scholarly journals Risk selection in primary care: a cross-sectional fixed effect analysis of Swedish individual data

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e020402
Author(s):  
David Isaksson ◽  
Paula Blomqvist ◽  
Ronnie Pingel ◽  
Ulrika Winblad
Keyword(s):  
Healthcare Provider ◽  
Primary Healthcare ◽  
Population Based ◽  
Skewed Distribution ◽  
Risk Selection ◽  
Swedish Population ◽  
Cross Sectional ◽  
Percentage Points ◽  
Primary Healthcare Provider ◽  
Private And Public

ObjectiveTo assess socioeconomic differences between patients registered with private and public primary healthcare centres.DesignPopulation-based cross-sectional study controlling for municipality and household.SettingSwedish population-based socioeconomic data collected from Statistics Sweden linked with individual registration data from all 21 Swedish regions.ParticipantsAll individuals residing in Sweden on 31 December 2015 (n=9 851 017) were included in the study.Primary outcome measuresRegistration with private versus public primary healthcare centres.ResultsAfter controlling for municipality and household, individuals with higher socioeconomic status were more likely to be registered with a private primary healthcare provider. Individuals in the highest income quantile were 4.9 percentage points (13.7%) more likely to be registered with a private primary healthcare provider compared with individuals in the lowest income quantile. Individuals with 1–3 years of higher education were 4.7 percentage points more likely to be registered with a private primary healthcare provider compared with those with an incomplete primary education.ConclusionsThe results show that there are notable differences in registration patterns, indicating a skewed distribution of patients and health risks between private and public primary healthcare providers. This suggests that risk selection behaviour occurs in the reformed Swedish primary healthcare system, foremost through location patterns.

Fibromyalgia: Diagnosis and Management for the Primary Healthcare Provider

2008 ◽  
Vol 17 (8) ◽  
pp. 1379-1387 ◽  
Author(s):  
Christine N. Huynh ◽  
Leanne M. Yanni ◽  
Laura A. Morgan
Keyword(s):  
Healthcare Provider ◽  
Primary Healthcare ◽  
Diagnosis And Management ◽  
Primary Healthcare Provider

scholarly journals Quantifying contact patterns in response to COVID-19 public health measures in Canada

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gabrielle Brankston ◽  
Eric Merkley ◽  
David N. Fisman ◽  
Ashleigh R. Tuite ◽  
Zvonimir Poljak ◽  
...  
Keyword(s):  
Public Health ◽  
Population Based ◽  
Skewed Distribution ◽  
Cross Sectional ◽  
Health Measures ◽  
Contact Patterns ◽  
Region Of Residence ◽  
Control Procedures ◽  
The Impact ◽  
Made In

Abstract Background A variety of public health measures have been implemented during the COVID-19 pandemic in Canada to reduce contact between individuals. The objective of this study was to provide empirical contact pattern data to evaluate the impact of public health measures, the degree to which social contacts rebounded to normal levels, as well as direct public health efforts toward age- and location-specific settings. Methods Four population-based cross-sectional surveys were administered to members of a paid panel representative of Canadian adults by age, gender, official language, and region of residence during May (Survey 1), July (Survey 2), September (Survey 3), and December (Survey 4) 2020. A total of 4981 (Survey 1), 2493 (Survey 2), 2495 (Survey 3), and 2491 (Survey 4) respondents provided information about the age and setting for each direct contact made in a 24-h period. Contact matrices were constructed and contacts for those under the age of 18 years imputed. The next generation matrix approach was used to estimate the reproduction number (Rt) for each survey. Respondents with children under 18 years estimated the number of contacts their children made in school and extracurricular settings. Results Estimated Rt values were 0.49 (95% CI: 0.29–0.69) for May, 0.48 (95% CI: 0.29–0.68) for July, 1.06 (95% CI: 0.63–1.52) for September, and 0.81 (0.47–1.17) for December. The highest proportion of reported contacts occurred within the home (51.3% in May), in ‘other’ locations (49.2% in July) and at work (66.3 and 65.4% in September and December). Respondents with children reported an average of 22.7 (95% CI: 21.1–24.3) (September) and 19.0 (95% CI 17.7–20.4) (December) contacts at school per day per child in attendance. Conclusion The skewed distribution of reported contacts toward workplace settings in September and December combined with the number of reported school-related contacts suggest that these settings represent important opportunities for transmission emphasizing the need to support and ensure infection control procedures in both workplaces and schools.

