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  • 1.
    Abioye, Ajibola I.
    et al.
    Brown Univ, RI 02912 USA; Rhode Isl Hosp, RI USA; Rhode Isl Hosp, RI USA.
    Park, Sangshin
    Brown Univ, RI 02912 USA; Rhode Isl Hosp, RI USA; Rhode Isl Hosp, RI USA.
    Ripp, Kelsey
    Brown Univ, RI 02912 USA.
    McDonald, Emily A.
    Brown Univ, RI 02912 USA; Rhode Isl Hosp, RI USA; Rhode Isl Hosp, RI USA.
    Kurtis, Jonathan D.
    Brown Univ, RI 02912 USA; Rhode Isl Hosp, RI USA; Rhode Isl Hosp, RI USA.
    Wu, Hannah
    Brown Univ, RI 02912 USA; Rhode Isl Hosp, RI USA; Rhode Isl Hosp, RI USA.
    Pond-Tor, Sunthorn
    Rhode Isl Hosp, RI USA.
    Sharma, Surendra
    Brown Univ, RI 02912 USA; Women and Infants Hosp Rhode Isl, RI 02908 USA.
    Ernerudh, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk immunologi och transfusionsmedicin.
    Baltazar, Palmera
    Res Inst Trop Med, Philippines; Remedios Trinidad Romualdez Hosp, Philippines.
    Acosta, Luz P.
    Res Inst Trop Med, Philippines.
    Olveda, Remigio M.
    Res Inst Trop Med, Philippines.
    Tallo, Veronica
    Res Inst Trop Med, Philippines.
    Friedman, Jennifer F.
    Brown Univ, RI 02912 USA; Rhode Isl Hosp, RI USA; Rhode Isl Hosp, RI USA.
    Anemia of Inflammation during Human Pregnancy Does Not Affect Newborn Iron Endowment2018Ingår i: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 148, nr 3, s. 427-436Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: To our knowledge, no studies have addressed whether maternal anemia of inflammation (AI) affects newborn iron status, and few have addressed risk factors for specific etiologies of maternal anemia. Objectives: The study aims were to evaluate 1) the contribution of AI and iron deficiency anemia (IDA) to newborn iron endowment, 2) hepcidin as a biomarker to distinguish AI from IDA among pregnant women, and 3) risk factors for specific etiologies of maternal anemia. Methods: We measured hematologic biomarkers in maternal blood at 12 and 32 wk of gestation and in cord blood from a randomized trial of praziquantel in 358 pregnant women with Schistosoma japonicum in The Philippines. IDA was defined as anemia with serum ferritin amp;lt; 30 ng/mL and non-IDA (NIDA), largely due to AI, as anemia with ferritin amp;gt;= 30 ng/mL. We identified cutoffs for biomarkers to distinguish IDA from NIDA by using area under the curve (AUC) analyses and examined the impact of different causes of anemia on newborn iron status (primary outcome) by using multivariate regression modeling. Results: Of the 358 mothers, 38% (n = 136) had IDA and 9% (n = 32) had NIDA at 32 wk of gestation. At 32 wk of gestation, serum hepcidin performed better than soluble transferrin receptor (sTfR) in identifying women with NIDA compared with the rest of the cohort (AUCs: 0.75 and 0.70, respectively) and in identifying women with NIDA among women with anemia (0.73 and 0.72, respectively). The cutoff that optimally distinguished women with NIDA from women with IDA in our cohort was 6.1 mu g/L. Maternal IDA, but not NIDA, was associated with significantly lower newborn ferritin (114.4 ng/mL compared with 148.4 mu g/L; P = 0.042). Conclusions: Hepcidin performed better than sTfR in identifying pregnant women with NIDA, but its cost may limit its use. Maternal IDA, but not NIDA, is associated with decreased newborn iron stores, emphasizing the need to identify this cause and provide iron therapy.

  • 2.
    Abong'o, Deborah
    et al.
    University of Nairobi, Kenya.
    Wandiga, Shem
    University of Nairobi, Kenya.
    Jumba, Isaac
    University of Nairobi, Kenya.
    Madadi, Vincent
    University of Nairobi, Kenya.
    Kylin, Henrik
    Linköpings universitet, Institutionen för tema, Tema vatten i natur och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Impacts of pesticides on human health and environment in the River Nyando catchment, Kenya2014Ingår i: International Journal of Humanities, Arts, Medicine and Sciences, ISSN 2348-0521, Vol. 2, nr 3, s. 1-14Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    The population of the River Nyando catchment largely relies on rain fed agriculture for their subsistence.

    Important crops grown include cereals, cash crops fruits and vegetables. Farming is one of the contributors of pollution to Lake Victoria. Organophosphates and other banned organochlorine pesticides such as lindane, aldrin and dieldrin were used by farmers. The pesticides transport was by storm water run-off and air drift into the lake. Environmental risk assessment background information was collected through questionnaire and interviews of farmers to determine knowledge and safe use of pesticides. Fourteen pesticides were identified as commonly used of which four are toxic to bees and five to birds. The farmers identified declines in the number of pollinating insects, the disappearance of Red-billed Oxpecker (Buphagus erythrorthynchus) and wild bird’s fatalities. The general knowledge among farmers about chemicals risks, safety, and chronic illnesses was low. Activities that increases environmental awareness and safety of pesticides should be initiated by the agrochemical firms and government.

  • 3.
    Adini, B.
    et al.
    Tel Aviv University, Israel.
    Bodas, M.
    Tel Aviv University, Israel.
    Nilsson, Heléne
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Katastrofmedicinskt centrum.
    Peleg, K.
    Tel Aviv University, Israel; Gertner Institute Health Policy and Epidemiol, Israel.
    Policies for managing emergency medical services in mass casualty incidents2017Ingår i: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 48, nr 9, s. 1878-1883Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Diverse decision-making is needed in managing mass casualty incidents (MCIs), by emergency medical services (EMS). The aim of the study was to review consensus among international experts concerning policies of EMS management during MCIs. Methods: Applicability of 21 EMS policies was tested through a 2-cycle modified e-Delphi process, in which 38 multi-disciplinary experts from 10 countries participated. Threshold for approving proposed solutions was defined as consensus of amp;gt;80%. Policies that did not achieve the targeted consensus were reviewed to detect variability according to respondents origin country. Results: 16 policies were endorsed in the first cycle including collaboration between ambulance service providers; implementing a unified mode of operation; preparing criteria for ground versus aerial evacuation; and, developing support systems for caregivers exposed to violence. An additional policy which proposed that senior EMS officers should not necessarily act as on-site MCI commanders was endorsed in the second cycle. Demographic breakdown of views concerning non-consensual policies revealed differences according to countries of origin. Assigning ambulances to off-duty team members was highly endorsed by experts from Israel and South Africa and strongly rejected by European respondents. Avoiding entry to risk areas until declared safe was endorsed by European, Asian and Oceanic experts, but rejected by Israeli, South African and North American experts. Conclusions: Despite uniqueness of countries and EMS agencies, solutions to most dilemmas were applicable to all organizations, regardless of location or affiliation. Cultural diversity was found concerning readiness to implement military-civilian collaboration in MCIs and a rigid separation between work-leisure responsibilities. (C) 2017 Elsevier Ltd. All rights reserved.

  • 4.
    Aerts, Marc
    et al.
    Interuniversity Institute for Biostatistics and Statistical Bioinformatics.
    Minalu, Girma
    Interuniversity Institute for Biostatistics and Statistical Bioinformatics.
    Bösner, Stefan
    Department of General Practice and Family Medicine, Philipps University Marburg, Germany..
    Buntinx, Frank
    Department of Public Health and Primary Care, KU Leuven, Belgium; Department of General Practice, Maastricht University, The Netherlands..
    Burnand, Bernard
    Institute of Social and Preventive Medicine, Lausanne University Hospital, Switzerland..
    Haasenritter, Jörg
    Department of General Practice and Family Medicine, Philipps University Marburg, Germany..
    Herzig, Lilli
    Institute of Family Medicine, University of Lausanne, Switzerland..
    Knottnerus, J André
    Department of General Practice, Maastricht University, The Netherlands..
    Nilsson, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Vikbolandet.
    Renier, Walter
    Department of Public Health and Primary Care, KU Leuven, Belgium.
    Sox, Carol
    Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, USA..
    Sox, Harold
    Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH , USA; Patient-Centered Outcomes Research Institute, Washington, USA..
    Donner-Banzhoff, Norbert
    Department of General Practice and Family Medicine, Philipps University Marburg, Germany..
    Pooled individual patient data from five countries were used to derive a clinical prediction rule for coronary artery disease in primary care.2017Ingår i: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 81, s. 120-128Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To construct a clinical prediction rule for coronary artery disease (CAD) presenting with chest pain in primary care.

    STUDY DESIGN AND SETTING: Meta-Analysis using 3,099 patients from five studies. To identify candidate predictors, we used random forest trees, multiple imputation of missing values, and logistic regression within individual studies. To generate a prediction rule on the pooled data, we applied a regression model that took account of the differing standard data sets collected by the five studies.

    RESULTS: The most parsimonious rule included six equally weighted predictors: age ≥55 (males) or ≥65 (females) (+1); attending physician suspected a serious diagnosis (+1); history of CAD (+1); pain brought on by exertion (+1); pain feels like "pressure" (+1); pain reproducible by palpation (-1). CAD was considered absent if the prediction score is <2. The area under the ROC curve was 0.84. We applied this rule to a study setting with a CAD prevalence of 13.2% using a prediction score cutoff of <2 (i.e., -1, 0, or +1). When the score was <2, the probability of CAD was 2.1% (95% CI: 1.1-3.9%); when the score was ≥ 2, it was 43.0% (95% CI: 35.8-50.4%).

    CONCLUSIONS: Clinical prediction rules are a key strategy for individualizing care. Large data sets based on electronic health records from diverse sites create opportunities for improving their internal and external validity. Our patient-level meta-analysis from five primary care sites should improve external validity. Our strategy for addressing site-to-site systematic variation in missing data should improve internal validity. Using principles derived from decision theory, we also discuss the problem of setting the cutoff prediction score for taking action.

