Diseño de un driver ODBC

The primary objective of the research is to analyze mechanisms behind social differences in health and health care and to develop and evaluate health system interventions in order to increase equity in health. The main fields of the research programme are quality and equity in medical care and health system interventions for vulnerable groups.

The research of the group is established internationally in the field of quality and equity in health

care, and includes international collaboration with several universities. We have contributed to the

development of the studies of avoidable mortality, i.e. mortality from causes of death amenable to medical intervention, by integrating this concept into the field of quality and equity in health care, by introducing a gender perspective, by developing methods for small-area analyses, by performing comparisons with former Soviet Baltic states and by evaluating studies of avoidable factors preceding death. Furthermore we have contributed to the methodological development of cause of death statistics by introducing validity analyses based on international classification rules (ICD) and by targeting for non-obvious errors in causes of death.

We have published several studies on mechanisms behind social differences in health and equity in health care utilization, including studies of potentially vulnerable groups such as unemployed, lone parents and immigrants. We are also studying the consequences of inequity on for instance the health of the children of lone parents and the prognosis for unemployed to return to employment.

The research field also include studies of the diffusion of innovations and implementation of evidence based medicine as well as evaluation of the implementation of organizational programs, such as waiting time guarantee and quality systems in health care.

We are presently developing a research line on health system interventions for vulnerable groups in which a health system and a health promotion approach is combined. In this research field we are collaborating with several counties, municipalities and other authorities in Sweden as well as other research groups and departments at Uppsala University and outside Uppsala. For instance, we are performing evaluations of health system interventions for immigrants, and for persons on long-term sick leave and for school children.

The research group is multi- professional including persons with the backgrounds as medical doctors as well as from behavioural, economical and Public Health sciences.

Members of the group during 2012

Ragnar Westerling, Professor

Per Lytsy, MD, PhD. University adjunct. Achraf Daryani, PhD. Researcher Annika Åhs, PhD, Researcher. Marcus Westin, MD, PhD Marianne Hanning, PhD Lars-Age Johansson, PhD Afsaneh Roshanai, PhD Stefan Kunkel, PhD.

Ulrika Paulsson, Doctoral student Peter Berg, M.D. Doctoral Student, Mikael Skärlund, Research asssistent

Susanne Sundell Lecerof, Doctoral student, collaboration with Lunds and Malmö University Anna Ohlsson, M.D. Clinical research assistant.

Hans Nordlöf, Doctoral student, Collaboration with University of Gävle Ebba Hallberg, MPh

Josefin Wångdahl, MPh, University adjunct Eva Flodström, Mph, Project coordinator Erik Berglund, MPh.

Anna Cooray, Clinical research assistent.

Publications 2010-2012

1. Lytsy P, Hansson AS, Anderzén I. Återgång till arbete är möjlig för långtidssjukskrivna Resultat från samverkansprojekt mellan sjukvården och Försäkringskassan. (In Swedish: Return to work is possible for persons on long term sick leave. Results from a collaboration project between health care and the Social Insurance administration). Läkartidningen 2010;307:1480-1482.

2. Lytsy P, Burell G, Westerling R. Views on treatment necessity, harm, and benefits in patients using statins. Med Decis Making. 2010 Sep-Oct;30(5):594-609.

3. Lytsy P. Slutrapport. Utvärdering av samverkan med rehabkoordinatorer och kontaktpersoner i primärvården respektive psykiatrin under 2010 (In Swedish: Final report. Evaluation of collaboration between rehabilitation coordinators and contact persons in primary care and psychiatry, respectively in 2010.). Dnr PUBCARE 2010/1

4. Anderzén I, Hansson AS, Lytsy P, Liljestam Hurtigh A. Slutrapport – NySatsa Haninge Projekt med syfte att främja individens möjligheter till återgång i arbete genom individuell utveckling och vägledning (In Swedish: Final report – NySatsa haninge- a project aiming at promoting individuals possibilities to return to work by personal development and guidance). Report 2010.

5. Lytsy P, Hansson AS, Anderzén I. Återgång till arbete för långtidssjukskrivna – resultat från pilotprojektet Nysatsa.(In Swedish. Return to work for persons on long term sick leave- results from a pilot study NySatsa). Läkartidningen 2010(107) 22; 1480-82.

6. Lytsy, P. Alternativmedicin som snyggt packad placebo. Recension av boken Snake Oil Science. The Truth about Complementary and Alternative Medicine (R. Barker Bausell). Svenska statistikfrämjandet tidskrift Qvintensen, nr 2010-3

7. Hanning M.Hälsoeconomi- en vetenskapsgren I tillväxt. (In Swedish: Health economic – a growing scientific field). SMT 2010(87):407-413.