scholarly journals Purple urinary bag syndrome: what every primary healthcare provider should know

2018 ◽  
pp. bcr-2018-226395
Author(s):  
Siddharth Pandey ◽  
Tushar Pandey ◽  
Ashish Sharma ◽  
Satyanarayan Sankhwar
Keyword(s):  
Healthcare Provider ◽  
Primary Healthcare ◽  
Primary Healthcare Provider

scholarly journals Death Associated With Coronavirus (COVID-19) Infection in Individuals With Severe Mental Disorders in Sweden During the Early Months of the Outbreak—An Exploratory Cross-Sectional Analysis of a Population-Based Register Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Martin Maripuu ◽  
Marie Bendix ◽  
Louise Öhlund ◽  
Micael Widerström ◽  
Ursula Werneke
Keyword(s):  
Age Groups ◽  
Population Based ◽  
Register Study ◽  
Control Group ◽  
Swedish Population ◽  
Cross Sectional ◽  
Risk Of Death ◽  
Increased Risk ◽  
Somatic Comorbidity ◽  
Set Up

Background: Individuals with severe mental disorder (SMD) have a higher risk of somatic comorbidity and mortality than the rest of the population. We set up a population-based study to assess whether individuals with SMD had a higher risk of death associated with a COVID-19 infection (COVID-19 associated death) than individuals without SMD.Methods: Exploratory analysis with a cross-sectional design in the framework of a population-based register study covering the entire Swedish population. The Swedish Board for Health and Welfare (Socialstyrelsen) provided anonymized tabulated summary data for further analysis. We compared numbers of COVID-19 associated death in individuals with SMD (cases) and without SMD (controls). We calculated the odds ratio (OR) for the whole sample and by age group and four comorbidities, namely diabetes, cardiovascular disease, hypertension, chronic lung disease.Results: The sample comprised of 7,923,859 individuals, 103,999 with SMD and 7,819,860 controls. There were 130 (0.1%) COVID-19 associated deaths in the SMD group and 4,945 (0.06%) in the control group, corresponding to an OR of 1.98 (CI 1.66-2.35; p < 0.001). The odds were 4-fold for the age groups between 60 and 79 years and 1.5-fold for cardiovascular diseases. Individuals with SMD without any of the risk factors under study had 3-fold odds of COVID-19 associated death.Conclusion: Our preliminary results identify individuals with SMD as a further group at increased risk of COVID-19 associated death. In regard to comorbidities, future studies should explore the potential confounding or mediation role in the relationship between SMD and COVID-19 associated deaths.

scholarly journals Association between added sugar intake and micronutrient dilution: a cross-sectional study in two adult Swedish populations

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Esther González-Padilla ◽  
Joana A. Dias ◽  
Stina Ramne ◽  
Kjell Olsson ◽  
Cecilia Nälsén ◽  
...  
Keyword(s):  
Data Collection ◽  
Dietary Intake ◽  
Daily Intake ◽  
Population Based ◽  
Food Diary ◽  
Swedish Population ◽  
Cross Sectional ◽  
Added Sugar ◽  
Sugar Intake ◽  
The Impact

