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  • 1.
    Areskoug Josefsson, Kristina
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson Bäck, Monica
    Department of Social Work, University of Gothenburg, Gothenburg, Sweden.
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Workers’ experiences of healthy work environment indicators at well-functioning primary care units in Sweden: a qualitative study2018In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, no 4, p. 406-414Article in journal (Refereed)
    Abstract [en]

    Objective: Staff experiences of healthy work environment (HWE) indicators at primary care units can assist in understanding why some primary care units function better than others. The aim of the study was to create increased understanding of how workers experienced HWE indicators at well-functioning primary care units.

    Design: Fifty in-depth interviews with staff at six primary care units in Sweden were analysed with deductive content analysis, revisiting a systematic review of HWE indicators.

    Results: The study presents additional perspectives on staff experiences of HWE indicators at well-functioning primary care units. The included primary care units (PCU) shared a similar pattern of work environment indicators, with unique solutions and strategies to meet shared challenges. Staff at the included PCUs were encouraged to work to create and sustain a HWE, but each domain (indicator) also provided challenges that the staff and organisation needed to meet. The results suggest that useful approaches for a healthy work environment could be to address issues of organisational virtuousness, employee commitment and joy at work.

    Conclusions: Both managers and staff are encouraged to actively work not only to create and sustain an HWE but also to promote organisational virtuousness, employee commitment, joy at work and to increase the performance at work, which is of benefit to staff, patients and society.

    Key Points

    • Staff at well-functioning primary care units (PCUs) experienced healthy work environments
    • The included PCUs shared a similar pattern of work environment indicators, with unique solutions and strategies to meet shared challenges.
    • Staff at the included PCUs were encouraged to work to create and sustain a healthy work environment, but each domain (indicator) also provided challenges that the staff and organisation needed to meet.
    • The results suggest that useful approaches for a healthy work environment could be to address issues of organisational virtuousness, employee commitment and joy at work.
  • 2. Björkelund, Cecilia
    et al.
    Andersson-Hange, Dominique
    Andersson, Kate
    Bengtsson, Calle
    Blomstrand, Ann
    Bondyr-Carlsson, Dorota
    Eiben, Gabriele
    Rödström, Kerstin
    Sjöberg, Agneta
    Sundh, Valter
    Weman, Lilian
    Zylberstein, Dimitri
    Hakeberg, Magnus
    Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Lissner, Lauren
    Secular trends in cardiovascular risk factors with a 36-year perspective: observations from 38- and 50-year-olds in the Population Study of Women in Gothenburg.2008In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 26, no 3, p. 140-146Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To study secular trends in cardiovascular risk factors in four different cohorts of women examined in 1968-1969, 1980-1981, 1992-1993 and 2004-2005. DESIGN: Comparison of four representative cohorts of 38- and 50-year-old women over a period of 36 years. SETTING: Gothenburg, Sweden with approximately 450,000 inhabitants. SUBJECTS: Four representative samples of 38- and 50-year-old women were invited to free health examinations (participation rate 59-90%, n =1901). MAIN OUTCOME MEASURES: Body mass index (BMI), systolic and diastolic blood pressure (SBP, DBP), leisure time exercise, use of antihypertensive medication, smoking, levels of haemoglobin, b-glucose, s-cholesterol, s-triglycerides and HDL-cholesterol. RESULTS: There was no significant difference in mean BMI from 1968-1969 versus 2004-2005. Mean leisure time exercise was significantly higher in later born cohorts; in 1968, around 15% were physically active compared with 40% in 2004. SBP and DBP, mean s-cholesterol and s-triglyceride levels were significantly lower in both 38- and 50-year-old cohorts in 2004-2005 versus 1968-1969. HDL-cholesterol (not measured until 1992-1993), showed a significantly higher mean level in 2004-2005. Reduction of risk factors was apparent in women with a high as well as low level of physical activity. Smoking declined most in women with high levels of physical activity. CONCLUSIONS: Several cardiovascular risk factors related to lifestyle have improved in middle-aged women from the 1960s until today. Most of the positive trends are observed in women with both low and high physical activity.