8. Lytsy P, Burell G, Westerling R.How do prescribing doctors anticipate the effect of statins? J Eval Clin Pract 2011 Jun;17(3):420-8

9. Westerling R. Internationella jämförelser av åtgärdbar dödlighet. (In Swedish: International comparisons of avoidable mortality). SMT 2010(87):356-369.

10. Hansson AS, Lytsy P, Anderzén I. Restart - Return To Work After Long-tem Sickness Absence From Work: A Quasi-experimental Study. Webmedcentral 2010

(www.webmedcentral.com on 03-Dec-2010, 05:44:24 PM).

11. Johansson LA, Korpi H, Pedersen AG. NOMESCO Report on Mortality Statistics for the Nordic/Baltic Countries. Copenhagen 2010. Nordic Medico-Statistical Committee 92:2010. 12. Lytsy P. Power of the Pill : Views about Cardiovascular Risk and the Risk-reducing Effect of

Statins. SMT 2010(87):433.

13. Fugelstad A, Johansson LA, Thiblin I. Allt fler dör av metadon. »Läckage« från dagens mer liberala behandlingsprogram kan vara en orsak.(In Swedish: More people die from Metadon. A ”leackage” from todays more liberal treatment programs may be an explanation.

Läkartidningen 2010, 18:1225-8.

14. Lytsy P. Power of the Pill: Views about Cardiovascular Risk and the Risk-reducing Effect of Statins. Department of Public Health and Caring Sciences, Social Medicine, Uppsala University, Dissertations from the Faculty of Medicine. Uppsala 2010. (Thesis)

15. Lytsy P. Patienter överskattar statiners preventiva effekt. (In Swedish: Patients overestimate the effects of statins) Läkartidningen 2010;107:1692.

16. Plug I, Hoffmann R, Khoshaba B, Westerling, Jougla E, Rey G, Mckee, M, Mackenbach, JP. AMIEHS, avoidable mortality in the European Union: towards better indicators for the effectiveness of health systems. European J Public Health 2010; 20(suppl 1):93-93.

17. Daryani A. Hälsa – en rättighet för alla? En beskrivning av hälsan bland irakier, som kom till Malmö 2005-2007. (In Swedish: Health – a right for all ? A description of healthamong Iraqi immigrants to Malmö 2005-2007) Report, IMHad 2010. MIM, Malmö högskola,Social Medicine, Uppsala University. Social Medicine and Global Health, Lunds University. 18. Sundell Lecerof S. Olika villkor – olika hälsa. Hälsan bland irakier i åtta av Sveriges län

2008.(In Swedish: Different conditions – different health. Health among Iraqi immigrants in Eight Swedish counties 2008. Report, IMHad 2010. MIM, Malmö högskola, Social

Medicine,Uppsala University. Social Medicine och Global Health, Lunds Universitet. 19. Daryani A. Olika villkor – olika hälsa. Hälsan bland irakier folkbokförda i Malmö2005-2007.

(In Swedish;Different conditions – different health. Health among Iraqi immigrants in Malmö). MIM, Malmö högskola, Social Medicine, Uppsala University. Social Medicine, Department of Public Health and Caring Sciences, Uppsala University och Global Health, Lunds University, Rapport IMHAD 2010.

20. Sundell Lecerof S, Westerling R, Moghaddassi M, Östergren PO. Health information for migrants: the role of educational level in prevention of overweight. Scand J Public Health. 2011 Mar;39(2):172-8.

21. Westerling R. Country specific report on mortality trends in Sweden. In:Plug I, Hoffmann R, Macheknbach J (eds). AMIEHS. Avoidable mortality in the European Union: Towards better indicators for the effectiveness of health systems. : EU Public Health Program 2007106, August 2011.

22. Westerling R, Plug I, Hoffmann R, Khoshaba B, Jougla E, Rey G, Lang K, Parna K, Hellmeier W, Alfonso J, Mckee, M, Mackenbach JP. Between-country variations in the timing of introduction of new interventions. Eur J Public Health 2011;21(suppl 1):183-183 23. Paulsson U, Edlund B, Westerling R. Underlying structure of vulnerability for unhealthy

behaviours in 13-16 year old Swedish Adolescents. Department of Public Health and Caring Sciences, Social Medicine, Uppsala University 2011 (Submitted).

24. Westerling R, Westin M. Analysis of the introduction of new health care interventions. In: Plug I, Hoffmann R, Macheknbach J (eds). AMIEHS. Avoidable mortality in the European Union: Towards better indicators for the effectiveness of health systems. EU Public Health Program 2007106, August 2011.

25. ReyG, AoubaA, PavillonG, HoffmanR, PlugI, WesterlingR, Jougla E, MackenbachJ. Cause-specific mortality time series analysis: a general method to detect and correct for abrupt data production changes. Popul Health Metr. 2011 Sep 19;9:52.

