total 2,422 subjects and 35 health posts were enrolled in the study. The average cost-effectiveness ratio showed that the parascreen pan/pf based strategy was more cost-effective (US$1.69/CTC) than both the paracheck pf (US$4.66/CTC) and the presumptive (US$11.08/CTC) based strategies. The incremental cost for the parascreen pan/pf based strategy was US$0.59/CTC to manage 65% more cases. The sensitivity analysis also confirmed parascreen pan/pf based strategy as the most cost-effective.This study showed that the parascreen pan/pf based strategy should be the preferred option to be used at health post level in rural Tigray. This finding is relevant nationwide as the entire country's malaria epidemiology is similar to the study area.Malaria continues to be a global challenge with half of the world's population at risk of the disease. In 2006 about 250 million episodes of malaria occurred globally with nearly a million deaths, mostly of children under 5 years of age. More than 85% of this disease burden was concentrated in countries in Sub-Saharan Africa (SSA). Ethiopia was one of the five main contributors to the overall African malaria burden [1,2].In Ethiopia, despite the long history of malaria control since the 1950s, the disease is still a major public health problem[3]. Though some improvements, both in mortality and morbidity, have been recently achieved, malaria has been consistently reported as one of the three
Adherence to a six-dose regimen of artemether-lumefantrine among uncomplicated Plasmodium falciparum patients in the Tigray Region, Ethiopia
Hailemariam Lemma, Curt Lfgren, Miguel San Sebastian
Malaria Journal , 2011, DOI: 10.1186/1475-2875-10-349
Abstract: The study was conducted under routine health service delivery at health posts level. Patients/caregivers were not informed about their home visit and were traced on the day after they finished the AL regimen. By combining the response to a structured questionnaire and the tablet count from the blister, adherence level was classified into three categories: definitely non-adherent, probably non-adherent and probably adherent. Reasons for being definitely non-adherent were also assessed. For the purpose of examine risk factors, definitely non-adherent and probably non-adherent was merged into a non-adherent group. Variables found significantly associated (p < 0.05) with the adherence level on the univariate analysis were fitted into a multivariate logistic regression model.Out of the total initially enrolled 180 patients, 86.1% completed the follow-up. Out of these, 38.7% were classified as probably adherent, 34.8% as probably non-adherent, and 26.5% were definitely non-adherent. The most common reasons that definitely non-adherents gave for not taking the full dose were "too many tablets" (37.3%) and to "felt better before finished the treatment course" (25.5%). The adherence of the patients was associated with the ownership of a radio (adjusted odd ratio, AOR: 3.8; 95% CI: 1.66-8.75), the belief that malaria can be treated traditionally (AOR: 0.09; 95% CI: 0.01-0.78) and a delay of more than one day in seeking treatment after the onset of fever (AOR: 5.39; 95% CI: 1.83-15.88).The very low adherence to AL found in this study raises serious concerns for the malaria control in the region. The implementation of a monitoring adherence system is essential to ensure long-term treatment efficacy.Despite the current surge of global efforts to scale up malaria control interventions, the disease is still the leading cause of morbidity, mortality and economic losses in sub-Saharan African (SSA) countries [1,2]. Ethiopia is among the countries which contribute most to this burden
Measuring the value of older people's production: a diary study
Klas-G?ran Sahlen, Curt Lfgren, H?kan Brodin, Lars Dahlgren, Lars Lindholm
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-4
Abstract: Diaries kept for one week were collected among 23 older people in the north of Sweden. The texts were analysed with a grounded theory approach; an interplay between ideas and empirical data.Some productive activities of older people must be valued as the opportunity cost of time or according to the market value, and others must be valued with the replacement cost. In order to make the choice between these methods, it is important to consider the societal entitlement. When there is no societal entitlement, the first or second method must be used; and when it exists, the third must be used.An explicit investigation of the content of the entitlement is needed to justify the choice of valuation method for each activity. In a questionnaire addressing older people's production, each question must be adjusted to the type of production. In order to fully understand this production, it is important to consider the degree of free choice to conduct an activity, as well as health-related quality of life.This article deals with a dilemma in health economics. Healthcare can sometimes improve a person's productive capacity, which is of course a benefit both for the individual and for the rest of society. However, improved productive capacity is usually only valued for persons below normal retirement age. This view is a stereotype - it assumes that people produce up to age 65, after which they only consume. In reality, however, it is reasonable to assume rather that young and old people are heterogeneous, and that some older people may produce much more than we commonly expect. This question has received little attention in health economic guidelines [1]. However, given that more than 17% of the Swedish population are over 65, and that it is well known that people in this age group utilise a large amount of healthcare it is important in Sweden, and similarly in other countries.After this introduction, which includes a brief review of the concept of "value", this article is organise
Endometrial Polyps: Which Patients Should Be Selected for Hysteroscopic Surgery?
