BackgroundColorectal cancer (CRC) diagnostics are challenging in primary care and reliable diagno... more BackgroundColorectal cancer (CRC) diagnostics are challenging in primary care and reliable diagnostic aids are desired. Qualitative faecal immunochemical tests (FITs) have been used for suspected CRC in Sweden since the mid-2000s, but evidence regarding their effectiveness is scarce. Anaemia and thrombocytosis are both associated with CRC.AimTo evaluate the usefulness of qualitative FITs requested for symptomatic patients in primary care, alone and combined with findings of anaemia and thrombocytosis, in the diagnosis of CRC.Design and settingA population-based cohort study using electronic health records and data from the Swedish Cancer Register, covering five Swedish regions.MethodPatients aged ≥18 years in the five regions who had provided FITs requested by primary care practitioners from 1 January 2015 to 31 December 2015 were identified. FIT and blood-count data were registered and all CRC diagnoses made within 2 years were retrieved. Diagnostic measurements were calculated.Res...
UNSTRUCTURED Key informant interviews found challenges to the digitialization of health care in S... more UNSTRUCTURED Key informant interviews found challenges to the digitialization of health care in Sweden across areas of technical, regulatory, and patient safety and quality of care. While technical conditions are favorable, digitalization may reinforce existing inequalities. The regulatory environment is weak with several actors with unclear mandates and roles. Digital care needs to be evaluated to ensure patient safety. Enhanced availability of data may improve decision making and quality of care. The COVID-19 pandemic enhanced the role of digital care and provided a safe way to deliver services. Further analyses will expand the understanding of some of the preconditions for effective digitalization of health care.
ObjectiveHigh vitreous levels of soluble (s)CD163 have been demonstrated in severe diabetic retin... more ObjectiveHigh vitreous levels of soluble (s)CD163 have been demonstrated in severe diabetic retinopathy (DR). The aim of this study was to explore the predictive values of plasma sCD163 and glycated haemoglobin (HbA1c) for DR progression in adults with type 1 diabetes.Methods and analysesThe study design was prospective. Fundus photography performed in 2009 and at follow-up (≤12 years later) were compared after being categorised according to the International Clinical Diabetic Retinopathy Disease Severity Scale. ‘DR progression at least one level’ was calculated. In 2009, data collection (sex, age, diabetes duration, metabolic variables, serum creatinine, macroalbuminuria and lifestyle factors) and biochemical analyses were performed. Plasma sCD163 and HbA1c were divided into quartiles. Logistic regression analyses were performed.ResultsThe prevalence of DR in 2009 versus at follow-up in 270 participants (57% male) were: no apparent 28% vs 18%; mild 20% vs 13%; moderate 24% vs 26%; ...
UNSTRUCTURED Key informant interviews found challenges to the digitialization of health care in S... more UNSTRUCTURED Key informant interviews found challenges to the digitialization of health care in Sweden across areas of technical, regulatory, and patient safety and quality of care. While technical conditions are favorable, digitalization may reinforce existing inequalities. The regulatory environment is weak with several actors with unclear mandates and roles. Digital care needs to be evaluated to ensure patient safety. Enhanced availability of data may improve decision making and quality of care. The COVID-19 pandemic enhanced the role of digital care and provided a safe way to deliver services. Further analyses will expand the understanding of some of the preconditions for effective digitalization of health care.
Journal of General Internal Medicine, Apr 30, 2017
Geriatrics in primary carePrevention, Population and Disease management (PrePoD)Public Health and... more Geriatrics in primary carePrevention, Population and Disease management (PrePoD)Public Health and primary car
Contentment in the moment”Contentment in the moment” is a classic grounded theory exploring safet... more Contentment in the moment”Contentment in the moment” is a classic grounded theory exploring safety and contentment within a small community in northern Norway. The purpose of the study was to explo ...
This is a classic grounded theory based in longitudinal data from everyday life in an environment... more This is a classic grounded theory based in longitudinal data from everyday life in an environment in Northern Norway characterized by long distances, a harsh climate and people living close to nature and each other. The place has a history of poverty and isolation. Yet, old survival strategies prevail despite modernisation. The theory reveals a culture of momentary contentment with three dimensions: Doing safety, destiny readiness and middle consciousness. This momentary contentment culture explains how the participants resolve their main concern of enjoying life. Doing safety means that common and individual acts create stability. Destiny readiness illuminates a discourse of acceptance, a way of thinking that, with the aid of linguistic strategies, prepares for life changing events. Middle consciousness shows a way of handling difficulties by dividing and separating different phenomena.
The usefulness of Faecal Immunochemical Tests alone and combined with blood counts in the diagnos... more The usefulness of Faecal Immunochemical Tests alone and combined with blood counts in the diagnosis of colorectal cancer in primary care in Sweden
AimsBecause evidence regarding risk stratification predicting prognosis of patients with heart fa... more AimsBecause evidence regarding risk stratification predicting prognosis of patients with heart failure (HF) decompensation attended in primary care is lacking, we developed and externally validated a model to forecast death/hospitalization during the first 30 days after an episode of decompensation. The predictive model is based on variables easily obtained in primary care settings.Methods and resultsHEFESTOS is a multinational study consisting of a derivation cohort of HF patients recruited in 14 primary healthcare centres in Barcelona and a validation cohort from primary healthcare in 9 other European countries. The derivation and validation cohorts included 561 and 250 patients, respectively. Percentages of women in the derivation and validation cohorts were 56.3% and 47.6% (P = 0.026), respectively. Mean age was 82.2 years (SD 8.03) in the derivation cohort, and 79.3 years (SD 10.3) in the validation one (P = 0.001). HF with preserved ejection fraction represented 72.1% in the d...
