Hälso- och sjukvårdsforskningens framväxt och utveckling

Hälso- och sjukvårdsforskning är ett tvärvetenskapligt, tillämpat forskningsområde som växte fram i vårt land på 1960- och 1970- talen. Denna artikel beskriver vad forskningen handlar om och ger exempel på några tidiga svenska studier inom området, bland an- nat hämtade från Claes Sundelins arbeten om barns hälso- och sjukvård. Medicinska forskningsrådets (MFR) initiativ för hälso- och sjukvårdsforskningen på 1970- och 1980-talen och den vidare utvecklingen av området beskrivs översiktligt.

Health Classifications in the Nordic Countries

This book covers the following: The History of the Classification of Diseases; The Growth of Nordic Cooperation on Classifications; Development of Common Nordic Classifications; ICF – International Developments and Nordic Cooperation. This presentation of Nordic cooperation on health classifications reveals both the positive results that can be achieved and the difficulties that are encountered when different countries and organizations with different professional and administrative development and traditions cooperate

Människans hälsa och ohälsa

Föreliggande uppsatser med det övergripande namnet "Människans hälsa och ohälsa" är utarbetade med utgångspunkt från föredrag vid en KVVS-konferens med samma titel som ägde rum i oktober 2011. I dessa uppsatser behandlas olika problemområden med anknytning till hälsa och ohälsa hos människan. Socialmedicinska frågor som mortalitet, dödsorsaker och morbiditet ges en övergripande beskrivning. Personlig vård inom medicinen kontra regelverk i form av generella riktlinjer beskrivs som delvis kolliderande strategier. Vaccinationsproblematiken diskuteras utifrån erfarenheter från de influensapandemier som drabbar världen med viss regelbundenhet. Smärta och smärtupplevelser behandlas utifrån historiska, diagnostiska och behandlingsmässiga aspekter. Rollen hos brunt fett i vävnader diskuteras utifrån bl.a. nya angreppssätt att komma tillrätta med övervikt och diabetes. Sambanden mellan kostmönster och uppkomst av hjärt-kärlsjukdomar och cancer utreds. En sista uppsats berör fettsyror i bröstmjölk och hur spädbarn tar upp dessa med implikationer för uppkomsten av olika livsstilssjukdomar i vuxen ålder, s.k. epigenetik

Cost containment, solidarity and cautious experimentation: Swedish dilemmas

This paper uses secondary data analysis and a literature review to explore a "Swedish Dilemma": Can Sweden continue to provide a high level of comprehensive health services for all regardless of ability to pay -- a policy emphasizing "solidarity" -- or must it decide to impose increasing constraints on health services spending and service delivery -- a policy emphasizing "cost containment?" It examines recent policies and longer term trends including: changes in health personnel and facilities; integration of health and social services for older persons; introduction of competition among providers; cost sharing for patients; dismantling of dental insurance; decentralization of government responsibility; priority settings for treatment; and encouragement of the private sector. It is apparent that the Swedes have had considerable success in attaining cost containment -- not primarily through "market mechanisms" but through government budget controls and service reduction. Further, it appears that equal access to care, or solidarity, may be adversely affected by some of the system changes.Cost containment Solidarity Access Market reforms System change Health policy Sweden

Psychotropic drug use in a Swedish community--Patterns of individual use during 2 years

Psychotropic drug use in a Swedish community with a general population of about 20,000 was studied using data from a research registry on prescriptions. Patterns of individual psychotropic drug use during 2 years, 1980 and 1981, were analyzed. Use during the second year was studied in relation to use during the first year, and individuals with continued and new use were identified. About two thirds of those who obtained psychotropics during the first year continued using such drugs during the following year. Among those with no use during the first year, 6% obtained psychotropic drugs during the second year. Both continued and new use increased with age. Psychotropic drug use was nearly twice as common among women as compared to men among new users, whereas practically no sex difference was observed in continued use among previous users of psychotropics. Despite the finding that male psychotropic drug users were almost as likely as females to continue using these drugs, the overall proportion of continuous users in the population remained considerably higher among women as compared to men. The results from this study suggest that the greater use of psychotropics among women can be explained by a greater extent of occasional use as well as continuous use among women as compared to men.pharmacoepidemiology psychotropic drugs general population longitudinal study

Validation of automated post-adjustments of HDR prostate brachytherapy treatment plans by quantitative measures and oncologist observer study

PURPOSE: The aim was to evaluate a postprocessing optimization algorithms ability to improve the spatial properties of a clinical treatment plan while preserving the target coverage and the dose to the organs at risk. The goal was to obtain a more homogenous treatment plan, minimizing the need for manual adjustments after inverse treatment planning. MATERIALS AND METHODS: The study included 25 previously treated prostate cancer pa-tients. The treatment plans were evaluated on dose-volume histogram parameters established clin-ical and quantitative measures of the high dose volumes. The volumes of the four largest hot spots were compared and complemented with a human observer study with visual grading by eight oncologists. Statistical analysis was done using ordinal logistic regression. Weighted kappa and Fleiss kappa were used to evaluate intra-and interobserver reliability. RESULTS: The quantitative analysis showed that there was no change in planning target volume (PTV) coverage and dose to the rectum. There were significant improvements for the adjusted treatment plan in: V150% and V200% for PTV, dose to urethra, conformal index, and dose nonhomogeneity ratio. The three largest hot spots for the adjusted treatment plan were significantly smaller compared to the clinical treatment plan. The observers preferred the adjusted treatment plan in 132 cases and the clinical in 83 cases. The observers preferred the adjusted treatment plan on homogeneity and organs at risk but preferred the clinical plan on PTV coverage. CONCLUSIONS: Quantitative analysis showed that the postadjustment optimization tool could improve the spatial properties of the treatment plans while maintaining the target coverage. (c) 2022 The Authors. Published by Elsevier Inc. on behalf of American Brachytherapy Society. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/