—A Study Using Data from the Swedish National Quality Registry of Gynecological Surgery
 [PDF]

Stefan Zacharias, Mats Lfgren
Open Journal of Obstetrics and Gynecology (OJOG) , 2015, DOI: 10.4236/ojog.2015.511084
Abstract: Objective: To illuminate the findings after hysteroscopic surgery of endometrial polyps. Method: Data were extracted from The Swedish National Quality Registry of Gynecological Surgery. Endometrial polyps were identified in 1934 cases in a total of 4512 hysteroscopic operations. Data on all hysteroscopic procedures registered as surgery of endometrial polyps between 1997 and January 2013 were analyzed with logistic regression analysis and effect size was calculated. Main outcome measure was malignancy in endometrial polyps. Results: The most frequently reported symptoms of endometrial polyps were: postmenopausal bleeding, metrorrhagia, pain, and infertility. Among the registered biopsies, there were: 30 malignancies (1.8%), and 41 dysplasias (2.5%). The remaining polyps were benign. Only 1/30 cancer patients were <52 years old (p < 0.001). Among those women with dysplasia, 12/41 (29%) were <52 years old (p = 0.07). All cancer patients at age ≥52 had postmenopausal bleeding. The <52-year-old cancer patient had treatment-resistant bleeding. Increasing weight was a risk factor associated with tissue alterations in endometrial polyps (p = 0.014), controlling for age as a confounding factor. Conclusion: Hysteroscopic surgery should be recommended for women with postmenopausal bleeding and presence of endometrial polyps according to the findings of this study. The results further indicate a low risk of malignancy in premenopausal women <52 years with endometrial polyps. In those cases, it seems to be safe to refrain from surgery.
Remedierad vardag. Mediebruk mellan rutin och dagdr m
Ovar Lfgren
MedieKultur : Journal of Media and Communication Research , 2007,
Abstract: Det r i vardagen som medier konfronteras, blandas och domesticeras. Det r h r globala eller nationella massmedier bearbetas och transformeras till personliga upplevelser och erfarenheter. Varje generation l r sig kombinera gamla och nya medier, och i hemmet sker en intressant kombination av high tech och low tech. Somliga medier blir s vardagliga att de inte l ngre uppfattas som medier. Artikeln tar utg ngspunkt i de s tt varp olika generationer skapar sina egna domesticerade medielandskap och f r nya mediekompetenser. Det kan g lla f rm gan till simultankapacitet, att blanda mediekonsumtion med andra aktiviteter. Hur omorganiserar medierna vardagen och vice versa? Centralt st r diskussionen av mediala mikrofysiker, som hj lper till att skapa rytm och rum, intimitet och avst nd i vardagslivet.
Lack of Consensus and Dense Content in Informational Letters on Benign Gynecological Surgery  [PDF]
Sofia Widetun, Margareta Nilsson, Mats Lfgren, Maria Lindqvist
Open Journal of Obstetrics and Gynecology (OJOG) , 2018, DOI: 10.4236/ojog.2018.814159
Abstract: Objective: This study maps the contents of departmental informational letters and explores whether the national GynOp letters live up to the patients’ expectations and needs. Introduction: Patients who are well informed before undergoing surgery experience reduced stress and increased understanding of the postoperative process. Although providing patients with written information before gynecological surgery is widely used and assumed important, no study has investigated what information patients truly need. Methods: In 2014, all 59 gynecological departments in Sweden were asked to provide the information letter they send to patients before hysterectomy on benign indication. 32 letters were analyzed using frequency analysis. In addition, three focus groups were conducted and these data were submitted to Qualitative Content Analysis. Results: The analysis of the information letters showed great variation and discrepancy in pre-operative information. The analysis of the focus groups resulted in the theme You can’t see the forest for the trees, reflecting that, the women found it very difficult to identify the most important information among the massive amount information received. Conclusions: The informational letters did not meet the patients’ expectations and needs. Practice implications: This study could serve as a foundation for the content of informational letters.
Grenzenlose Visionen. Die Fehmarnbeltregion im Transitkorridor Hamburg-Kopenhagen
Dirk Keil,Karl Lfgren
Nordeuropaforum , 2011,
Abstract: The authors analyse regional integration in Europe in the case of the emerging Femern Belt Region, which is mainly based on the building of a permanent traffic link crossing the Femern Belt. Beyond that, there are only few further common denominators. Therefore the project of region building appears as a rather difficult one. To achieve coherence within a new emerging cross-border region appears a challenge to the re-gions actors. This paper asks how these actors operate and interact across borders with the context given. It takes its point of departure in theories on network governance and new regionalism. Empirically, this paper focuses on a group of decision-makers within the field of local and regional administrations, which are actively involved in cross-border cooperation. Methodologically, the paper is based on qualitative semi-structured interviews with eleven actors in the Femern Belt Region.