ObjectivesCancer survival rates vary widely between European countries, with differences in timel... more ObjectivesCancer survival rates vary widely between European countries, with differences in timeliness of diagnosis thought to be one key reason. There is little evidence on the way in which different healthcare systems influence primary care practitioners’ (PCPs) referral decisions in patients who could have cancer.This study aimed to explore PCPs’ diagnostic actions (whether or not they perform a key diagnostic test and/or refer to a specialist) in patients with symptoms that could be due to cancer and how they vary across European countries.DesignA primary care survey. PCPs were given vignettes describing patients with symptoms that could indicate cancer and asked how they would manage these patients. The likelihood of taking immediate diagnostic action (a diagnostic test and/or referral) in the different participating countries was analysed. Comparisons between the likelihood of taking immediate diagnostic action and physician characteristics were calculated.SettingCentres in 20...
Background Depression is a risk factor for type 2 diabetes (T2D) and cardiovascular disease (CVD)... more Background Depression is a risk factor for type 2 diabetes (T2D) and cardiovascular disease (CVD). The aims were to explore the prevalence of depression, anxiety, antidepressant use, obesity, Hemoglobin A1c > 64 mmol/mol, life-style factors, pre-existing CVD, in patients with newly diagnosed T2D; to explore associations with depression; and to compare with Swedish general population data. Methods Multicentre, cross-sectional study. Inclusion criteria: adults with serologically verified newly diagnosed T2D. Included variables: age, sex, current depression and anxiety (Hospital Anxiety and Depression Scale), previous depression, antidepressant use, obesity (BMI ≥ 30 and ≥ 40 kg/m2), Hemoglobin A1c, pre-existing CVD. Logistic regression analyses were performed. Results In 1027 T2D patients, aged 18–94 years, depression was associated with age (per year) (inversely) (odds ratio (OR) 0.97), anxiety (OR 12.2), previous depression (OR 7.1), antidepressant use (OR 4.2), BMI ≥ 30 kg/m2 (O...
BackgroundColorectal cancer (CRC) diagnostics are challenging in primary care and reliable diagno... more BackgroundColorectal cancer (CRC) diagnostics are challenging in primary care and reliable diagnostic aids are desired. Qualitative faecal immunochemical tests (FITs) have been used for suspected CRC in Sweden since the mid-2000s, but evidence regarding their effectiveness is scarce. Anaemia and thrombocytosis are both associated with CRC.AimTo evaluate the usefulness of qualitative FITs requested for symptomatic patients in primary care, alone and combined with findings of anaemia and thrombocytosis, in the diagnosis of CRC.Design and settingA population-based cohort study using electronic health records and data from the Swedish Cancer Register, covering five Swedish regions.MethodPatients aged ≥18 years in the five regions who had provided FITs requested by primary care practitioners from 1 January 2015 to 31 December 2015 were identified. FIT and blood-count data were registered and all CRC diagnoses made within 2 years were retrieved. Diagnostic measurements were calculated.Res...
UNSTRUCTURED Key informant interviews found challenges to the digitialization of health care in S... more UNSTRUCTURED Key informant interviews found challenges to the digitialization of health care in Sweden across areas of technical, regulatory, and patient safety and quality of care. While technical conditions are favorable, digitalization may reinforce existing inequalities. The regulatory environment is weak with several actors with unclear mandates and roles. Digital care needs to be evaluated to ensure patient safety. Enhanced availability of data may improve decision making and quality of care. The COVID-19 pandemic enhanced the role of digital care and provided a safe way to deliver services. Further analyses will expand the understanding of some of the preconditions for effective digitalization of health care.
ObjectiveHigh vitreous levels of soluble (s)CD163 have been demonstrated in severe diabetic retin... more ObjectiveHigh vitreous levels of soluble (s)CD163 have been demonstrated in severe diabetic retinopathy (DR). The aim of this study was to explore the predictive values of plasma sCD163 and glycated haemoglobin (HbA1c) for DR progression in adults with type 1 diabetes.Methods and analysesThe study design was prospective. Fundus photography performed in 2009 and at follow-up (≤12 years later) were compared after being categorised according to the International Clinical Diabetic Retinopathy Disease Severity Scale. ‘DR progression at least one level’ was calculated. In 2009, data collection (sex, age, diabetes duration, metabolic variables, serum creatinine, macroalbuminuria and lifestyle factors) and biochemical analyses were performed. Plasma sCD163 and HbA1c were divided into quartiles. Logistic regression analyses were performed.ResultsThe prevalence of DR in 2009 versus at follow-up in 270 participants (57% male) were: no apparent 28% vs 18%; mild 20% vs 13%; moderate 24% vs 26%; ...