  • 3.
    Broström, Anders
    et al.
    Jönköping University, School of Health Science, HHJ. ADULT.
    Sunnergren, Ola
    Ryhov Cty Hosp, Ear Nose & Throat Clin, Jönköping, Sweden.
    Årestedt, Kristofer
    Linköping Univ, Fac Hlth Sci, Div Nursing Sci, Dept Med & Hlth Sci, Linköping, Sweden.
    Johansson, Peter
    Linköping Univ Hosp, Dept Cardiol, S-58185 Linköping, Sweden.
    Ulander, Martin
    Linköping Univ Hosp, Dept Clin Neurophysiol, S-58185 Linköping, Sweden.
    Riegel, Barbara
    Linköping Univ, Fac Hlth Sci, Div Cardiovasc Med, Dept Med & Hlth Sci, Linköping, Sweden.
    Svanborg, Eva
    Linköping Univ Hosp, Dept Clin Neurophysiol, S-58185 Linköping, Sweden.
    Factors associated with undiagnosed obstructive sleep apnoea in hypertensive primary care patients2012In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 30, no 2, p. 107-113Article in journal (Refereed)
    Abstract [en]

    Objective. In hypertensive primary care patients below 65 years of age, (i) to describe the occurrence of undiagnosed obstructive sleep apnoea (OSA), and (ii) to identify the determinants of moderate/severe OSA. Design. Cross-sectional. Setting. Four primary care health centres in Sweden. Patients. 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed and treated hypertension (BP > 140/90). Main outcome measures. Occurrence of OSA as measured by the apnoea hypopnoea index (AHI). Results. Mild (AHI 5-14.9/h) and moderate/severe (AHI > 15/h) OSA were seen among 29% and 30% of the patients, respectively. Comparing those without OSA with those with mild or moderate/severe OSA, no differences were found in blood pressure, pharmacological treatment (anti-hypertensive, anti-depressive, and hypnotics), sleep, insomnia symptoms, daytime sleepiness, or depressive symptoms. Obesity (BMI > 30 kg/m(2)) was seen in 30% and 68% of the patients with mild and moderate/severe OSA, respectively. Male gender, BMI > 30 kg/m(2), snoring, witnessed apnoeas, and sleep duration > 8 hours were determinants of obstructive sleep apnoea. Conclusion. Previously undiagnosed OSA is common among patients with hypertension in primary care. Obesity, snoring, witnessed apnoeas, long sleep duration, and male gender were the best predictors of OSA, even in the absence of daytime sleepiness and depressive symptoms.

  • 4.
    Golsäter, Marie
    et al.
    Jönköping University, School of Health and Welfare, HHJ. CHILD. Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Futurum Academy for Health and Care Region Jönköping County, Sweden.
    Johansson, Lars-Olof
    Futurum Academy for Health and Care Region Jönköping County, Sweden.
    Harder, Maria
    Mälardalen University, Sweden.
    General practitioners’ accounts of how to facilitate consultations with toddlers: An interview study2017In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, no 1, p. 3-9Article in journal (Refereed)
    Abstract [en]

    Objective: To describe general practitioners’ (GPs’) accounts of how to facilitate consultations with children aged 1–2 years.

    Design: A qualitative study based on focus group interviews.

    Setting and subjects: Five focus group interviews were conducted with a total of 25 GPs at Swedish primary health care (PHC) centres. The GPs regularly invited toddlers to consultations.

    Result: The GPs’ accounts of how to facilitate consultations with toddlers revealed descriptions of making efforts to instil confidence in the situation to enable the consultation. Toddlers in need of health care always visit the GP with adults such as their parents, guardians or other relatives. Therefore, the GP directs efforts towards the adults and the child more or less simultaneously, as they both need to rely on the GP. The GPs describe how they instil confidence in the adults by establishing a mutual understanding that the consultation is necessary to secure the child’s health. Regarding the child, the GP instils confidence by establishing a relationship in order to approach the child and accomplish bodily examinations.

    Conclusion: The result shows that GPs’ encounters with children in consultations are two-sided. The GP needs to conduct bodily examinations to secure the child’s health and development, but to do so he/she needs to establish purposeful relationships with the adults and the child by instilling confidence. This indicates that establishing relationships in the consultation is significant, and a way to achieve a child-centred consultation.