Ethnography in the Marketplace
Billy Ehn,Orvar Lfgren
Culture Unbound : Journal of Current Cultural Research , 2009,
Abstract: What happens when cultural analysis enters the world of applied research and academics become consultants working with corporations and public institutions? The divide between academic research and commercial ethnography has often hampered communication and critical exchanges between these two worlds.In this paper we look at the experiences of consultants, drawing on Danish and Swedish examples. What can we learn from them when it comes to organizing research under time pressure, communicating results and making people understand the potentials of cultural analysis? And how could consultants “out there” benefit from a continuing dialogue with their colleagues in Academia?
What physicians want to learn about sickness certification: analyses of questionnaire data from 4019 physicians
Anna Lfgren, Jan Hagberg, Kristina Alexanderson
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-61
Abstract: The data for analysis were collected in 2004 in Stockholm and ?sterg?tland Counties, Sweden, by use of a comprehensive questionnaire about sickness certification issues, which was sent to 7,665 physicians aged ≤ 64 years. The response rate was 71% (n = 5455). Analyses of association and factor analysis were applied to the various aspects of competence to establish a skills index and a knowledge index, which were used to compare the results for physicians in different clinical settings.Most physicians stated they needed more knowledge and skills in handling sickness certification, e.g. regarding how to assess work capacity (44%) and optimal length and degree of sickness absence (50%), and information about aspects of the social insurance system (43-63%). Few (20%) reported needing to know more about issuing sickness certificates. The index scores varied substantially between different clinical settings, and this disparity remained after adjustment for sex, years in practice, workplace policy, and support from management. Scores on the skills index were significantly higher for physicians in primary care than for those working in other areas.A majority of physicians in most types of clinics/practices, not only primary care, indicated the need for more knowledge and skills in handling sickness certification cases. Increased knowledge and skills are needed in order to protect both the health and equity of patients. However, few physicians stated that they needed more skills in filling out sickness certificates, which contradicts previous findings about such documents being of poor quality and suggests that factors other than mere knowledge and skills are involved.Physicians have a key role in the sickness insurance systems in most countries. In Sweden, these medical professionals are responsible for providing the Social Insurance Office (SIO) with sickness certificates for patients who are unable to work as a result of disease or injury. Thus in patient consultations, t
Outcomes of vaginal hysterectomy for uterovaginal prolapse: a population-based, retrospective, cross-sectional study of patient perceptions of results including sexual activity, urinary symptoms, and provided care
Mojgan Pakbaz, Ingrid Mogren, Mats Lfgren
BMC Women's Health , 2009, DOI: 10.1186/1472-6874-9-9
Abstract: We analyzed data from the Swedish National Register for Gynecological Surgery (SNRGS) from January 1997 to August 2005. Women participating in the SNRGS were asked to complete surveys at two and six months postoperatively. Of 941 women who underwent vaginal hysterectomy for uterovaginal prolapse, 791 responded to questionnaires at two months and 682 at six months. Complications during surgery and hospital stay were investigated. The two-month questionnaire investigated complications after discharge, and patients' satisfaction with their health care. Sexual activity and urinary symptoms were reported and compared in preoperative and six-month postoperative questionnaires.Almost 60% of women reported normal activity of daily life (ADL) within one week of surgery, irrespective of their age. Severe complications occurred in 3% and were mainly intra-abdominal bleeding and vaginal vault hematomas. Six months postoperative, sexual activity had increased for 20% (p = 0.006) of women and urinary urgency was reduced for 50% (p = 0.001); however, 14% (n = 76) of women developed urinary incontinence, 76% (n = 58) of whom reported urinary stress incontinence. Patients were satisfied with the postoperative result in 93% of cases and 94% recommended the surgery.Vaginal hysterectomy is a patient-evaluated efficient treatment for uterovaginal prolapse with swift recovery and a low rate of complication. Sexual activity and symptoms of urinary urgency were improved. However, 14% developed incontinence, mainly urinary stress incontinence (11%). Therefore efforts to disclose latent stress incontinence should be undertaken preoperatively.In Sweden, at least 15% of women over the age of 40 years suffer from vaginal prolapse or urinary incontinence [1-3]. The incidence of pelvic organ prolapse increases with age, and by age 80 a woman's lifetime risk of undergoing a single operation for prolapse or urinary incontinence is 11%, with a 29% risk of reoperation [4]. As the population ages, the
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