HPH2013 - 21st HPH Conference Gothenburg 2013 - Welcome to HPH 2013

Plenary 4

Plenary 4 

Friday, May 24, 2013 09:00-10:30

Measuring Patient-Reported Health Outcomes

What Are Patient-Reported Health Outcomes, And Why Do We Need Them For Clinical Learning?

Prof. Margareta KRISTENSON

Linköping University (SWE)





  • 1976: Medical Degree, Uppsala University.
  • 1978: Medical doctor.
  • 1985: Specialist in Family Medicine.
  • 2000: Specialist in Social Medicine and Public Health. 

Doctors Diploma

  • 1998: PhD,  Dep. of Health and Environment, Medical Faculty, Linköping University.
  • 2003: Associate Professor in Social Medicine and Public Health, Linköping University.
  • 2009: Professor in Social Medicine and Public Health, Linkoping University. 

Present employment

  • October 2009 ff: Professor in Social Medicine and Public Health, Linköping University.
  • January 1996 ff: Chief Physician, Centre for Public Health, Östergötland County. 

Earlier employments

  • 2007-2011: Medical Adviser at the National Board for Health and Welfare (30%).
  • 2002-2009: Senior and Chief Lecturer, Department of Health and Society, Linköping 
  • 1998-2002: Director of Studies, Master Programme Linköping University.
  • 1992-1995: Chief Physician, Preventive Medicine, University Hospital, Linköping.
  • 1990-1992: Physician in Community Medicine, Primary Care Trust, Östergötland.
  • 1986-1990: Head of Primary Care, Primary Care Area 3, Central Östergötland.
  • 1986-1990: Head of Kärna Primary Care Centre, Central Östergötland.
  • 1986-1990: Family Physician, Kärna Primary Care Centre, Central Östergötland. 

Main tutor for doctoral studies (finalised studies)

  • Elaine Sjögren, Psychosocial factors in adult life- relations to biological markers (cortisol and IL-6), socioeconomic status and self-rated health among men and women. (2005).
  • Peter Garvin, Plasma levels of matrix metalloproteinase-9 in a normal population – a psychoneuroendocrinological approach. (2008).
  • Johanna Lundberg, Social status- a state of mind? (2008).
  • Marika Wenemark; Respondent’s perspective in survey design (2010)

At present four doctoral students.

Other appointments

  • 1997 ff: National Coordinatior for the Swedish HPH network
  • 2011 ff: Chair for PROM center, a  national resource for national quality registers
  • 2002 ff: Head of the research programme Life Conditions, Stress and Health,
  • 2002 ff: Member of Steering Group for the National Stress Research Network.
  • 2008 ff: Chair for the Swedish Association for Social Medicine.
  • 2007 ff: Medical Adviser  at the National Board for Health and Welfare
  • 2007-2011: Member of Steering Group for National Guidelines for Lifestyle Change.
  • 2009-2011: Medical Expert at Scientific Board for the National Institute for Public Health
  • 2007-2011: Chair for ScanCort, a Scandinavian Stress Research Network
  • 2002-2006: Research Assistant,  financed by the National Research Council.
  • 2000-2004: Member of   “European Science Foundation (ESF) Scientific Programme, Social variations in Health Expectancy in Europe”, Working group II ”Health effects of stressful environments in adult life, the interaction of biological and psychosocial factors”. 