  • 5.
    Af Sandeberg, Margareta
    et al.
    Department of Women's and Children's Health, Karolinska Institutet, Children's and Women's Health, Karolinska University Hospital.
    Wenemark, Marika
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för verksamhetsstöd och utveckling, Verksamhetsutveckling vård och hälsa.
    Bartholdson, Cecilia
    Department of Women's and Children's Health, Karolinska Institutet, Children's and Women's Health, Karolinska University Hospital.
    Lützén, Kim
    Department of Women's and Children's Health, Karolinska Institutet.
    Pergert, Pernilla
    Department of Women's and Children's Health, Karolinska Institutet, Children's and Women's Health, Karolinska University Hospital.
    To change or not to change - translating and culturally adapting the paediatric version of the Moral Distress Scale-Revised (MDS-R)2017Ingår i: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 18, nr 14, s. 1-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Paediatric cancer care poses ethically difficult situations that can lead to value conflicts about what is best for the child, possibly resulting in moral distress. Research on moral distress is lacking in paediatric cancer care in Sweden and most questionnaires are developed in English. The Moral Distress Scale-Revised (MDS-R) is a questionnaire that measures moral distress in specific situations; respondents are asked to indicate both the frequency and the level of disturbance when the situation arises. The aims of this study were to translate and culturally adapt the questionnaire to the context of Swedish paediatric cancer care. In doing so we endeavoured to keep the content in the Swedish version as equivalent to the original as possible but to introduce modifications that improve the functional level and increase respondent satisfaction.

    METHODS: The procedure included linguistic translation and cultural adaptation of MDS-R's paediatric versions for Physicians, Nurses and Other Healthcare Providers to the context of Swedish paediatric cancer care. The process of adjustment included: preparation, translation procedure and respondent validation. The latter included focus group and cognitive interviews with healthcare professionals in paediatric cancer care.

    RESULTS: To achieve a Swedish version with a good functional level and high trustworthiness, some adjustments were made concerning design, language, cultural matters and content. Cognitive interviews revealed problems with stating the level of disturbance hypothetically and items with negations caused even more problems, after having stated that the situation never happens.

    CONCLUSIONS: Translation and cultural adaptation require the involvement of various types of specialist. It is difficult to combine the intention to keep the content as equivalent to the original as possible with the need for modifications that improve the functional level and increase respondent satisfaction. The translated and culturally adapted Swedish MDS-R seems to have equivalent content as well as improved functional level and respondent satisfaction. The adjustments were made to fit paediatric cancer care but it could be argued that the changes are relevant for most areas of paediatric care of seriously ill patients.

  • 6.
    Agnew, Louise
    et al.
    University of Queensland, Australia.
    Johnston, Venerina
    University of Queensland, Australia.
    Landén Ludvigsson, Maria
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Rehab Väst.
    Peterson, Gunnel
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Uppsala University, Sweden.
    Overmeer, Thomas
    Malardalen University, Sweden; University of Örebro, Sweden.
    Johansson, Gun
    Karolinska Institute, Sweden.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. University of Queensland, Australia.
    FACTORS ASSOCIATED WITH WORK ABILITY IN PATIENTS WITH CHRONIC WHIPLASH-ASSOCIATED DISORDER GRADE II-III: A CROSS-SECTIONAL ANALYSIS2015Ingår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, nr 6, s. 546-551Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To investigate the factors related to self-perceived work ability in patients with chronic whiplash-associated disorder grades II-III. Design: Cross-sectional analysis. Patients: A total of 166 working age patients with chronic whiplash-associated disorder. Methods: A comprehensive survey collected data on work ability (using the Work Ability Index); demographic, psychosocial, personal, work- and condition-related factors. Forward, stepwise regression modelling was used to assess the factors related to work ability. Results: The proportion of patients in each work ability category were as follows: poor (12.7%); moderate (39.8%); good (38.5%); excellent (9%). Seven factors explained 65% (adjusted R-2 = 0.65, p less than 0.01) of the variance in work ability. In descending order of strength of association, these factors are: greater neck disability due to pain; reduced self-rated health status and health-related quality of life; increased frequency of concentration problems; poor workplace satisfaction; lower self-efficacy for performing daily tasks; and greater work-related stress. Conclusion: Condition-specific and psychosocial factors are associated with self-perceived work ability of individuals with chronic whiplash-associated disorder.

  • 7.
    Ahlberg, Eva-Lena
    et al.
    Region Östergötland, Centrum för verksamhetsstöd och utveckling.
    Elfström, Johan
    Region Östergötland, Centrum för verksamhetsstöd och utveckling.
    Borgstedt Risberg, Madeleine
    Region Östergötland, Centrum för verksamhetsstöd och utveckling.
    Öhrn, Annica
    Region Östergötland, Regionstyrelsen.
    Andersson, Christer
    Region Östergötland, Regionstyrelsen.
    Sjödahl, Rune
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionstyrelsen. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Learning From Incident Reporting?: Analysis of Incidents Resulting in Patient Injuries in a Web-Based System in Swedish Health Care2017Ingår i: Journal of patient safety, ISSN 1549-8417, E-ISSN 1549-8425Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives Incident reporting (IR) systems have the potential to improve patient safety if they enable learningfrom the reported risks and incidents. The aim of this study was to investigate incidents registered in an IR system in a Swedish county council.

    Methods The study was conducted in the County Council of Östergötland, Sweden. Data were retrieved from the IR system, which included 4755 incidents occurring in somatic care that resulted in patient injuries from 2004 to 2012. One hundred correctly classified patient injuries were randomly sampled from 3 injury severity levels: injuries leading to deaths, permanent harm, and temporary harm. Three aspects were analyzed: handling of the incident, causes of the incident, and actions taken to prevent its recurrence.

    Results Of the 300 injuries, 79% were handled in the departments where they occurred. The department head decided what actions should be taken to prevent recurrence in response to 95% of the injuries. A total of 448 causes were identified for the injuries; problems associated with procedures, routines, and guidelines were most common. Decisions taken for 80% of the injuries could be classified using the IR system documentation and root cause analysis. The most commonly pursued type of action was change of work routine or guideline.

    Conclusions The handling, causes, and actions taken to prevent recurrence were similar for injuries of different severity levels. Various forms of feedback (information, education, and dialogue) were an integral aspect of the IR system. However, this feedback was primarily intradepartmental and did not yield much organizational learning.

  • 8.
    Ahlgren, Thorbjörn
    et al.
    Luppen kunskapscentrum.
    Näslund, Johan
    Linköpings universitet, Institutionen för beteendevetenskap. Linköpings universitet, Filosofiska fakulteten.
    Kartläggning av barn i behov av stöd år 2002: Eksjö kommun2003Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Följande rapport bygger på enkätsvar från olika myndigheter i Eksjö kommun som har rapporterat de barn/ungdomar i åldern 0-18 år som man i sin verksamhet kommer i kontakt med och som man känner oro för, p.g.a. en ogynnsam utveckling. Tjugo förutbestämda kriterier användes för att beskriva orsaken till myndighetens oro. Myndigheterna har också rapporterat om de insatser som görs redan idag samt om man bedömer att det kan bli aktuellt med ytterligare insatser nu eller i framtiden.

    Totalt inrapporterades 842 barn och ungdomar. Socialförvaltningen rapporterade 78 barn och ungdomar, Barnavårdscentralen 30 barn och skolan 689 barn och ungdomar. Av 45 enkätsvar framgår det inte vem som är rapportör. Vid bearbetningen av insamlat material har 10 enkätsvar uteslutits eftersom de inte var tillräckligt ifyllda. 103 enkätsvar uteslöt för att de flerrapporterade barn och/eller ungdomar och 17 enkätsvar uteslöts eftersom de rapporterade ungdomar som inte är skrivna i Eksjö kommun. Slutligen kom 712 barn och ungdomar att ingå i kartläggningen. Detta är drygt 18,8 % av alla aktuella barn och ungdomar. Av dessa är en klar majoritet pojkar (446 dvs. 62,6 %). För hela målgruppen främst tre huvudorsaker som ger anledning till oro hos berörda myndigheter. Det är;

    1. Föräldrarna brister i omsorgen, i stödet till den unge eller möjligheten att ge stimulans pågrund av sociala, mentala, fysiska eller psykiska handikapp och/eller missbruksproblem. För130 (av 712) barn och ungdomar anser man att det är huvudorsaken till oro.
    2. Barn/ungdomar som är introverta (tysta, blyga, nedstämda, mutister). För 69 av (712) barnoch ungdomar är det huvudorsaken till att man känner oro.
    3. Föräldrars separation eller ständiga konflikter påverkar den unge negativt. För 66 av (712)barn och ungdomar är det huvudorsaken till att man känner oro.

    Resultatredovisningen visar att skolan är den myndighet vars insatser dominerande är det också så att olika insatser inom skolan dominerar. Vanligast är undervisning i liten grupp och olika typer av specialundervisning. Olika typer av anpassad studiegång är också en vanlig insats att möta barn och ungdomar med olika svårigheter. Även olika psykosociala åtgärder förekommer också t.ex. stödsamtal med skolsköterska eller kurator. Vanligast av socialförvaltningens insatser är kontaktperson/familj.

    Berörda myndigheter uppmanas också att föreslå olika typer av nya insatser för de rapporterade barnen och ungdomarna. Även här dominerar olika typer av skolinriktade insatser. Vanliga förslag är undervisning i liten grupp och/eller olika typer av specialundervisning. När socialförvaltningen anses vara ansvarig myndigheter för önskade insatser föreslår rapporterande myndigheter allt från olika typer av familjestöd till direkta förslag till omhändertagande och placering på behandlingshem.