    KEY POINTS Research regarding GPs’ encounters with toddlers in consultation is limited, even though toddlers frequently visit PHC. GPs make efforts to instil confidence by establishing mutual understanding with parents and a relationship with the child. Establishing purposeful relationships with both the child and parent is significant in enabling the consultation. Establishing a relationship with the child overrides conducting the bodily examination, t opromote the child’s feeling of ease and allow a child-centred consultation.

  • 5. Lindström, Kjell
    et al.
    Ekedahl, Anders
    Carlsten, Anders
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Mölstad, Sigvard
    Can selective serotonin inhibitor drugs in elderly patients in nursing homes be reduced?2007In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 25, no 1, p. 3-8Article in journal (Refereed)
  • 6. Nilsson, S
    et al.
    Baigi, A
    Marklund, B
    Fridlund, Bengt
    Högskolan i Halmstad.
    Trends in the misuse of androgenic anabolic steroids among boys 16-17 years old in a primary health care area in Sweden2001In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 19, no 3, p. 181-182Article in journal (Refereed)
  • 7.
    Norberg, Gabriella
    et al.
    School of Health Sciences, Research Centre PreHospen, University of Borås.
    Sundström, Birgitta W.
    School of Health Sciences, Research Centre PreHospen, University of Borås.
    Christensson, Lennart
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Nyström, Maria
    School of Health Sciences, University of Borås, Sweden.
    Herlitz, Johan
    Sciences, Research Centre PreHospen, University of Borås.
    Swedish emergency medical services' identification of potential candidates for primary healthcare: Retrospective patient record study2015In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 33, no 4, p. 311-317Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate patients who called the emergency medical services (EMS) for primary healthcare (PHC) problems.

    Design: A retrospective and exploratory patient record study from an EMS perspective, comparing two groups: those who were potential candidates for PHC and those who were not. All data were gathered from EMS and hospital records.

    Settings: The study was completed at the EMS and five hospital areas in the western region of Sweden.Subjects: The patients (n=3001) who called the EMS in 2011. Data were missing for 10%.

    Main outcome measures: The frequency and the clinical characteristics of the patients who called the EMS and were actually potential candidates for PHC.

    Results: Of a total of 2703 patients, a group of 426 (16%) were assessed as potential candidates for PHC and could thus be treated at a level of care other than the emergency department. Patients who were classified as suitable for PHC were found at all priority levels and within all symptom groups, but were younger and healthier than the other group.

    Conclusion: Numerous patients seeking help from the EMS do not end up at the most appropriate level in the healthcare system.

    Implications: In the EMS, guidelines are needed to enable pre-hospital emergency nurses to assess and triage patients to the most appropriate level of healthcare.

  • 8. Rodhe, Nils
    et al.
    Löfgren, Sture
    Strindhall, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform.
    Matussek, Andreas
    Mölstad, Sigvard
    Cytokines in urine in elderly subjects with acute cystitis and asymptomatic bacteriuria.2009In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 27, no 2, p. 74-79Article in journal (Refereed)
    Abstract [en]

    Objective. Searching for useful diagnostic tools to discriminate between asymptomatic bacteriuria (ASB) and acute cystitis, this study compared urinary levels of cytokines/chemokines and leukocyte esterase in three groups of elderly subjects; those with acute cystitis, those with ASB, and those without bacteriuria. Design. Comparative laboratory. Setting. Primary care. Subjects. A total of 16 patients with acute cystitis, 24 subjects with ASB, and 20 controls without bacteriuria, all of whom were aged 80 or over. Main outcome measures. Urinary levels of IL-1, TNF-, IL-12, IL-18, CXCL1 (GRO-), CXCL8 (IL-8), CCL2 (MCP-1), IL-6, IL-10, and leukocyte esterase. Results. Urinary levels of CXCL1, CXCL8, and IL-6 were significantly higher in acute cystitis patients than in the ASB group. The sensitivities and specificities for CXCL8, IL-6, and leukocyte esterase to discriminate between acute cystitis and ASB were 63% (95% CI 36-84) and 96% (95% CI 77-100) (cut-off 285 pg/mg creatinine), 81% (95% CI 54-95) and 96% (95% CI 77-100) (cut-off 30 pg/mg creatinine), and 88% (95% CI 60-98) and 79% (95% CI 57-92) (cut-off 2, on a scale of 0-4), respectively. Conclusions. The results indicate that measurement of urinary cytokines, and also leukocyte esterase, when using a cut-off value 2, could be useful in clinical practice to discriminate between symptomatic and asymptomatic urinary tract infections in the elderly. A combination of IL-6 and leukocyte esterase could be even more useful. This needs to be evaluated in prospective studies on the diagnosis and treatment of urinary tract infections in an elderly population.