UNSTRUCTURED Key informant interviews found challenges to the digitialization of health care in S... more UNSTRUCTURED Key informant interviews found challenges to the digitialization of health care in Sweden across areas of technical, regulatory, and patient safety and quality of care. While technical conditions are favorable, digitalization may reinforce existing inequalities. The regulatory environment is weak with several actors with unclear mandates and roles. Digital care needs to be evaluated to ensure patient safety. Enhanced availability of data may improve decision making and quality of care. The COVID-19 pandemic enhanced the role of digital care and provided a safe way to deliver services. Further analyses will expand the understanding of some of the preconditions for effective digitalization of health care.
Journal of General Internal Medicine, Apr 30, 2017
Geriatrics in primary carePrevention, Population and Disease management (PrePoD)Public Health and... more Geriatrics in primary carePrevention, Population and Disease management (PrePoD)Public Health and primary car
Contentment in the moment”Contentment in the moment” is a classic grounded theory exploring safet... more Contentment in the moment”Contentment in the moment” is a classic grounded theory exploring safety and contentment within a small community in northern Norway. The purpose of the study was to explo ...
This is a classic grounded theory based in longitudinal data from everyday life in an environment... more This is a classic grounded theory based in longitudinal data from everyday life in an environment in Northern Norway characterized by long distances, a harsh climate and people living close to nature and each other. The place has a history of poverty and isolation. Yet, old survival strategies prevail despite modernisation. The theory reveals a culture of momentary contentment with three dimensions: Doing safety, destiny readiness and middle consciousness. This momentary contentment culture explains how the participants resolve their main concern of enjoying life. Doing safety means that common and individual acts create stability. Destiny readiness illuminates a discourse of acceptance, a way of thinking that, with the aid of linguistic strategies, prepares for life changing events. Middle consciousness shows a way of handling difficulties by dividing and separating different phenomena.
The usefulness of Faecal Immunochemical Tests alone and combined with blood counts in the diagnos... more The usefulness of Faecal Immunochemical Tests alone and combined with blood counts in the diagnosis of colorectal cancer in primary care in Sweden
AimsBecause evidence regarding risk stratification predicting prognosis of patients with heart fa... more AimsBecause evidence regarding risk stratification predicting prognosis of patients with heart failure (HF) decompensation attended in primary care is lacking, we developed and externally validated a model to forecast death/hospitalization during the first 30 days after an episode of decompensation. The predictive model is based on variables easily obtained in primary care settings.Methods and resultsHEFESTOS is a multinational study consisting of a derivation cohort of HF patients recruited in 14 primary healthcare centres in Barcelona and a validation cohort from primary healthcare in 9 other European countries. The derivation and validation cohorts included 561 and 250 patients, respectively. Percentages of women in the derivation and validation cohorts were 56.3% and 47.6% (P = 0.026), respectively. Mean age was 82.2 years (SD 8.03) in the derivation cohort, and 79.3 years (SD 10.3) in the validation one (P = 0.001). HF with preserved ejection fraction represented 72.1% in the d...
ObjectivesCancer survival rates vary widely between European countries, with differences in timel... more ObjectivesCancer survival rates vary widely between European countries, with differences in timeliness of diagnosis thought to be one key reason. There is little evidence on the way in which different healthcare systems influence primary care practitioners’ (PCPs) referral decisions in patients who could have cancer.This study aimed to explore PCPs’ diagnostic actions (whether or not they perform a key diagnostic test and/or refer to a specialist) in patients with symptoms that could be due to cancer and how they vary across European countries.DesignA primary care survey. PCPs were given vignettes describing patients with symptoms that could indicate cancer and asked how they would manage these patients. The likelihood of taking immediate diagnostic action (a diagnostic test and/or referral) in the different participating countries was analysed. Comparisons between the likelihood of taking immediate diagnostic action and physician characteristics were calculated.SettingCentres in 20...
Background Depression is a risk factor for type 2 diabetes (T2D) and cardiovascular disease (CVD)... more Background Depression is a risk factor for type 2 diabetes (T2D) and cardiovascular disease (CVD). The aims were to explore the prevalence of depression, anxiety, antidepressant use, obesity, Hemoglobin A1c > 64 mmol/mol, life-style factors, pre-existing CVD, in patients with newly diagnosed T2D; to explore associations with depression; and to compare with Swedish general population data. Methods Multicentre, cross-sectional study. Inclusion criteria: adults with serologically verified newly diagnosed T2D. Included variables: age, sex, current depression and anxiety (Hospital Anxiety and Depression Scale), previous depression, antidepressant use, obesity (BMI ≥ 30 and ≥ 40 kg/m2), Hemoglobin A1c, pre-existing CVD. Logistic regression analyses were performed. Results In 1027 T2D patients, aged 18–94 years, depression was associated with age (per year) (inversely) (odds ratio (OR) 0.97), anxiety (OR 12.2), previous depression (OR 7.1), antidepressant use (OR 4.2), BMI ≥ 30 kg/m2 (O...
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Papers by Hans Thulesius