  • 9.
    Ahlvin, Anna
    et al.
    Linköpings universitet. Region Östergötland, Folktandvården.
    Warnberg Gerdin, Elisabeth
    Regional Örebro County, Sweden.
    Bågesund, Mats
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Folktandvården.
    Ordell, Sven
    Region Östergötland, Folktandvården.
    Self-perceived oral health among 19-year-olds in a Swedish County - A comparative study between 2004 and 20112016Ingår i: Swedish Dental Journal, ISSN 0347-9994, Vol. 40, nr 1, s. 53-65Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    For decades, Swedish dental professionals have collected clinical epidemiological data from the dental records. To supplement the epidemiology, Ostergotland County Council decided to examine patient perceptions of oral health: self-rated knowledge, self-perceived oral health, and opinions about oral health. The aim was to compare self-perceived oral health among 19-year-olds to determine differences between genders, various municipalities and between 2004 and 2011. This study analysed the responses from two cross-sectional surveys of the entire population of 19-year-olds in Ostergotland County, Sweden, performed in 2004 and 2011. Of the 2,413 (53 %) (50 % men, 50 % women) 19-year-olds who responded to the questionnaire in 2004 and the 3,803 (67 %) (50 % men, 50 % women) in 2011, most 19-year-olds (88.1 % [2004] and 87.5 % [am]) reported satisfaction with their oral health. Around half of the respondents rated their knowledge on periodontitis as low. Boys rated their knowledge about avoiding periodontitis higher than girls (p&lt;0.05 in 2004 and p&lt;0.001 in 2011). In 2004, 84.7 % reported shooting pain. In 2011 that figure was 83.7 %. The respondents expressed some uncertainty about the benefits of fluoride toothpaste (7.5 % in 2004 and 9.3 % in 2011), especially the boys (10.3 % in 2004 and 10.5 % in 2011). Girls reported both a higher social impact and greater concern about aesthetics related to their oral health. They also reported headache (27.5 %) nearly twice as often as boys (14.2 %) (p&gt;0.001). Responses between the municipalities did not differ, with the exception of items regarding periodontitis. Thus, this study found indications that perceptions of oral health and knowledge in Ostergotland County complied with Swedish Dental Act. The study also found patient perceptions of oral health among 19-year-olds to be good.

  • 10.
    Aho, Nikolas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Victimization, Prevalence, Health and Peritraumatic Reactions in Swedish Adolescents2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The aim of this thesis was to expand the knowledge of victimization in children and youth in Sweden. Victimization, prevalence, health and peritraumatic reactions were explored in a cross sectional, representative sample of 5,960 second grade high school students in Sweden. A computerized survey was developed and administered in class room setting.

    Lifetime victimization was found in 84.1% of the sample (m=83.0%, f=85.2%), and, in relation to the five domains, 66.4% had experienced conventional crime, 24% child maltreatment, 54.4% peer and sibling victimization, 21.8% sexual victimization, and 54% had experienced witness victimization. Females experienced significantly more child maltreatment, peer and sibling victimization, sexual victimization, and witnessed victimization, males more conventional crime (p<0.001). Using logistic regression risk factors for victimization were confirmed by a significant increase OR regarding gender, environment and lack of both parents.

    Symptoms (TSCC), were clearly associated with both victimizations per se and the number of victimizations. The results indicated a relatively linear increase in symptoms with an increase in number of events experienced. Mental health of the polyvictimized group was significantly worse than that of the non-polyvictimized group, with significantly elevated TSCC scores (t<0.001). Hierarchical regression analysis resulted in beta value reduction when polyvictimization was introduced supporting the independent effect on symptoms. Social anxiety was found in 10.2 % (n = 605) of the total group (n = 5,960). A significant gender difference emerged, with more females than males reporting social anxiety. Elevated PTSS was found in 14.8 % (n=883). Binary logistic regression revealed the highest OR for having had contact with child and adolescent psychiatry was found for the combined group with social anxiety and elevated PTSS (OR = 4.88, 95 % CI = 3.53–6.73, p<001). Significant associations were also found between use of child and adolescent psychiatry and female gender (OR = 2.05, 95 % CI = 1.70–2.45), Swedish birth origin (OR = 1.68, 95 % CI = 1.16–2.42) and living in a small municipality (OR = 1.33, 95 % CI = 1.02–1.73).

    Mediation models used peritraumatic reactions (PT): total, physiological arousal (PA), peritraumatic dissociation (PD), and intervention thoughts (IT) and JVQ and TSCC. Of the n=5,332 cases, a total of n=4,483 (84.1%) reported at least one victimizing event (m = 83.0%, f = 85.2%). Of these, 74.9% (n=3,360) also experienced a PT reaction of some kind. The effect mediated by PT tot was b= 0.479, BCa CI [0.342 – 0.640], representing a relatively small effect of 7.6%, κ2=0.076, 95% BCa CI [0.054- 0.101]. The mediating effect of JVQ on TSCC was mediated by PD more for males (b=0.394 BCa CI [0.170-0.636]) than for females (b=0.247, BCa CI [0.021-0.469]). The indirect effect of the JVQ on the TSCC tot mediated by the different PT reactions was significant for PD (b=0.355, BCa CI [0.199- 0.523]. In males a mediating effect of PD could be seen in the different models, while females had a more mixed result. IT did not show any indirect effect in males, but had a mixed effect for females.

    The empirical findings in this thesis lead to the conclusion that victimization is highly prevalent in children and youth and is related to health issues. The association of victimization on symptoms was mediated by peritraumatic reactions. Using a comprehensive instrument such as the JVQ provides the researcher or clinician the opportunity to acquire more complete measurement and also makes it possible to identify polyvictimization, a high-level category of events with severe impact on health.  

    Delarbeten
    1. The Prevalence of Potentially Victimizing Events, Poly-Victimization, and Its Association to Sociodemographic Factors: A Swedish Youth Survey
    Öppna denna publikation i ny flik eller fönster >>The Prevalence of Potentially Victimizing Events, Poly-Victimization, and Its Association to Sociodemographic Factors: A Swedish Youth Survey
    2016 (Engelska)Ingår i: Journal of Interpersonal Violence, ISSN 0886-2605, E-ISSN 1552-6518, Vol. 31, nr 4, s. 620-651Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Studying the extent to which children are exposed to victimizing events is important to fully understand the effect of such exposure in shaping them as adults. The aim of this study was to use self-report by adolescents to measure the prevalence of victimizing events and of poly-victimization. A representative sample of 5,960 students (aged 17) from high schools in Sweden was given the self-administrated version of the Juvenile Victimization Questionnaire (JVQ) along with questions concerning gender, birthplace, parents birthplace and employment, residence, educational program, and municipality size. The results show that 84.1% (83.0% young men and 85.2% young women) of the students had experienced victimization during their lifetime, and 10.3% were categorized as poly-victims (8.1% young men and 12.5% young women; OR = 1.62, 95% confidence interval [CI] = [1.35, 1.94]). Adolescents living with both parents were at lower risk of any form of victimization for both genders, while females were at higher risk of maltreatment, peer victimization, and, most significantly, sexual victimization. In conclusion, the vast majority of young people have been victimized during their lifetime. A greater awareness of the impact of these victimizing events on children and adolescents is important as a basis for providing a safer milieu and establishing better interventions, especially for those that have been victimized on multiple occasions. The high-exposure group was determined by using 10 events as a cutoff. Findings on this group corresponded with findings in other international studies regarding distribution, elevated risk for females, and the possibility of limiting the effects of victimization by modifying living conditions.

    Ort, förlag, år, upplaga, sidor
    SAGE PUBLICATIONS INC, 2016
    Nyckelord
    JVQ; victim; youth; poly-victimization; sociodemographics
    Nationell ämneskategori
    Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
    Identifikatorer
    urn:nbn:se:liu:diva-124456 (URN)10.1177/0886260514556105 (DOI)000367838200004 ()25392393 (PubMedID)
    Anmärkning

    Funding Agencies|Crime Victim Compensation and Support Authority in Sweden; Medical Research Council of Southeast Sweden

    Tillgänglig från: 2016-02-02 Skapad: 2016-02-01 Senast uppdaterad: 2018-02-21
    2. Victimization, polyvictimization , and health in Swedish adolescents
    Öppna denna publikation i ny flik eller fönster >>Victimization, polyvictimization , and health in Swedish adolescents
    2016 (Engelska)Ingår i: Adolescent Health, Medicine and Therapeutics, ISSN 1179-318X, Vol. 7, s. 89-99Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The main objective of this article was to study the relationship between the different areas of victimization (eg, sexual victimization) and psychological symptoms, taking into account the full range of victimization domains. The final aim was to contribute further evidence regarding the bias that studies that focus on just one area of victimization may be introduced into our psychological knowledge. The sample included 5,960 second-year high school students in Sweden with a mean age of 17.3 years (range =16–20 years, standard deviation =0.652), of which 49.6% were females and 50.4% males. The Juvenile Victimization Questionnaire and the Trauma Symptom Checklist for Children were used to assess victimization and psychological problems separately. The results show that a majority of adolescents have been victimized, females reported more total events and more sexual victimization and childhood maltreatment, and males were more often victims of conventional crime. The majority of victimization domains as well as the sheer number of events (polyvictimization [PV]) proved to be harmful to adolescent health, affecting females more than males. PV explained part of the health effect and had an impact on its own and in relation to each domain. This suggests the possibility that PV to a large degree explains trauma symptoms. In order to understand the psychological effects of trauma, clinicians and researchers should take into account the whole range of possible types of victimization.

    Ort, förlag, år, upplaga, sidor
    Dovepress, 2016
    Nyckelord
    victimization, childhood trauma, psychological symptoms, JVQ, TSCC
    Nationell ämneskategori
    Klinisk medicin Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi Psykiatri Neurovetenskaper
    Identifikatorer
    urn:nbn:se:liu:diva-132626 (URN)10.2147/AHMT.S109587 (DOI)27616895 (PubMedID)
    Tillgänglig från: 2016-11-17 Skapad: 2016-11-17 Senast uppdaterad: 2018-02-21Bibliografiskt granskad
    3. Posttraumatic stress symptoms and mental health services utilization in adolescents with social anxiety disorder and experiences of victimization
    Öppna denna publikation i ny flik eller fönster >>Posttraumatic stress symptoms and mental health services utilization in adolescents with social anxiety disorder and experiences of victimization
    Visa övriga...
    2013 (Engelska)Ingår i: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 22, nr 3, s. 177-184Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Recent findings from studies on adults show similarities between social anxiety disorder (SAD) and posttraumatic stress in the form of recurrent memories and intrusive and distressing images of earlier aversive events. Further, treatment models for SAD in adults have been successfully developed by using transdiagnostic knowledge on posttraumatic stress symptoms (PTSS). Studies on adolescents are though missing. The present study aimed at exploring the association between PTSS and SAD in Swedish adolescents. A second aim was to study mental health services utilization in relation to these conditions. A total of 5,960 high-school students participated and reported on SAD, life time victimization, PTSS and mental health service utilization. Socially anxious adolescents reported significantly higher levels of PTSS than adolescents not reporting SAD and this difference was seen in victimized as well as non-victimized subjects. Contact with a school counselor was the most common mental health service utilization in subjects with SAD and those with elevated PTSS. In the prediction of contact with a CAP-clinic, significant odds ratios were found for a condition of SAD and elevated PTSS (OR = 4.88, 95 % CI = 3.53–6.73) but not for SAD only. Screening of PTSS in adolescents with SAD is recommended. The service of school counselors is important in detecting and helping young people with SAD and elevated PTSS. Clinical studies on SAD and PTSS in adolescents could aid in modifying treatment models for SAD.