  • 9.
    Tyrstrup, Mia
    et al.
    Department of Clinical Sciences, General Practice, Lund University, Lund, Sweden.
    van der Velden, Alike
    Department of Clinical Sciences, General Practice, Lund University, Lund, Sweden.
    Engström, Sven
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Primary Care Research and Development Unit, Jönköping, Sweden.
    Goderis, Geert
    Katholieke Universiteit Leuven, Academic Center for General Practice, Leuven, Belgium.
    Molstad, Sigvard
    Department of Clinical Sciences, General Practice, Lund University, Lund, Sweden.
    Verheij, Theo
    Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
    Coenen, Samuel
    Department of Primary and Interdisciplinary Care (ELIZA), Center for General Practice, University of Antwerp, Antwerp, Belgium.
    Adriaenssens, Niels
    Department of Primary and Interdisciplinary Care (ELIZA), Center for General Practice, University of Antwerp, Antwerp, Belgium.
    Antibiotic prescribing in relation to diagnoses and consultation rates in Belgium, the Netherlands and Sweden: use of European quality indicators2017In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 35, no 1, p. 10-18Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the quality of antibiotic prescribing in primary care in Belgium, the Netherlands and Sweden using European disease-specific antibiotic prescribing quality indicators (APQI) and taking into account the threshold to consult and national guidelines.

    DESIGN: A retrospective observational database study.

    SETTING: Routine primary health care registration networks in Belgium, the Netherlands and Sweden.

    SUBJECTS: All consultations for one of seven acute infections [upper respiratory tract infection (URTI), sinusitis, tonsillitis, otitis media, bronchitis, pneumonia and cystitis] and the antibiotic prescriptions in 2012 corresponding to these diagnoses.

    MAIN OUTCOME MEASURES: Consultation incidences for these diagnoses and APQI values (a) the percentages of patients receiving an antibiotic per diagnosis, (b) the percentages prescribed first-choice antibiotics and (c) the percentages prescribed quinolones.

    RESULTS: The consultation incidence for respiratory tract infection was much higher in Belgium than in the Netherlands and Sweden. Most of the prescribing percentage indicators (a) were outside the recommended ranges, with Belgium deviating the most for URTI and bronchitis, Sweden for tonsillitis and the Netherlands for cystitis. The Netherlands and Sweden prescribed the recommended antibiotics (b) to a higher degree and the prescribing of quinolones exceeded the proposed range for most diagnoses (c) in Belgium. The interpretation of APQI was found to be dependent on the consultation incidences. High consultation incidences were associated with high antibiotic prescription rates. Taking into account the recommended treatments from national guidelines improved the results of the APQI values for sinusitis in the Netherlands and cystitis in Sweden.

    CONCLUSION: Quality assessment using European disease-specific APQI was feasible and their inter-country comparison can identify opportunities for quality improvement. Their interpretation, however, should take consultation incidences and national guidelines into account. Differences in registration quality might limit the comparison of diagnosis-linked data between countries, especially for conditions such as cystitis where patients do not always see a clinician before treatment. Key points The large variation in antibiotic use between European countries points towards quality differences in prescribing in primary care.  • The European disease-specific antibiotic prescribing quality indicators (APQI) provide insight into antibiotic prescribing, but need further development, taking into account consultation incidences and country-specific guidelines.  • The incidence of consultations for respiratory tract infections was almost twice as high in Belgium compared to the Netherlands and Sweden.  • Comparison between countries of diagnosis-linked data were complicated by differences in data collection, especially for urinary tract infections.

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