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  • Gyllensten, Hanna
    et al.
    Karolinska Institutet; University of Gothenburg.
    Kavaliunas, Andrius
    Karolinska Institutet.
    Murley, Chantelle
    Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet; Karolinska University Hospital.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Costs of illness progression for different multiple sclerosis phenotypes: a population-based study in Sweden2019Ingår i: Multiple Sclerosis Journal Experimental, Translational and Clinical, ISSN 2055-2173, Vol. 5, nr 2, artikel-id 2055217319858383Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Population-based estimates of costs of illness and health-related quality of life, by disability levels among people with multiple sclerosis, are lacking.

    Objectives

    To estimate the annual costs of illness and health-related quality of life, by disability levels, among multiple sclerosis patients, 21–64 years of age.

    Methods

    Microdata from Swedish nationwide registers were linked to estimate the prevalence-based costs of illness in 2013, including direct costs (prescription drug use and specialised healthcare) and indirect costs (calculated using sick leave and disability pension), and health-related quality of life (estimated from the EQ-5D). Disability level was measured by the Expanded Disability Status Scale (EDSS).

    Results

    Among 8906 multiple sclerosis patients, EDSS 0.0–3.5 and 7.0–9.5 were associated with mean indirect costs of SEK 117,609 and 461,357, respectively, whereas direct costs were similar between the categories (SEK 117,423 and 102,714, respectively). Prescription drug costs represented 40% of the costs of illness among multiple sclerosis patients with low EDSS, while among patients with high EDSS more than 80% were indirect costs. Among the 1684 individuals who had reported both EQ-5D and EDSS, the lowest health-related quality of life scores were found among those with a high EDSS.

    Conclusion

    Among people with multiple sclerosis, we confirmed higher costs and lower health-related quality of life in higher disability levels, in particular high indirect costs.

  • Mattsson, Janet
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet.
    It is Time we Become Child Centered at all Children’s Hospitals2019Ingår i: Acta Scientific Paediatrics, ISSN 2581-883X, Vol. 2, nr 9, s. 01-02Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    In the Pediatric Intensive Care Unit (PICU) family- and childcentered care does not have the same prepared tools to relay on as, for example, neonatal care. In neonatal care the parents are quickly involved in the child's care. The caring philosophy NIDCAP (Newborn individualized Developmental Care and Assessment Program) and SFS-Situation adapted family co-operation, are both adapted for the child and for the parents. Both these "utensils" are based on individualizing the nursing care from a family-centered perspective. However, the same prepared tools or tools are not available from a child-centered care perspective, which gives the child a disadvantage and every act of involvement rests upon the nurse’s knowledge and ability to vindicate such child centered care in the caring situation [1]. According to the United Nations Convention on Children's Rights [2], the child´s best interest needs to be put firsthand when health and medical care is given to children. The idea is that the child should be in the center. The focus is thus moved from a family-centered perspective, to a child-centered perspective.

  • Wiberg, Michael
    et al.
    Karolinska Institutet.
    Murley, Chantelle
    Karolinska Institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Palmer, Edward
    Uppsala University.
    Hillert, Jan
    Karolinska Institutet.
    Stenbeck, Magnus
    Karolinska Institutet / Swedish Social Insurance Agency.
    Friberg, Emilie
    Karolinska Institutet.
    Earnings among people with multiple sclerosis compared to references, in total and by educational level and type of occupation: a population-based cohort study at different points in time.2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 7, artikel-id e024836Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To investigate earnings among people with multiple sclerosis (PwMS) before and after MS diagnosis compared with people without MS, and if identified differences were associated with educational levels and types of occupations. Furthermore, to assess the proportions on sickness absence (SA) and disability pension (DP) in both groups.

    DESIGN: Population-based longitudinal cohort study, 10 years before until 5 years after MS diagnosis.

    SETTING: Working-age population using microdata linked from nationwide Swedish registers.

    PARTICIPANTS: Residents in Sweden in 2004 aged 30-54 years with MS diagnosed in 2003-2006 (n=2553), and references without MS (n=7584) randomly selected by stratified matching.

    OUTCOME MEASURES: Quartiles of earnings were calculated for each study year prior to and following the MS diagnosis. Mean earnings, by educational level and type of occupation, before and after diagnosis were compared using t-tests. Tobit regressions investigated the associations of earnings with individual characteristics. The proportions on SA and/or DP, by educational level and type of occupation, for the diagnosis year and 5 years later were compared.

    RESULTS: Differences in earnings between PwMS and references were observed beginning 1 year before diagnosis, and increased thereafter. PwMS had lower mean earnings for the diagnosis year (difference=SEK 28 000, p<0.05), and 5 years after diagnosis, this difference had more than doubled (p<0.05). These differences remained after including educational level and type of occupation. Overall, the earnings of PwMS with university education and/or more qualified occupations were most like their reference peers. The proportions on SA and DP were higher among PwMS than the references.

    CONCLUSIONS: The results suggest that the PwMS' earnings are lower than the references' beginning shortly before MS diagnosis, with this gap increasing thereafter. Besides SA and DP, the results indicate that educational level and type of occupation are influential determinants of the large heterogeneity of PwMS' earnings.

  • Zava, Elena
    et al.
    Röda Korsets Högskola.
    Zuckerman, Amanda
    Röda Korsets Högskola.
    Livet efter förlossningen: Förlossningsskador ur kvinnors perspektiv2019Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    BAKGRUND: Bland förlossningsskador är de vanligaste beskrivna symtomen urin- och fekalinkontinens, smärta under samlag och mellangårdssmärta efter bristningar och suturer. För dom kvinnor som söker vård för långvariga besvär är rutinerna  för uppföljning, utredning och behandling av förlossningsskador bristfällig.

    SYFTE: Syftet med studien var att belysa kvinnors upplevelser av en förlossningsskada och mötet med vården. 

    METOD: En allmän litteraturöversikt baserat på sex artiklar med kvalitativa data. 

    RESULTAT: Två kategorier och fem underkategorier presenteras; Att leva med förlossningsskador- fysiska och emotionella begränsningar i vardagen, normalisering av förlossningsskador och Möte med vården- bristande information och uppföljning, bemötandet från vården. 

    SLUTSATSER: Kvinnor normaliserar idag sina besvär efter en förlossning vilket medför att de inte söker hjälp. Stigmat kring besvären är också en bidragande faktor till att kvinnor undviker att kontakta vården. De upplever också sig som avfärdade av vårdpersonal och en känsla om att inte bli tagna på allvar. Vårdpersonal bör informera kvinnorna om de berörda besvären som kan uppkomma och ge information var de kan söka hjälp.