    Ort, förlag, år, upplaga, sidor
    Springer, 2013
    Nyckelord
    Social anxiety disorder, victimization, mental health service utilization, adolescents
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-89939 (URN)10.1007/s00787-012-0336-z (DOI)000315736200005 ()
    Tillgänglig från: 2013-03-11 Skapad: 2013-03-11 Senast uppdaterad: 2018-02-21
  • 11.
    Aho, Nikolas
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Gren Landell, Malin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping. Linköpings universitet, Centrum för social och affektiv neurovetenskap (CSAN).
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    The Prevalence of Potentially Victimizing Events, Poly-Victimization, and Its Association to Sociodemographic Factors: A Swedish Youth Survey2016Ingår i: Journal of Interpersonal Violence, ISSN 0886-2605, E-ISSN 1552-6518, Vol. 31, nr 4, s. 620-651Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Studying the extent to which children are exposed to victimizing events is important to fully understand the effect of such exposure in shaping them as adults. The aim of this study was to use self-report by adolescents to measure the prevalence of victimizing events and of poly-victimization. A representative sample of 5,960 students (aged 17) from high schools in Sweden was given the self-administrated version of the Juvenile Victimization Questionnaire (JVQ) along with questions concerning gender, birthplace, parents birthplace and employment, residence, educational program, and municipality size. The results show that 84.1% (83.0% young men and 85.2% young women) of the students had experienced victimization during their lifetime, and 10.3% were categorized as poly-victims (8.1% young men and 12.5% young women; OR = 1.62, 95% confidence interval [CI] = [1.35, 1.94]). Adolescents living with both parents were at lower risk of any form of victimization for both genders, while females were at higher risk of maltreatment, peer victimization, and, most significantly, sexual victimization. In conclusion, the vast majority of young people have been victimized during their lifetime. A greater awareness of the impact of these victimizing events on children and adolescents is important as a basis for providing a safer milieu and establishing better interventions, especially for those that have been victimized on multiple occasions. The high-exposure group was determined by using 10 events as a cutoff. Findings on this group corresponded with findings in other international studies regarding distribution, elevated risk for females, and the possibility of limiting the effects of victimization by modifying living conditions.

  • 12.
    Aho, Nikolas
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Proczkowska-Björklund, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Victimization, polyvictimization , and health in Swedish adolescents2016Ingår i: Adolescent Health, Medicine and Therapeutics, ISSN 1179-318X, Vol. 7, s. 89-99Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The main objective of this article was to study the relationship between the different areas of victimization (eg, sexual victimization) and psychological symptoms, taking into account the full range of victimization domains. The final aim was to contribute further evidence regarding the bias that studies that focus on just one area of victimization may be introduced into our psychological knowledge. The sample included 5,960 second-year high school students in Sweden with a mean age of 17.3 years (range =16–20 years, standard deviation =0.652), of which 49.6% were females and 50.4% males. The Juvenile Victimization Questionnaire and the Trauma Symptom Checklist for Children were used to assess victimization and psychological problems separately. The results show that a majority of adolescents have been victimized, females reported more total events and more sexual victimization and childhood maltreatment, and males were more often victims of conventional crime. The majority of victimization domains as well as the sheer number of events (polyvictimization [PV]) proved to be harmful to adolescent health, affecting females more than males. PV explained part of the health effect and had an impact on its own and in relation to each domain. This suggests the possibility that PV to a large degree explains trauma symptoms. In order to understand the psychological effects of trauma, clinicians and researchers should take into account the whole range of possible types of victimization.

  • 13.
    Albin, Björn
    et al.
    Linnaeus University, Växjö, Sweden; Lund University, Malmö, Sweden.
    Hjelm, Katarina
    Linnaeus University, Växjö, Sweden; Lund University, Malmö, Sweden.
    Elmståhl, Sölve
    Lund University, Universitetssjukhuset MAS, Malmö, Sweden.
    Comparison of Stroke Mortality in Finnish-Born Migrants Living in Sweden 1970-1999 and in Swedish-Born Individuals2014Ingår i: Journal of Immigrant and Minority Health, ISSN 1557-1912, E-ISSN 1557-1920, Vol. 16, nr 1, s. 18-23Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A limited number of studies have been found on stroke mortality in migrants showing higher mortality for some groups. Influence of time of residence has been studied by a previous  research group. A previous study showed a significantly higher number of deaths in Diseases of the circulatory system in Finnish migrants compared to native Swedes. The aim was to test the hypothesis of a higher mortality in and a decrease in mortality over time in stroke among Finnish migrants in Sweden. The study was based on National Population registry data. The study population included 321,407 Swedish and 307,174 foreign born persons living in Sweden 1987-1999. Mean age was lower at time for death for Finnish migrants than native Swedes, men 5.1 years difference and women 2.3 years. The dissimilarity decreased over time. The risk of death by stroke was higher for migrants with short time of residence in Sweden than with long time (≤10 years, OR 1.61-1.36 vs ≥11 year, OR 1.18). Migrants with short time of residence in Sweden died 9.8-5.3 years earlier than native Swedes. The hypothesis was confirmed and an indication of adjustment to life in the new host country was found. International studies show similar results for other migrant groups but further studies are needed to verify if a similar pattern can be found in other migrant groups living in Sweden and to be able to generalise the findings.

  • 14.
    Alehagen, Urban
    et al.
    Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin.
    Johansson, Peter
    Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten.
    Björnstedt, Mikael
    Division of Pathology F42, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Rosén, Anders
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten.
    Post, Claes
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten.
    Aaseth, Jan
    Research Department, Innlandet Hospital Trust and Hedmark University College, Norway.
    Relatively high mortality risk in elderly Swedish subjects with low selenium status2016Ingår i: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 70, nr 1, s. 91-96Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background/Objectives: 

    The daily dietary intake of selenium (Se), an essential trace element, is still low in Sweden in spite of decades of nutritional information campaigns and the effect of this on the public health is presently not well known. The objective of this study was to determine the serum Se levels in an elderly Swedish population and to analyze whether a low Se status had any influence on mortality.

    Subjects/Methods: 

    Six-hundred sixty-eight (n=668) elderly participants were invited from a municipality and evaluated in an observational study. Individuals were followed for 6.8 years and Se levels were re-evaluated in 98 individuals after 48 months. Clinical examination of all individuals included functional classification, echocardiography, electrocardiogram and serum Se measurement. All mortality was registered and endpoints of mortality were assessed by Kaplan–Meier plots, and Cox proportional hazard ratios adjusted for potential confounding factors were calculated.

    Results: 

    The mean serum Se level of the study population (n=668) was 67.1 μg/l, corresponding to relatively low Se intake. After adjustment for male gender, smoking, ischemic heart disease, diabetes, chronic obstructive pulmonary disease and impaired heart function, persons with serum Se in the lowest quartile had 43% (95% confidence interval (CI): 1.02–2.00) and 56% (95% CI: 1.03–2.36) increased risk for all-cause and cardiovascular mortality, respectively. The result was not driven by inflammatory effects on Se concentration in serum.

    Conclusion: 

    The mean serum Se concentration in an elderly Swedish population was 67.1 μg/l, which is below the physiological saturation level for several selenoprotein enzymes. This result may suggest the value of modest Se supplementation in order to improve the health of the Swedish population.

  • 15.
    Alehagen, Urban
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Slind Olsen, Renate
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. County Hospital Ryhov, Sweden.
    Länne, Toste
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Matussek, Andreas
    County Hospital Ryhov, Sweden.
    Wågsäter, Dick
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten.
    PDGF-D gene polymorphism is associated with increased cardiovascular mortality in elderly men2016Ingår i: BMC Medical Genetics, ISSN 1471-2350, E-ISSN 1471-2350, Vol. 17, nr 62Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Platelet-derived growth factor (PDGF) D has been reported to be active in fibroblasts, and in areas of myocardial infarction. In this longitudinal study we evaluated the association between PDGF-D polymorphism and cardiovascular mortality, and attempted to discover whether specific genotype differences regarding risk could be observed, and if gender differences could be seen. Methods: Four hundred seventy-six elderly community participants were included in this study. All participants underwent a clinical examination, echocardiography, and blood sampling including PDGF-D single nucleotide polymorphism (SNP) analyses of the rs974819 A/A, G/A and G/G SNP. The follow-up time was 6.7 years. Results: No specific genotype of rs974819 demonstrated increased cardiovascular mortality in the total population, however, the male group with genotypes A/A and G/A demonstrated an increased risk that persisted in a multivariate evaluation where adjustments were made for well-known cardiovascular risk factors (2.7 fold compared with the G/G genotype). No corresponding finding was observed in the female group. Conclusion: We report here for the first time that the genotypes G/A or A/A of the SNP rs974819 near PDGF-D exhibited a 2.7 fold increased cardiovascular mortality risk in males. Corresponding increased risk could not be observed in either the total population and thus not in the female group. However, the sample size is was small and the results should be regarded as hypothesis-generating, and thus more research in the field is recommended.