26. Lytsy P, Anderzén I. Slutrapport. Vitalisprojektet 2010-2011. (In Swedish: Vitalis. Final report 2010-2011. CEOS, Academic hospital, Uppsala 2011.

27. Gjertsen F, Johansson LA. Changes in statistical methods affected the validity of official suicide rates. J Clin Epidemiol 2011 Oct;64(10):1102-8.

28. Mackenbach J P. Hoffmann R, Khoshaba B, Plug I, Rey G, Westerling R, Pärna K, Jougla E, Alfonso J, Looman CWN, McKee M. Using ‘amenable mortality’ as indicator of health care effectiveness in international comparisons: results of a validation study. Department of Public Health, Erasmus Medical Center, Rotterdam, London School of Hygiene & Tropical

Medicine, London, INSERM , France, Nordrhein-Westfalen Institute of Health and Work,

Düsseldorf, Germany, Department of Public Health, University of Tartu, Department of Preventive Medicine and Public Health, University of Valencia and Department of Public Health and caring sciences, Uppsala University 2011 (Submitted)

29. Grandahl M, Tyden T,Gottvall M, Westerling R,Oscarsson M. Immigrant women’s experiences and views on prevention of cervical cancer: A qualitative study. Department of Public Health and Caring Scinces, Uppsala University and School of Health and Caring, Linneus University, Kalmar 2011. (Submitted)

30. Wångdahl J, Mårtensson L. The Communicative and critical health literacy scale- Swedish version. Department of Public Health and Caring Sciences, Uppsala University and Department of Social Medicine, Gothenbourg 2011. (Submitted).

31. Daryani A, Löthberg K. Olika villkor – olika hälsa. Modersmålbaserade

hälsokommunikation.(In Swedish; Different conditions .-different health: Home language based health communication. MIM, Malmö högskola, Social Medicine, Department of Public health and Caring Sciences, Uppsala University. Social Medicine och Global Health, Lunds University. Rapport IMHAD 2011.

32. Berg P, Sundelin C, Westerling R. The connection between socioeconomic and psycho-social factors and bicycle helmet use among school children and teenagers. Department of Public Health and Caring Sciences, Social Medicine, Uppsala University (Submitted)

33. Westin M, Sundelin C, Westerling R . Swedish parental characteristics and children’s mental health. Department of Public Health and Caring Sciences, Uppsala University, (submitted). 34. Hoffmann R, Plug I, McKee M, Khoshaba B, Westerling R, Looman C, Rey G, Jougla E,

Luis Alfonso J, Lang K, Pärna K, Mackenbach JP. Innovations in medical care and mortality trends from four circulatory diseases between 1970 and 2005. Department of Public Health, Erasmus Medical Center, Rotterdam, London School of Hygiene & Tropical Medicine, London, INSERM , France, Nordrhein-Westfalen Institute of Health and Work, Düsseldorf, Germany, Department of Public Health, University of Tartu, Department of Preventive Medicine and Public Health, University of Valencia and Department of Public Health and caring sciences,Uppsala University 2011 (Accepted for publication in Eur J Public Health) 35. Lytsy P, Berglund L, Sundström J. A proposal for an additional clinical trial outcome measure

assessing preventive effect as delay of events. Eur J Epidemiol. 2012 Dec;27(12):903-9. doi: 10.1007/s10654-012-9752-0. Epub 2012 Dec 7.

36. Hanning M, Åhs A, Winblad U, Lundström M: Impact of increased patient choice of providers in Sweden: cataract surgery. J Health Serv Res Policy 2012(Apr);17(2):101-5 37. Roshanai AH, Lampic C, Ingvoldstad C, Björvatn C, Rosenquist R, Nordin K. What

Information Do Cancer Genetic Counselees Prioritize? J Genet Couns. 2012 Aug;21(4):510- 26.

38. Roshanai, A H, Nordin K., Berglund G. Factors influencing primary Care physicians’ decision to order prostate-specific antigen (PSA) test for healthy men. [Accepted for publication in Acta Oncologica)

39. Westerling R. Utveckla formerna för att främja invandrares hälsa och integration. (In Swedish; Develop the methods for promoting the health and integration of immigrants) SMT 2012;89:99-103.

40. Daryani A, Löthberg K, Feldman I, Westerling R. Olika villkor – olika hälsa. (In Swedish; Different conditions – different health) SMT 2012;89:112-125.

41. Tillman A, Westerling R. Nyinvandrade irakiers syn på hälsa och den svenska hälso- och sjukvården. (In Swedish; Newly immigrated iraques perceptions on health and the Swedish health care) SMT 2012;89:126-130.