Selected Publications

  1. Kristenson M, Ziedén B, Kucinskiene Z, Schäfer-Elinder L, Bergdahl B, Elwing B, et al. Antioxidant state and mortality from coronary heart disease in Lithuanian and Swedish men: concomitant cross sectional study of men aged 50. British Medical Journal 1997;314:629-633.
  2. Kristenson M, Kucinskiene Z, Bergdahl B, Calkauskas H, Urmonas V, Orth-Gomér K. Increased psychosocial strain in Lithuanian vs. Swedish men: The LiVicordia study. Psychosomatic Medicine 1998;60:277-282
  3. Kristenson M, Orth-Gomér K, Kucinskiene Z, Bergdahl B, Calkauskas H, Balinkyiene I, et al. Attenuated cortisol response to a standardised stress test in Lithuanian vs. Swedish men: The LiVicordia study. International Journal of Behavioral Medicine 1998;5:17-30.
  4. Ziedén B, Kaminskas A, Kristenson M, Kucinskiene Z, Vessby B, Olsson AG, et al. Increased plasma 7b-hydroxycholesterol concentrations in a population with a high risk for cardiovascular disease. Atherosclerosis, Thrombosis and Vascular Biology 1999;19:967-971
  5. Kaminskas A, Zieden B, Elwing B, Kristenson M, Abarabicius A, Bergdahl B, Olsson AG, Kucinskiene Z. Adipose tissue fatty acids in men from two populations with different cardiovascular risk: the LiVicordia study. Scandinavian Journal of Laboratory Investigations 1999, 59, 227-232.
  6. Kristenson M, Eriksen H, Sluiter JK, Starke D, Ursin H. Psychobiological mechanisms for socioeconomic differences in health. Social Science and Medicine; 2004; 58 (8), 1511-1522.
  7. Bobak M, Kristenson M, Pikhart H, Marmot M. Life span and disability: a cross sectional comparison of Russian and Swedish community-based data. BMJ 2004; 329; 767-
  8. Kristenson M,  Kucinskiene Z, Olsson AG, Good self-rated health is related to psychosocial resources and a strong cortisol response to acute stress; the LiVicordia study of middle-aged men. International Journal of Behavioural Medicine, 2005;12(3):153-60
  9. Sjögren E, Kristenson M. Can gender differences in psychosocial factors be explained by socioeconomic status? Scandinavian Journal of Public Health, 2006; 34:59-68
  10. Sjögren E,  Leanderson  P, Kristenson M. Diurnal Saliva Cortisol Levels and Relations to Psychosocial Factors in a Population Sample of Middle-Aged Swedish Men and Women. International Journal of Behavioral Medicine, 2006, 13: 193-200.
  11. Lundberg J, Bobak M, Malyutina S, Kristenson M, Pikhart H. Adverse health effects of low levels of perceived control in Swedish and Russian community samples. BMC Public Health. 2007 Nov 2;7:314
  12. Nijm J, Kristenson M, Olsson AG, Jonasson L. Impaired cortisol response to acute stressors in patients with coronary heart disease. Implications for inflammatory activity. J Intern Med. 2007; 262: 375-84
  13. Hollman G, Kristenson M. The prevalence of the metabolic syndrome and its risk factors in a middle-aged Swedish population-mainly a function of overweight? Eur J Cardiovasc Nurs. 2008; 7: 21-6
  14. Garvin P, Nilsson L, Carstensen J, Jonasson L, Kristenson M. Circulating matrix metalloproteinase-9 is associated with cardiovascular risk factors in a middle-aged normal population. PLoS ONE; 2008 Mar 12; 383:el774
  15. Lindhe Söderlund L, Nielsen P, Kristenson M. Learning Motivational Interviewing- Exploring primary care nurses´ training and counseling experiences. Health Education Journal, 2008; 67; 102
  16. Lundberg J, Kristenson M, Is subjective status influenced by psychosocial factors? Accepted for publication in Social Indicators Research
  17. Garvin P, Nilsson L, Jonasson L, Carstensen J, Kristenson M. Plasma levels of matrix metalloproteinase-9 are independently associated with psychosocial factors in a middle-aged normal population. Psychosom Med. 2009 Apr;71(3):292-300. Epub 2009 Feb 5
  18. Frisman GH, Kristenson M, Psychosocial Status and Health Related Quality of Life in relation to the Metabolic Syndrome in a Swedish middle-aged population, Eur J Cardiovasc Nurs. 2009 Sep;8(3):207-15. Epub 2009 Feb 26
  19. Lundberg J, Kristenson M, Starrin B. Status incongruence revisited - associations with shame and mental well-being (GHQ). Sociol Health Illn. 2009 May;31(4):478-93
  20. Wenemark M, Frisman GH, Olsson T, Kristenson M. Time to listen to the respondents? Respondent burden and respondent satisfaction in health-related surveys. Accepted for publication. Field Methods
  21. Lundberg J, Karlsson N, Kristenson M Does 2-year stability of psychosocial factors differ by socioeconomic position? Test-retest correlations of self-esteem, mastery, perceived control, sense of coherence, cynicism, hopelessness, vital exhaustion and depression in a middle-aged Swedish normal population. Psychological Reports 2009 , 105, 1009-1022
  22. Karlsson N, Skargren E, Kristenson M Emotional support predicts more sickness absence and poorer self assessed work ability: a two-year prospective cohort study.BMC Public Health. 2010 Oct 26;10:648
  23. Szymanowski A, Nijm J, Kristenson M, Jonasson L. Elevated levels of circulating matrix metalloproteinase-9 are associated with a dysregulated cortisol rhythm.A case-control study of coronary artery disease. Psychoneuroendocrinology. 2011 Jan;36(1):139-43.Epub 2010 Jul 31.
  24. Kristenson M, Lundberg J, Garvin P. Socioeconomic differences in outpatient healthcare utilisation are mainly seen for musculoskeletal problems in groups with poor self-rated health.  Scand J Public Health. 2011 Dec;39(8):805-12. Epub 2011 Oct 5
  25. Carlfjord S, Kristenson M, Lindberg M. Experiences of working with the tobacco issue in the context of health promoting hospitals and health services: a qualitative study. Int J Environ Res Public Health. 2011 Feb;8(2):498-513. Epub 2011 Feb 15
  26. Kristenson M. Commentary: Impact of socioeconomic determinants on psychosocial factors and lifestyle - implications for health service: The Swedish experience. Soc Sci Med. 2011 Dec 27. [Epub ahead of print] No abstract available. 