Abstract Background The evidence on the impact of high sugar consumption on micronutrient dilution does not yet allow for the establishment of clear thresholds of consumption. To establish upper and lower limit intake thresholds for added sugar, more studies from different countries and multiple populations are needed. The aim of this study was to examine the association between the intakes of added sugar and various micronutrients among the adult Swedish population across almost two decades. Methods The data were obtained from the samples from two populations: 1) Riksmaten Adults, a national dietary survey (n = 1797, 44% male, aged 18–80 years, data collection from 2010 to 11) that assessed dietary intake using a 4-day web-based food diary; and 2) the Malmö Diet and Cancer Study, a population-based cohort study (n = 12,238, 45% male, aged 45–68 years, data collection from 1991 to 1994) that assessed dietary intake via a combination of a 7-day food diary, a food frequency questionnaire and an interview. The mean daily intake of nine micronutrients (calcium, folate, iron, magnesium, potassium, selenium, vitamin C, vitamin D, and zinc), adjusted for age, sex, BMI and energy intake, were examined across six added-sugar-intake groups (< 5%E, 5–7.5%E, 7.5–10%E, 10–15%E, 15–20%E, and >  20%E). Results We observed significant inverse associations between the intake of added sugar and the intake of all micronutrients in both populations. The associations were linear; however, we could not determine the threshold of added sugar intake beyond which the micronutrient intake was clearly compromised. Conclusions These findings suggest that in two Swedish populations the higher the intake of added sugar in the diet, the more likely it is that the intake of micronutrients will be compromised, in two Swedish populations. However, although the trends are significant and consistent with those obtained in other studies on the subject, future studies are needed in order to build the necessary scientific knowledge to establish a threshold of added sugar intake based on micronutrient dilution.

scholarly journals Surveillance of indeterminate pulmonary nodules detected with CT in a Swedish population-based study (SCAPIS): psychosocial consequences and impact on health-related quality of life—a multicentre prospective cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e048721
Author(s):  
Elisabeth Andersson ◽  
Ying Dai Ydrefelt ◽  
Marit Johannesson ◽  
Maria Lundbäck ◽  
Maria Mannila ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Pulmonary Nodules ◽  
Population Based ◽  
Health Related Quality ◽  
Swedish Population ◽  
Cross Sectional ◽  
Related Quality ◽  
Health Related

ObjectivesTo investigate whether surveillance of pulmonary nodules detected with low-dose CT (LDCT) impacted health-related quality of life and psychosocial consequences in the Swedish population-based study, Swedish CArdioPulmonary bioImage Study (SCAPIS).DesignA prospective cross-sectional study.Settings and participantsThis multicentre (five sites) observational study, which included a cohort from SCAPIS, consisted of 632 participants with indeterminate pulmonary nodules detected with LDCT. These participants continued surveillance for up to 36 months, during which lung cancer was not detected (surveillance group). Additionally, 972 participants with a negative pulmonary LDCT scan were included as a control group. Matching criteria were LDCT date (±2 weeks), gender and site.Outcome measuresAll participants completed a health-related quality of life questionnaire (RAND-36) and the Consequences of Screening (COS) questionnaire, an average of 3 years after LDCT was conducted at entry into SCAPIS.ResultsParticipants were 51–70 years old at study commencement. Overall, the two groups did not differ in demographic or psychosocial variables, smoking habits or pulmonary medical history. Individuals from countries other than Sweden and those with low socioeconomic status were less likely to participate (p<0.001). No effects on health-related quality of life were observed via RAND-36. In COS, the surveillance group demonstrated a higher OR for anxiety about lung cancer (OR 3.96, 95% CI 2.35 to 6.66, p<0.001), experiencing a sense of dejection (OR 1.35, 95% CI 1.06 to 1.72, p=0.015) and thoughts about existential values (OR 1.30, 95% CI 1.04 to 1.60, p=0.018).ConclusionsLung surveillance with LDCT contributed to significant experiences of sense of dejection, anxiety about lung cancer and development of thoughts about existential values among participants in the surveillance group compared with the controls. The risk of side effects should be communicated for informed decision-making about (non-)attendance in lung cancer screening.

scholarly journals Quantifying Contact Patterns in Response to COVID-19 Public Health Measures in Canada