  • 16.
    Alexanderson, Kristina
    et al.
    Linköpings universitet, Institutionen för hälsa och samhälle, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Leijon, Margareta
    Linköpings universitet, Institutionen för hälsa och samhälle, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Åkerlind, Ingemar
    Linköpings universitet, Institutionen för hälsa och samhälle, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Rydh, Hillevi
    Linköpings universitet, Institutionen för hälsa och samhälle, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Bjurulf, Per
    Linköpings universitet, Institutionen för hälsa och samhälle, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Epidemiology of sickness absence in a Swedish county in 1985, 1986 and 1987: A three year longitudinal study with focus on gender, age and occupation1994Ingår i: Scandinavian Journal of Social Medicine, ISSN 0300-8037, Vol. 22, nr 1, s. 27-34Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In order to get a better epidemiological base for preventive intervention in the county of Östergötland, Sweden, a comprehensive study of sickness absence was done. During the years 1985, 1986 and 1987, all new periods of sick-leave exceeding seven days were registered with demographic variables. This information was related to data about the total population of Östergötland. Each year approx. 45,000 persons had approx. 61,000 sickness spells. These figures were stable over the years while the number of sick-leave days increased. Blue-collar occupations had the highest sick-leave rates and the female sick-leave rate was higher in general and much higher in most male-dominated occupations. The male rate was lower within female-dominated areas, except among secretaries and textile workers. Females in extremely male-dominated groups had the highest rates, while both male and female sick-leave rates were lower in more gender-integrated occupations.

  • 17.
    Alonso, Juan-Manuel
    et al.
    Int Assoc Athlet Federat, Med & Antidoping Commiss, Monaco, Monaco; Qatar Orthoped & Sports Med Hosp, Sports Med Dept, Aspetar, Doha, Qatar.
    Jacobsson, Jenny
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Timpka, Toomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Region Östergötland, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Ronsen, Ola
    Int Assoc Athlet Federat, Med & Antidoping Commiss, Monaco, Monaco; Aker Solut, Lysaker, Norway.
    Kajenienne, Alma
    Int Assoc Athlet Federat, Med & Antidoping Commiss, Monaco, Monaco; Lithuanian Univ Hlth Sci, Inst Sport, Kaunas, Lithuania.
    Dahlström, Örjan
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för beteendevetenskap, Institutet för handikappvetenskap, IHV.
    Spreco, Armin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Edouard, Pascal
    Univ Hosp St Etienne, Fac Med, Sports Med Unity, Dept Clin & Exercise Physiol, St Etienne, France; Univ Lyon, Exercise Physiol Lab, LPE EA 4338, St Etienne, France; French Athlet Federat, Med Commiss, Paris, France.
    Preparticipation injury complaint is a risk factor for injury: a prospective study of the Moscow 2013 IAAF Championships.2015Ingår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 49, nr 17, s. 1118-U45Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To determine the health status of athletes before the start of an international athletics championship and to determine whether preparticipation risk factors predicted in-championship injuries.

    METHODS: At the beginning of the 2013 International Association of Athletics Federations (IAAF) World Championships, all registered athletes (n=1784) were invited to complete a preparticipation health questionnaire (PHQ) on health status during the month preceding the championships. New injuries that occurred at the championships were prospectively recorded.

    RESULTS: The PHQ was completed by 698 (39%) athletes; 204 (29.2%) reported an injury complaint during the month before the championships. The most common mode of onset of preparticipation injury complaints was gradual (43.6%). Forty-nine athletes in the study reported at least one injury during the championships. Athletes who reported a preparticipation injury complaint were at twofold increased risk for an in-championship injury (OR=2.09; 95% CI 1.16 to 3.77); p=0.014). Those who reported a preparticipation gradual-onset injury complaint were at an almost fourfold increased risk for an in-championship time-loss injury (OR=3.92; 95% CI 1.69 to 9.08); p=0.001). Importantly, the preparticipation injury complaint severity score was associated with the risk of sustaining an in-championship injury (OR=1.14; 95% CI 1.06 to 1.22); p=0.001).

    SUMMARY AND CONCLUSIONS: About one-third of the athletes participating in the study reported an injury complaint during the month before the championships, which represented a risk factor for sustaining an injury during the championship. This study emphasises the importance of the PHQ as a screening tool to identify athletes at risk of injuries before international championships.

  • 18.
    Altin, Carolina
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Kvist Lindholm, Sofia
    Linköpings universitet, Institutionen för tema, Tema Barn. Linköpings universitet, Filosofiska fakulteten.
    Wejdmark, Mats
    Nature School, Municipality of Nynäshamn, Stockholm, Sweden.
    Lättman-Masch, Robert
    Nature School, Municipality of Nynäshamn, Stockholm, Sweden.
    Boldemann, Cecilia
    Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden .
    Upgrading Preschool Environment in a Swedish Municipality: Evaluation of an Implementation Process2015Ingår i: Health Promotion Practice, ISSN 1524-8399, E-ISSN 1552-6372, Vol. 16, nr 4, s. 583-591Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Redesigning outdoor preschool environment may favorably affect multiple factors relevant to health and reach many children. Cross-sectional studies in various landscapes at different latitudes have explored the characteristics of preschool outdoor environment considering the play potential triggering combined physical activity and sun-protective behavior due to space, vegetation, and topography. Criteria were pinpointed to upgrade preschool outdoor environment for multiple health outcomes to be applied in local government in charge of public preschools. Purposeful land use policies and administrative management of outdoor land use may serve to monitor the quality of preschool outdoor environments (upgrading and planning). This study evaluates the process of implementing routines for upgrading outdoor preschool environments in a medium-sized municipality, Sweden, 2008-2011, using qualitative and quantitative analysis. Recorded written material (logs and protocols) related to the project was processed using thematic analysis. Quantitative data (m2 flat/multileveled, overgrown/naked surface, and fraction of free visible sky) were analyzed to assess the impact of implementation (surface, topography, greenery integrated in play). The preschool outdoor environments were upgraded accordingly. The quality of implementation was assessed using the theory of policy streams approach. Though long-term impact remains to be confirmed the process seems to have changed work routines in the interior management for purposeful upgrading of preschool outdoor environments. The aptitude and applicability of inexpensive methods for assessing, selecting, and upgrading preschool land at various latitudes, climates, and outdoor play policies (including gender aspects and staff policies) should be further discussed, as well as the compilation of data for monitoring and evaluation.

  • 19.
    Alwin, Jenny
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Bernfort, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Eckard, Nathalie
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Husberg, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Fixartjänster i Sveriges kommuner: Kartläggning och samhällsekonomisk analys. Regeringsuppdrag2013Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    En fixartjänst är en tjänst som primärt riktas till äldre personer och syftar till att förebygga fallolyckor i hemmet. Fixartjänster tillhandahålls i de flesta fall i kommunal regi. Omfattningen och användningen av fixartjänster i Sverige har tidigare inte studerats på nationell nivå. Syftet med denna studie är att genomföra en kartläggning av omfattningen och användningen av fixartjänster i kommunal regi i Sverige samt att uppskatta de samhällsekonomiska konsekvenserna av fixartjänster. Data har samlats in via postenkät alternativt via telefonintervju.

    Av Sveriges 290 kommuner är det 191 stycken (66 %) som har fixartjänst i kommunal regi. De arbetsuppgifter som primärt utförs inom ramen för fixartjänsten är sådana som innebär att äldre inte ska behöva klättra upp på stegar eller liknande, att förebygga fall genom att fästa lösa sladdar och borttagning av mattor samt översyn av olycksrisker i hemmet. I ett fåtal fall erbjuds även utomhustjänster såsom snöskottning. I majoriteten av kommunerna (58 %) är tjänsten kostnadsfri men brukaren får betala för förbrukningsmaterial, i 32 % är tjänsten helt kostnadsfri och i 9 % av kommunerna tas en kostnad ut för fixartjänsten. Tjänsten organiseras på olika sätt i kommunerna: fixartjänsten kan bedrivas helt i kommunal regi där utföraren är en eller flera fixare, personer tillhörande daglig verksamhet eller arbetsmarknadsenheten. I vissa fall bedrivs tjänsten av räddningstjänsten i samarbete med kommunen och i andra fall bedrivs tjänsten av företag på uppdrag av kommunen. Det finns även volontärorganisationer/ideellt arbetande personer som utför fixartjänster med mer eller mindre inblandning från kommunen, dessa har i denna rapport inte inkluderats som fixartjänster i kommunal regi till skillnad från de ovan nämnda. I 99 kommuner erbjuds inte fixartjänster i kommunal regi. Anledningar till detta är bland annat ekonomiska skäl samt svag efterfrågan.

    Upplevda vinster och nytta med fixartjänsterna som kommunerna själva rapporterar är bland annat fallprevention, att möjliggöra kvarboende, medverka till social samvaro samt möjlighet att erbjuda meningsfull sysselsättning. Problem som framkommit är exempelvis låg efterfrågan, svårighet att nå ut med information samt svårighet att mäta effekten på fallskador.

    En samhällsekonomisk modell för analys av fallskador har skapats. Denna modell inkluderar de stora kostnadsposterna fördelade på olika sektorer samt utfall i form av mortalitet samt livskvalitetsförlust när man drabbas av en fallskada. Kostnader för fallskador totalt i Sverige har i tidigare forskning beräknats till cirka 5 miljarder kronor, bara i direkta kostnader under det första året efter skadan. Av de totala fallolyckorna sker drygt hälften i hemmet. Ett beräkningsexempel baserat på kostnadsdata från litteraturen har i denna rapport genomförts och applicerats på en hypotetisk mellanstor kommun med 50 000 invånare. Sammanfattningsvis så visar detta räkneexempel att om endast en liten del av de allvarliga fallskador som leder till slutenvård kan förhindras genom en fixartjänst så motsvarar kostnadsinbesparingen den genomsnittliga budgeten.

    för en fixartjänst med en anställd person. Därtill kommer positiva bieffekter i form av att livskvalitetsförlust kan undvikas med mera. Utifrån detta kan en sammantagen bedömning göras att fixartjänster kan anses vara väl använda pengar sett ur såväl samhälleligt som kommunalt perspektiv. Beräkningar med reella data som inkluderar både kostnader och effekter i form av livskvalitet bör genomföras.

  • 20.
    Andersen, Pia
    et al.
    Department of Research and Development, Region Kronoberg, Sweden.
    Holmberg, Sara
    Region Kronoberg, Sweden.
    Lendahls, Lena
    Department of Research and Development, Region Kronoberg, Sweden.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Kristenson, Margareta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Physical Activity on Prescription with Counsellor Support: A 4-Year Registry-Based Study in Routine Health Care in Sweden2018Ingår i: Healthcare, E-ISSN 2227-9032, Vol. 6, nr 2, artikel-id E34Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Public health gains from physical activity on prescription (PAP) depend on uptake in routine care. We performed an evaluation of the implementation, in a Swedish county council, of counsellors who give personalized support to PAP recipients aimed at facilitating PAP delivery. The aim was to compare characteristics between PAP recipients and the health care population as well as between PAP recipients who used and did not use counsellor support. We also investigated professional belonging and health care setting of health care professionals who prescribed PAP. 