Subjective Pain Measurement In Clinical Routine: Implications For Patients And Staff

Dr. Simone TASSO

Veneto Region Outpatient Services (ITA)

Since 2011 he has been the Head of the Outpatient Service of the Italian Veneto Region (5 millions of inhabitants). In this role he has to program and to monitor the care provided  by outpatients departments in hospitals and in health services, both of public and private sector.

He is medical doctor, specialist in cardiology, specialist  in Hygiene - Preventive Medicine.

Since 1999 lecturer in Hospital Evaluation at University of Padua.

Since 2001 he has been HPH Coordinator of the Veneto Region Network.

In the past he applied different charges:

  • 1989-1991 General Practitioner
  • 1991-2008 Hospital Medical Director
  • 2005-2011 Medical Director of Outpatient Department of a Heath Local Trust
  • 2010-2012.  Member of International HPH Governance Board.

Fields of interest: Health Promotion, Hospital Evaluation, Digital Medicine.

The Systematic Use Of An Health Literacy Approach To Transform Health System Equity, Quality And Outcomes

Professor Richard OSBORNE

Chair of Public Health, School of Health and Social Development, Deakin University, Melbourne (AUS)

In 2009 Richard Osborne was appointed Professor of Public Health at Deakin University. He is Head of the Public Health Innovation unit, and Co-director of the Population Health Strategic Research Centre. Prior to this he was a Principle Research Fellow at the Department of Medicine, Royal Melbourne Hospital, The University of Melbourne.  In 2012, his research program was ranked by the prestigious Australian National Health and Medical Research Council (NHMRC) as one of Australia’s Top Ten. He is a recognised international leader in health literacy and chronic disease self-management.  He is a founding member the Nordic Health Literacy Network, is a Research Associate at Copenhagen University, and is a Honorary Professor at York University.

While his PhD was in psychoneuroimmunology and survival from breast cancer, Prof Osborne’s main areas are now health systems research and health equity. Over the past 10 years he has developed and implemented several tools and approaches that are used locally and globally.  

His research strongly prioritises the generation of public health innovations and evaluation systems that have lasting community impacts. These have included a new health-system-wide model for prioritisation and management of hip and knee replacement (www.health.vic.gov.au/oahks); an online self-management education program for people with musculoskeletal and mental health conditions (www.steppingup.org.au); a national quality and monitoring system for chronic disease self-management education programs (www.heiq.org.au) used in 20+ countries; and an influenza outcomes assessment tool that is used in global trials (www.fluiiq.com). Prof Osborne has developed and implemented several Patient Reported Outcome Measures (PROMs). He has advanced the methods of both conceptualising and generating these from patient and practitioner perspectives, as well as the processes to validate PROMs.

In recent years, Prof Osborne has focused on understanding and measuring the concept of health literacy. He is a consultant on the European Union Health Literacy Survey team, an executive member of the Global Working Group on Health Literacy within the International Union for Health Promotion and Health Education (IUHPE), and a member of the writing team for the upcoming WHO publication Health Literacy: the solid facts. His team has led the methodological approach for the development of the new Thai government measure of health literacy, and the Taiwanese national measure of health literacy in school children. He led the development and implementation of the Health Literacy Questionnaire (HLQ). The HLQ is a nine-dimension needs assessment tool, an evaluation system to inform the development of interventions (patient-level and organisational-level), and a precise outcomes assessment tool. Prof Osborne is also undertaking research that explores the role of health literacy in the quality of cancer survivorship, and the role health literacy assessments have on the quality of hospital services. 

Prof Osborne leads the development of the Victorian Health Literacy Response Frameworkusing a co-creation approach with the Victorian Government across eight healthcare organisations.