2021 ◽  
Author(s):  
Gabrielle Brankston ◽  
Eric Merkley ◽  
David N. Fisman ◽  
Ashleigh R. Tuite ◽  
Zvonimir Poljak ◽  
...  
Keyword(s):  
Public Health ◽  
Population Based ◽  
Skewed Distribution ◽  
Cross Sectional ◽  
Social Contacts ◽  
Health Measures ◽  
Contact Patterns ◽  
Region Of Residence ◽  
Control Procedures ◽  
Made In

AbstractBackgroundA variety of public health measures have been implemented during the COVID-19 pandemic in Canada to reduce contact between individuals.ObjectiveThe objective of this study was to construct contact patterns to evaluate the degree to which social contacts rebounded to normal levels, as well as direct public health efforts toward age- and location-specific settings.DesignFour population-based cross-sectional surveys.SettingCanada.ParticipantsMembers of a paid panel representative of Canadian adults by age, gender, official language, and region of residence.MethodsRespondents provided information about the age and setting for each direct contact made in a 24-hour period. Contact matrices were constructed and contacts for those under the age of 18 years imputed. The next generation matrix approach was used to estimate the reproduction number (Rt) for each survey. Respondents with children estimated the number of contacts their children made in school and extracurricular settings.ResultsEstimated Rt values were 0.49 (95% CI: 0.29-0.69) for May, 0.48 (95% CI: 0.29-0.68) for July, 1.06 (95% CI: 0.63-1.52) for September, and 0.81 (0.47-1.17) for December. The highest proportion of reported contacts occurred within the home (51.3% in May), in ‘other’ locations (49.2% in July) and at work (66.3% and 65.4% in September and December). Respondents with children reported an average of 22.7 (95% CI: 21.1-24.3) (September) and 19.0 (95% CI 17.7-20.4) (December) contacts at school per day per child in attendance.ConclusionThe skewed distribution of reported contacts toward workplace settings in September and December combined with the number of reported school-related contacts suggest that these settings represent important opportunities for transmission emphasizing the need to ensure infection control procedures in both workplaces and schools.

scholarly journals Comparing quality of primary healthcare between public and private providers in China: study protocol of a cross-sectional study using unannounced standardised patients in seven provinces of China

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040792
Author(s):  
Dong Xu ◽  
Jay Pan ◽  
Xiaochen Dai ◽  
Mengyao Hu ◽  
Yiyuan Cai ◽  
...  
Keyword(s):  
Private Sector ◽  
Primary Healthcare ◽  
Chinese Government ◽  
Health Coverage ◽  
Primary Analysis ◽  
Clinical Trial Registry ◽  
Cross Sectional ◽  
Private And Public ◽  
Standardised Patients

IntroductionThe Chinese government has encouraged the development of private sector in delivering healthcare, including primary healthcare (PHC) in the new round of national health reform since 2009. However, the debate about the role of the private sector in achieving universal health coverage continues with poor support from theories and empirical evidence. This study intends to compare the quality of PHC services between the private and public providers in seven provinces in China, using unannounced standardised patients (USPs).MethodsWe are developing and validating 13 USP cases most commonly observed in the PHC setting. Six domains of quality will be assessed by the USP: effectiveness, safety, patient centredness, efficiency, timeliness and equity. The USP will make 2200 visits to 705 public and 521 private PHC institutions across seven provinces, following a multistage clustered sample design. Using each USP-provider encounter as the analytical unit, we will first descriptively compare the raw differences in quality between the private and public providers and then analyse the association of ownership types and quality, using propensity score weighting.Ethics and disseminationThe study was primarily funded by the National Natural Science Foundation of China (#71974211, #71874116 and # 72074163) and was also supported by the China Medical Board (#16-260, #18-300 and #18-301), and have received ethical approval from Sun Yat-sen University (#2019–024). The validated USP tool and the data collected in this study will be freely available for the public after the primary analysis of the study.Trial registration numberChinese Clinical Trial Registry: #ChiCTR2000032773.

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