    Methods: All patients’ ≥18 years who received PAP during 2009–2012 in primary and secondary care in the County Council of Kronoberg were included (n = 4879). Data were retrieved from electronic medical records. Main outcome measures were patient and professional characteristics. 

    Results: A third of the PAP recipients had diseases in ≥5 diagnostic groups and more than half had ≥11 office visits the year before receiving PAP. Counsellor support was used by one-third and PAP recipients who used counsellor support had more multiple diagnoses and office visits compared with non-users. Physicians issued 44% of prescriptions and primary care was the predominant setting. The amount of PAP did not change over time, but the proportion of physicians’ prescriptions decreased while the proportion of nurses’ prescriptions increased. 

    Conclusions: PAP recipients had high morbidity and were frequent health care attenders, indicating that PAP was predominantly used for secondary or tertiary prevention. PAP rates did not increase as intended after the implementation of counsellor support. View Full-Text

  • 21.
    Anderson, Peter
    et al.
    Newcastle University, England; Maastricht University, Netherlands.
    Kaner, Eileen
    Newcastle University, England.
    Keurhorst, Myrna
    Radboud University of Nijmegen, Netherlands; Saxion University of Appl Science, Netherlands.
    Bendtsen, Preben
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Medicinska specialistkliniken.
    van Steenkiste, Ben
    Maastricht University, Netherlands.
    Reynolds, Jillian
    IDIBAPS, Spain.
    Segura, Lidia
    Govt Catalonia, Spain.
    Wojnar, Marcin
    Medical University of Warsaw, Poland.
    Kloda, Karolina
    Pomeranian Medical University, Poland.
    Parkinson, Kathryn
    Newcastle University, England.
    Drummond, Colin
    Kings Coll London, England; Maudsley NHS Fdn Trust, England.
    Okulicz-Kozaryn, Katarzyna
    State Agency Prevent Alcohol Related Problems, Poland.
    Mierzecki, Artur
    Pomeranian Medical University, Poland.
    Laurant, Miranda
    Radboud University of Nijmegen, Netherlands; HAN University of Appl Science, Netherlands.
    Newbury-Birch, Dorothy
    University of Teesside, England.
    Gual, Antoni
    IDIBAPS, Spain.
    Attitudes and Learning through Practice Are Key to Delivering Brief Interventions for Heavy Drinking in Primary Health Care: Analyses from the ODHIN Five Country Cluster Randomized Factorial Trial2017Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, nr 2, artikel-id 121Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In this paper, we test path models that study the interrelations between primary health care provider attitudes towards working with drinkers, their screening and brief advice activity, and their receipt of training and support and financial reimbursement. Study participants were 756 primary health care providers from 120 primary health care units (PHCUs) in different locations throughout Catalonia, England, The Netherlands, Poland, and Sweden. Our interventions were training and support and financial reimbursement to providers. Our design was a randomized factorial trial with baseline measurement period, 12-week implementation period, and 9-month follow-up measurement period. Our outcome measures were: attitudes of individual providers in working with drinkers as measured by the Short Alcohol and Alcohol Problems Perception Questionnaire; and the proportion of consulting adult patients (age 18+ years) who screened positive and were given advice to reduce their alcohol consumption (intervention activity). We found that more positive attitudes were associated with higher intervention activity, and higher intervention activity was then associated with more positive attitudes. Training and support was associated with both positive changes in attitudes and higher intervention activity. Financial reimbursement was associated with more positive attitudes through its impact on higher intervention activity. We conclude that improving primary health care providers screening and brief advice activity for heavy drinking requires a combination of training and support and on-the-job experience of actually delivering screening and brief advice activity.

  • 22.
    Andersson, David
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Magnusson, Henrik
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Carstensen, John
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Co-morbidity and health care utilisation five years prior to diagnosis for depression: A register-based study in a Swedish population2011Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, s. 552-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Depressive disorders have been associated with a number of co-morbidities, and we   hypothesized that patients with a depression diagnosis would be heavy users of health   care services, not only when first evaluated for depression, but also for preceding   years. The aim of this study was to investigate whether increased health care utilisation   and co-morbidity could be seen during five years prior to an initial diagnosis of   depression.

    Methods

    We used a longitudinal register-based study design. The setting comprised the general   population in the county of Östergötland, south-east Sweden. All 2470 patients who   were 20 years or older in 2006 and who received a new diagnosis of depression (F32   according to ICD-10) in 2006, were selected and followed back to the year 2001, five   years before their depression diagnosis. A control group was randomly selected among   those who were aged 20 years or over in 2006 and who had received no depression diagnosis   during the period 2001-2006.

    Results

    Predictors of a depression diagnosis were a high number of physician visits, female   gender, age below 60, age above 80 and a low socioeconomic status.

    Patients who received a diagnosis of depression used twice the amount of health care   (e.g. physician visits and hospital days) during the five year period prior to diagnosis   compared to the control group. A particularly strong increase in health care utilisation   was seen the last year before diagnosis. These findings were supported with a high   level of co-morbidity as for example musculoskeletal disorders during the whole five-year   period for patients with a depression diagnosis.

    Conclusions

    Predictors of a depression diagnosis were a high number of physician visits, female   gender, age below 60, age above 80 and a low socioeconomic status. To find early signs   of depression in the clinical setting and to use a preventive strategy to handle these   patients is important.

  • 23.
    Andersson, Réka
    Linköpings universitet, Institutionen för tema, Tema teknik och social förändring. Linköpings universitet, Filosofiska fakulteten.
    Gränsdragningar i Vårdens Vardag: Hanteringen av arbetsrelaterad psykisk ohälsa i det svenska välfärdssystemet2017Doktorsavhandling, monografi (Övrigt vetenskapligt)
    Abstract [sv]

    Psykisk ohälsa i arbetslivet är ett stort och växande problem i välfärdssamhället. Problemet har flera bottnar och väcker många frågor om vem som har ansvar, vad det egentligen är för ett slags fenomen och hur det bör hanteras. Den här studien undersöker hur arbetsrelaterad psykisk ohälsa hanteras av yrkesverksamma inom vården, med fokus på företagshälsovård och primärvård. Intresse riktas mot hur yrkesverksamma personerna resonerar kring arbetsrelaterad psykisk ohälsa, vilka dilemman de ställs inför och de strategier de har för att hantera dessa. Den söker också svar på ansvarsfrågan kring detta komplexa problem, inte minst i ljuset av privatiseringen av företagshälsovården.

    I studien används ett tvärvetenskapligt perspektiv, där begrepp från teknik- och vetenskapsstudier (STS), professionssociologi och organisationsteori kombineras för att analysera olika aspekter av vårdens hantering av arbetsrelaterad psykisk ohälsa. Det empiriska materialet bygger i huvudsak på intervjuer med läkare, psykoterapeuter, kuratorer, arbetsterapeuter, psykologer, rehabiliteringskoordinatorer och  beteendevetare, men inkluderar även observationer inom primärvård och företagshälsovård. Hanteringen av arbetsrelaterad psykisk ohälsa i vårdens vardag präglas av att orsaksbilden till problemet är komplext, ansvarsfördelningen otydlig och att psykosociala orsaker till sjukdom är kontroversiellt. I studien diskuteras utmaningarna och möjligheterna kring hanteringen av detta komplexa problem i bred bemärkelse. I analyserna uppmärksammas de yrkesverksammas gränsdragningar kring både ansvar och fenomenet arbetsrelaterad psykisk ohälsa. Begreppet kunskapsinfrastruktur används för att förklara och förstå den kunskapsmässiga och materiella struktur som de yrkesverksamma verkar inom. Analyserna visar att de yrkesverksamma har ett pragmatiskt förhållningssätt och använder olika strategier för att skapa sig handlingsutrymme i hur de hanterar arbetsrelaterad psykisk ohälsa.

  • 24.
    Andreae, Christina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Chung, Misook
    College of Nursing, University of Kentucky, Lexington, Kentucky, USA.
    Lennie, Terry
    College of Nursing, University of Kentucky, Lexington, Kentucky, USA.
    Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Depressive symptoms as a moderator and mediator of the relationship between physical activity, appetite and perceived health among patients with heart failure2015Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Purpose: Depressive symptoms have been shown to directly influence perceived health among persons with heart failure (HF). Decreased physical activity and appetite may also be predictive of poor perceived health.The purposes of this study were to determine whether appetite and physical activity predicted perceived health, and to determine whether depressive symptoms mediated or moderated their relationship with perceived health.

    Methods: A total of 184 patients with mild to severe HF were included. Appetite, depressive symptoms and perceived health were measured by self-report questionnaires (Council on Nutrition Appetite Questionnaire, Patient Health Questionnaire and EuroQol 5D index). Physical activity was measured by SenceWearTM for 6 days. A separate series of multiple linear regression analyses were run to determine whether depressive symptoms mediated or moderated the relationship between physical activity and perceived health, and between appetite and perceived health.

    Results: Higher physical activity predicted better perceived health (ß=0.202, p=.006) but the strength of the association decreased (ß=0.13, p=.048) when depressive symptoms were included in the model. There was a significant mediation effect for depressive symptoms on perceived health (sobel=2.03, p=.041) (Fig 1). Appetite was a significant predictor of perceived health. Examination of this association among those with and without depressive symptoms, however showed positive association between appetite and perceived health remained only for patients without depressive symptoms demonstrating a moderating effect (p<.001) (Fig 2).

    Conclusion: Identifying and treating depression simultaneously while addressing appetite and physical activity may be key to improving perceived health among persons with HF.

  • 25.
    Angelhoff, Charlotte
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    What about the parents?: Sleep quality, mood, saliva cortisol response and sense of coherence in parents with a child admitted to pediatric care2017Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Parents experience many stressful situations when their child is ill and needs medical care, irrespective of the child’s age, diagnosis or the severity of the illness. Poor sleep quality and negative mood decrease the parents’ ability to sustain attention and focus, to care for their ill child, and to cope with the challenges they face.

    The overall aim of this thesis was to evaluate sleep, mood, cortisol response, and sense of coherence (SOC) in parents caring for children in need of medical care, and to identify factors that may influence parents’ sleep.