42. Löthberg K, Fryklund B. Westerling R, Daryani A, Stafström M. Hälsokommunikation på modersmål –gör den någon skillnad ? Etablering, utveckling och värdering. (In Swedish;

Health communication in home language –does it make any difference? Establishment, development and evaluation) SMT 2012;89:131-139.

43. SkärlundM, Annika Åhs A, Westerling R. Health-related and social factors predicting non- reemployment amongst newly eunemployed. BMC Public Health 2012 Oct 23;12(1):893. 44. Mackenbach J P. Hoffmann R, Khoshaba B, Plug I, Rey G, Westerling R, Pärna K, Jougla E,

Alfonso J, Looman CWN, McKee M. Using ‘amenable mortality’ as indicator of health care J Epidemiol Community Health 2012 Sep 25. [Epub ahead of print)]

45. Grandahl M, Tyden T,Gottvall M, Westerling R, Oscarsson M. Immigrant women’s experiences and views on prevention of cervical cancer: A qualitative study. Health Expect. 2012 Dec 16. doi: 10.1111/hex.12034. [Epub ahead of print]

46. Berglund E. Lytsy P. Westerling R. Adherence to and beliefs in lipid lowering medical treatments: A structural equation modelling approach including the Necessity-Concern framework and locus of control factors. Department of Public Health and Caring Sciences, Social Medicine. Uppsala University. (In press in Patient Education and Counseling) 47. Westerling R, Westin M, McKee M, Hoffmann R, Plug I, Rey G, Jougla , Lang K, Pärna K,

Alfonso JL, Mackenbach, JP. The timing of introduction of pharmaceutical innovations in seven European countries Department of Public Health, Erasmus Medical Center, Rotterdam, London School of Hygiene & Tropical Medicine, London, INSERM , France, Department of Public Health, University of Tartu, Department of Preventive Medicine and Public Health, University of Valencia and Department of Public Health and caring sciences, Uppsala University 2012. (submitted)

48. Åhs A, Burell G, Westerling R. Care or Not Care-that is the Question: Predictors of

Healthcare Utilisation in Relation to Employment Status.Int J Behav Med. Int J Behav Med. 2012 Mar;19(1):29-38

49. Lytsy P, Burell G, Westerling R. Cardiovascular risk factor assessments and health

behaviours in patients using statins compared to a non-treated population. Int J Behav Med. Int J Behav Med. 2012 Jun;19(2):134-42

50. Hoffmann R, Plug I, Khoshaba B, McKee M, Mackenbach JP, AMIEHS working group. Amenable mortality revisited: the AMIEHS study. Gac Sanit. 2012 Nov 30. doi:pii: S0213- 9111(12)00258-0. 10.1016/j.gaceta.2012.08.004. [Epub ahead of print]

51. HELMI – Health, Migration and Integration. Somaliska och thailändska kvinnors hälsa och arbetsmarknadsanknytning i Sverige. (In Swedish; Health and working life associations of immigrants from Somalia and Thailand). MIM, Malmö högskola, Social Medicine,

Department of Public health and Caring Sciences, Uppsala University. Social Medicine och Global Health, Lunds University. Research report 2012.

52. Sundell Lecerof S, Stafström M, Westerling R, östergren P O. Can social capital protect individuals from the negative effects of post-migration risk factors for poor mental health among Iraqi migrants in Sweden? Social medicine and global health, Department of Clinical Sciences Malmö, Lund University and Social Medicine, Department of Public Health and Caring Sciences, Uppsala University 2012. (Submitted)

53. Flodström E. Unga irakiers syn på sexuell och reproduktiv hälsa och rättigheter. (In Swedish; Young Iraqis view on sexual and reproductive health and rights) SMT 2012;89: 140-149140- 149

54. Paulsson U, Edlund B, Westerling R. Age-related differences in vulnerability structure for unhealthy behaviours in Swedish Adolescents: a cross-sectional study. Department of Public Health and Caring Sciences, Social Medicine, Uppsala University 2012 (Submitted).

Agencies that support the work/Funding

Health, Migration and Integration. ((partnership with Malmö University, Lunds University, the municipalities of Bollebygds, Herrljunga, Marks, Svenljunga, Tranemo, Ulricehamn and the employment office of Borås. European Integration Fund. 3 635 000 skr 2010-2012.

Health examinations for asylum seekers: (partnership with the Swedish Institute for Communicable Disease Control, the Migration Board, the National Board of Health and Welfare, the Swedish organization of local authorities, Umeå University and regions and the counties(regions) of

Stockholm, Östergötland, Skåne and Norrbotten):30 000 000 (3 441 000 managed at our department) year 2012-2014 European refugee fund.

Athena (partnership with the municipality, county and employment office of Uppsala):4 389 146 skr (2 056 000 skr managed at our department) year 2012-2014. European Social fund.

Academic Hospital, Uppsala.

Research projects