    This thesis includes four original studies; two of these are quantitative, prospective, descriptive and comparative studies including parents (n=82) accommodated in six pediatric wards with their ill child, using questionnaires and sleep logs to measure sleep, mood and SOC, and saliva cortisol to measure cortisol response. A follow-up was performed four weeks later at home, after hospital discharge. The other two studies are qualitative, inductive and explorative interview studies, including parents (n=12) staying overnight with their preterm and/or ill infant in three neonatal intensive care units, and parents (n=15) with a child receiving hospital-based home care in two pediatric outpatient clinics. The interviews were analyzed with a phenomenographic method.

    Being together with one’s family seems beneficial for sleep and may decrease stress. The ability to stay with the child, in the hospital or at home, was highly appreciated by the parents. When caring for a child with illness, parents’ sleep quality was sufficient in the hospital; however, sleep quality improved further (p<0.05) at home after discharge. The parents reported frequent nocturnal awakenings in the hospital caused by the child, medical treatment and hospital staff. Concern and anxiety about the child’s health, and uncertainty about the future were stressors affecting the parents’ sleep and mood negatively. The parents had lower (p=0.01) morning awakening cortisol levels in the pediatric ward compared to at home, and parents accommodated for more than one night had lower (p<0.05) post-awakening cortisol levels compared to parents staying their first night.

    The findings of this thesis conclude that being together as a family is important for the parents’ sleep. The ability to be accommodated in the hospital and gather the family around the child may have given the parents time for relaxation and recovery, that in turn may lead to a less stressful hospital stay. When it is beneficial for the child, the whole family should be included in the pediatric care. Moreover, pediatric nurses must acknowledge parents’ sleep, in hospital and at home. Medical treatment and care at night should be scheduled and sleep promoted for the parents in order to maintain health and well-being in the family.

    Delarbeten
    1. Hindering and buffering factors for parental sleep in neonatal care. A phenomenographic study
    Öppna denna publikation i ny flik eller fönster >>Hindering and buffering factors for parental sleep in neonatal care. A phenomenographic study
    Visa övriga...
    2015 (Engelska)Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, nr 5-6, s. 717-727Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    AIMS AND OBJECTIVES:

    To explore and describe how parents of preterm and/or sick infants in neonatal care perceive their sleep.

    BACKGROUND:

    Parents experience many stressful situations when their newborn infant is preterm and/or sick. This affects bonding. By developing more family-centred care units with single-family rooms, parents are given the opportunity to stay and care for their newborn infant(s) 24 hours a day. Lack of sleep may affect new parents' ability to cope with the many challenges they face on a daily basis.

    DESIGN:

    A phenomenographic study with an inductive and exploratory design.

    METHODS:

    Semi-structured interviews were conducted with twelve parents of infants in neonatal care between January-March 2012. To describe variations in perception of the phenomenon, data were analysed using phenomenography.

    FINDINGS:

    Four descriptive categories were identified within the phenomenon sleep in parents of preterm and/or sick infants in neonatal care: impact of stress on sleep; how the environment affects sleep; keeping the family together improves sleep; and, how parents manage and prevent tiredness.

    CONCLUSION:

    Anxiety, uncertainty and powerlessness have a negative influence on sleep. This can be decreased by continuous information, guidance and practical support. Skin-to-skin care was perceived as a stress-reducing factor that improved relaxation and sleep and should be encouraged by the nurse. The parents also mentioned the importance of being together. Having a private place where they could relax and take care of themselves and their newborn infant improved sleep. It was also desirable to involve older siblings in order to decrease feelings of loneliness, sadness and isolation.

    RELEVANCE FOR CLINICAL PRACTICE:

    Improved parental sleep in neonatal care may help the families cope with the situation and facilitate problem-solving, emotional regulation and the transition to parenthood.

    Ort, förlag, år, upplaga, sidor
    John Wiley & Sons, 2015
    Nyckelord
    family nursing; family-centred care; kangaroo mother care; neonatal intensive care; nursing; siblings; skin-to-skin care
    Nationell ämneskategori
    Omvårdnad
    Identifikatorer
    urn:nbn:se:liu:diva-115549 (URN)10.1111/jocn.12654 (DOI)000350354700010 ()25041598 (PubMedID)
    Forskningsfinansiär
    Forskningsrådet i Sydöstra Sverige, FORSSLandstinget i Östergötland
    Tillgänglig från: 2015-03-16 Skapad: 2015-03-16 Senast uppdaterad: 2017-12-04
    2. Sleep of Parents Living With a Child Receiving Hospital-Based Home Care: A Phenomenographical Study.
    Öppna denna publikation i ny flik eller fönster >>Sleep of Parents Living With a Child Receiving Hospital-Based Home Care: A Phenomenographical Study.
    2015 (Engelska)Ingår i: Nursing Research, ISSN 0029-6562, E-ISSN 1538-9847, Vol. 64, nr 5, s. 372-380Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background: Caring for an ill child at home gives the family the chance to be together in a familiar environment. However, this involves several nocturnal sleep disturbances, such as frequent awakenings and bad sleep quality, which may affect parents' ability to take care of the child and themselves.

    Objectives: The aim of this study was to describe parents' perceptions of circumstances influencing their own sleep when living with a child enrolled in hospital-based home care (HBHC) services.

    Method: This is a phenomenographical study with an inductive, exploratory design. Fifteen parents (11 mothers and 4 fathers) with children enrolled in HBHC services were interviewed. Data were analyzed to discover content-related categories describing differences in ways parents experienced sleep when caring for their children receiving HBHC.

    Results: Four descriptive categories were detected: sleep influences mood and mood influences sleep; support influences safeness and safeness influences sleep; the child's needs influence routines and routines influence sleep; and "me time" influences sleep.

    Discussion: Sleep does not affect only the parents' well-being but also the child's care. Symptoms of stress may limit the parents' capacity to meet the child's needs. Support, me time, and physical activity were perceived as essential sources for recovery and sleep. It is important for nurses to acknowledge parental sleep in the child's nursing care plan and help the parents perform self-care to promote sleep and maintain life, health, and well-being.

    Ort, förlag, år, upplaga, sidor
    Lippincott-Ravn Publisher, 2015
    Nyckelord
    children, chronic illness, home care services, parents, qualitative research, sleep
    Nationell ämneskategori
    Omvårdnad
    Identifikatorer
    urn:nbn:se:liu:diva-121085 (URN)10.1097/NNR.0000000000000108 (DOI)000361361000006 ()26325279 (PubMedID)
    Projekt
    Parents’ stress and sleep quality when their children need medical care
    Forskningsfinansiär
    Landstinget i ÖstergötlandForskningsrådet i Sydöstra Sverige, FORSS
    Tillgänglig från: 2015-09-07 Skapad: 2015-09-07 Senast uppdaterad: 2017-12-04Bibliografiskt granskad
    3. Sleep quality and mood in mothers and fathers accommodated in the family-centred paediatric ward
    Öppna denna publikation i ny flik eller fönster >>Sleep quality and mood in mothers and fathers accommodated in the family-centred paediatric ward
    2018 (Engelska)Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, nr 3-4, s. e544-e550Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Aims and objectives

    To describe sleep quality and mood in parents accommodated with their sick child in a family‐centred paediatric ward. Secondary aims were to compare mothers’ and fathers’ sleep quality and mood in the paediatric ward and to compare the parents’ sleep quality and mood between the paediatric ward and in a daily‐life home setting after discharge.

    Background

    Frequent interruptions, ward noise and anxiety affect parents’ sleep quality and mood negatively when accommodated with their sick child in paediatric wards. Poor sleep quality and negative mood decrease the parents’ ability to sustain attention and focus, and to care for their sick child.

    Methods

    This was a prospective and descriptive study. Eighty‐two parents (61 mothers and 21 fathers) with children (median age 6.25 years) admitted to six paediatric wards participated in the study. Uppsala Sleep Inventory, a sleep diary and the Mood Adjective Checklist were used to measure sleep quality and mood.

    Results

    The parents had a good sleep quality in the paediatric ward even though they had more nocturnal awakenings compared to home. Moreover, they were less alert, less interested and had reduced concentration, and were more tired, dull and passive in the hospital than at home after discharge. Vital sign checks, noises made by the staff and medical treatment were given reasons influencing sleep. Poor sleep quality correlated with negative mood.

    Conclusion

    Parents’ sleep quality in family‐centred paediatric care is good. However, the habitual sleep efficacy before admittance to the hospital is lower than expected and needs to be further investigated.

    Relevance to Clinical Practice

    The healthcare professionals should acknowledge parents’ sleep and mood when they are accommodated with their sick child. Further should care at night be scheduled and sleep promoted for the parents to maintain health and well‐being in the family.

    Ort, förlag, år, upplaga, sidor
    John Wiley & Sons, 2018
    Nyckelord
    adolescents, child, child nursing, children’s nurses, family nursing, family-centred care, hospitalised child, paediatrics, parent, sleep
    Nationell ämneskategori
    Hälsovetenskaper
    Identifikatorer
    urn:nbn:se:liu:diva-143585 (URN)10.1111/jocn.14092 (DOI)000425733600018 ()28960555 (PubMedID)2-s2.0-85037348121 (Scopus ID)
    Anmärkning

    Funding agencies: Medical Research Council of Southeast Sweden [FORSS-159681]; Region of Ostergotland, Sweden

    Tillgänglig från: 2017-12-11 Skapad: 2017-12-11 Senast uppdaterad: 2019-05-01Bibliografiskt granskad
    4. The cortisol response in parents staying with a sick child at hospital
    Öppna denna publikation i ny flik eller fönster >>The cortisol response in parents staying with a sick child at hospital
    2019 (Engelska)Ingår i: Nursing Open, E-ISSN 2054-1058, Vol. 6, nr 2, s. 620-625Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Aim

    To study the cortisol response in parents staying with their child in paediatric wards, to compare the parents’ cortisol levels between the paediatric ward and at home 4 weeks after discharge and to compare the parents’ cortisol levels with data of an adult reference population, reported by Wust et al., as there are few studies investigating parental cortisol.

    Design

    This study has a descriptive and prospective comparative design.

    Method

    Thirty‐one parents participated. Saliva samples were collected in the paediatric ward and 4 weeks later at home.

    Results

    The parents had lower morning awakening cortisol levels in the paediatric ward than at home after discharge. There were no statistically significant differences in postawakening cortisol or cortisol awakening response (CAR). The child's age, diagnosis or previously diagnosed chronic condition did not affect the parents’ cortisol levels. The morning and postawakening cortisol levels were lower than those of the reference population.

    Conclusion

    The hospital stay with a sick child affects parents’ cortisol levels. Parental stress needs more attention to find interventions to prevent the risk of stress‐related complications that subsequently can affect the care of the child.

    Ort, förlag, år, upplaga, sidor
    Wiley-Blackwell Publishing Inc., 2019
    Nationell ämneskategori
    Omvårdnad
    Identifikatorer
    urn:nbn:se:liu:diva-155717 (URN)10.1002/nop2.245 (DOI)000461835600041 ()30918712 (PubMedID)2-s2.0-85062974527 (Scopus ID)
    Projekt
    What about the parents?: Sleep quality, mood, saliva cortisol response and sense of coherence in parents with a child admitted to pediatric care
    Forskningsfinansiär
    Forskningsrådet i Sydöstra Sverige, FORSS, FORSS‐159681
    Tillgänglig från: 2019-03-25 Skapad: 2019-03-25 Senast uppdaterad: 2019-09-24Bibliografiskt granskad
  • 26.
    Antelius, Eleonor
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen Åldrande och social förändring. Linköpings universitet, Filosofiska fakulteten.
    Hydén, Lars-ChristerLinköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen Åldrande och social förändring. Linköpings universitet, Filosofiska fakulteten.
    Living with dementia: Relation, responses and agency in everyday life2017Samlingsverk (redaktörskap) (Refereegranskat)
    Abstract [en]

    Traditionally, dementia has been defined primarily in terms of loss: loss of cognitive and communicative competencies, loss of identity, loss of personal relationships. People living with dementia have been portrayed as increasingly dependent on others, with their loved ones seen more as care givers than as spouses, children and relatives. However, in the last two decades this view of the person living with dementia as an 'empty vessel' has been increasingly challenged, and the focus has shifted from one of care to one of helping people to live with dementia. With contributions from an international range of expert authors, Living with Dementia strongly advocates this new perspective through in-depth discussion of what people with dementia and their loved ones can do, and how they can actively make use of remaining resources. Topics covered include: how to involve people with dementia in collaborative activities in the home, and the benefits this has on their cognitive and communicative abilities ways in which identity can be presented and preserved through storytelling, and the impact on identity of moving from home into residential care the benefits of a 'citizenship' approach to dementia: of recognising that a person living with dementia is an active agent, with the right to self-determination and the ability to exert power over their own lives. This important new contribution to the dementia debate is truly enlightening reading for students across the full range of health and social care disciplines, and offers a fresh perspective to existing practitioners and those who care for people with dementia.

  • 27.
    Armuand, Gabriela
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Lampic, C.
    Karolinska Institute, Sweden.
    Skoog-Svanberg, A.
    Uppsala University of Uppsala, Sweden.
    Wanggren, K.
    Karolinska Institute, Sweden.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Survey shows that Swedish healthcare professionals have a positive attitude towards surrogacy but the health of the child is a concern2018Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, nr 1, s. 101-109Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AimIn February 2016, Sweden upheld its ban on surrogacy following a Government enquiry. This survey investigated attitudes towards surrogacy among primary health professionals working with children and their experiences of working with families following surrogacy abroad. MethodsFrom April to November 2016, nurses, physicians and psychologist working in primary child health care in four counties in Sweden were invited to participate in a cross-sectional online survey about surrogacy. ResultsThe mean age of the 208 participants was 49.2years (range 27-68) and nearly 91% were women. Approximately 60% supported legalised surrogacy. Wanting a conscience clause to be introduced in Sweden was associated with not supporting surrogacy for any groups, while personal experiences of infertility and clinical experiences with families following surrogacy were associated with positive attitudes towards surrogacy for heterosexual couples. The majority (64%) disagreed that surrogate children were as healthy as other children, and many believed that they risked worse mental health (21%) and social stigmatisation (21%). ConclusionWe found that 60% supported legalised surrogacy, but many expressed concerns about the childrens health and greater knowledge about the medical and psychosocial consequences of surrogacy is needed.

  • 28.
    Arundale, Amelia
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Hägglund, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Football Research Group, Linköping University, Linköping, Sweden.
    Fältström, Anne
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden.
    Jumping performance based on duration of rehabilitation in female football players after anterior cruciate ligament reconstruction2019Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, nr 2, s. 556-563Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose

    To determine if female football players who had longer durations of rehabilitation, measured in months, after anterior cruciate ligament reconstruction would have lower tuck jump scores (fewer technique flaws) and smaller asymmetries during drop vertical jump landing.

    Methods

    One-hundred-and-seventeen female football players, aged 16ᅵ25 years, after primary unilateral ACL reconstruction (median 16 months, range 6ᅵ39) were included. Athletes reported the duration of rehabilitation they performed after anterior cruciate ligament reconstruction. Athletes also performed the tuck jump and drop vertical jump tests. Outcome variables were: tuck jump score, frontal plane knee motion and probability of peak knee abduction moment during drop vertical jump landing.

    Results

    There was no difference in tuck jump score based on duration of rehabilitation (n.s.). No interaction (n.s.), difference between limbs (n.s.), or duration of rehabilitation (n.s.) was found for peak knee abduction moment during drop vertical jump landing. No interaction (n.s.) or difference between limbs (n.s.) was found for frontal plane knee motion, but there was a difference based on duration of rehabilitation (P?=?0.01). Athletes with >?9 months of rehabilitation had more frontal plane knee motion (medial knee displacement) than athletes with <?6 months (P?=?0.01) or 6ᅵ9 months (P?=?0.03).

    Conclusion

    As there was no difference in tuck jump score or peak knee abduction moment based on duration of rehabilitation, the results of this study press upon clinicians the importance of using objective measures to progress rehabilitation and clear athletes for return to sport, rather than time alone.

  • 29.
    Asker, Martin
    et al.
    Karolinska Inst, Sweden; Naprapathogskolan Scandinavian Coll Naprapath Man, Sweden.
    Brooke, Hannah L.
    Karolinska Inst, Sweden.
    Waldén, Markus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Hassleholm Kristianstad Ystad Hosp, Sweden.
    Tranaeus, Ulrika
    Karolinska Inst, Sweden; GIH, Sweden.
    Johansson, Fredrik
    Karolinska Inst, Sweden; Naprapathogskolan Scandinavian Coll Naprapath Man, Sweden.
    Skillgate, Eva
    Karolinska Inst, Sweden; Naprapathogskolan Scandinavian Coll Naprapath Man, Sweden.
    Holm, Lena W.
    Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Risk factors for, and prevention of, shoulder injuries in overhead sports: a systematic review with best-evidence synthesis2018Ingår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, nr 20, s. 1312-+Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Objective To assess the evidence for risk factors and prevention measures for shoulder injuries in overhead sports. Design Systematic review with best-evidence synthesis. Data sources Medline (Ovid), PubMed (complementary search), Embase (Elsevier), Cochrane (Wiley), SPORTDiscus (Ebsco) and Web of Science Core Collection (Thomson Reuters), from 1 January 1990 to 15 May 2017. Eligibility criteria for selecting studies Randomised controlled trials, cohort studies and case-control studies on risk factors or prevention measures for shoulder injuries in overhead sports. The eligible studies were quality assessed using the Scottish Intercollegiate Guidelines Network criteria. Results Of 4778 studies identified, 38 were eligible for quality review and 17 met the quality criteria to be included in the evidence synthesis. One additional quality study presented a shoulder injury prevention programme. Most studies focused on baseball, lacrosse or volleyball (n = 13). The risk factors examined included participation level (competition vs training) (n = 10), sex (n = 4), biomechanics (n = 2) and external workload (n = 2). The evidence for all risk factors was limited or conflicting. The effect of the prevention programme within the subgroup of uninjured players at baseline was modest and possibly lacked statistical power. Conclusions All investigated potential risk factors for shoulder injury in overhead sports had limited evidence, and most were non-modifiable (eg, sex). There is also limited evidence for the effect of shoulder injury prevention measures in overhead sports.

  • 30.
    Atterby, Clara
    et al.
    Uppsala Univ, Sweden.
    Osbjer, Kristina
    Swedish Univ Agr Sci SLU, Sweden; Food and Agr Org United Nations, Cambodia.
    Tepper, Viktoria
    Swiss Fed Inst Technol, Switzerland.
    Rajala, Elisabeth
    Swedish Univ Agr Sci SLU, Sweden.
    Hernandez, Jorge
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Kalmar Cty Council, Dept Infect Dis, Sweden; Linnaeus Univ, Sweden; Kalmar Cty Hosp, Sweden.
    Seng, Sokerya
    Food and Agr Org United Nations, Cambodia.
    Holl, Davun
    Minist Agr Forestry and Fisheries, Cambodia.
    Bonnedahl, Jonas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi, infektion och inflammation. Linköpings universitet, Medicinska fakulteten. Linnaeus Univ, Sweden.
    Börjesson, Stefan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi, infektion och inflammation. Linköpings universitet, Medicinska fakulteten. Natl Vet Inst SVA, Sweden.
    Magnusson, Ulf
    Swedish Univ Agr Sci SLU, Sweden.
    Jarhult, Josef D.
    Uppsala Univ, Sweden.
    Carriage of carbapenemase- and extended-spectrum cephalosporinase-producing Escherichia coli and Klebsiella pneumoniae in humans and livestock in rural Cambodia; gender and age differences and detection of bla(OXA-48 )in humans2019Ingår i: Zoonoses and Public Health, ISSN 1863-1959, E-ISSN 1863-2378Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives This study investigates the frequency and characteristics of carbapenemase-producing Escherichia coli/Klebsiella pneumoniae (CPE/K) and extended-spectrum cephalosporinase-producing E. coli/K. pneumoniae (ESCE/K) in healthy humans and livestock in rural Cambodia. Additionally, household practices as risk factors for faecal carriage of ESCE/K are identified. Methods Faecal samples were obtained from 307 humans and 285 livestock including large ruminants, pigs and poultry living in 100 households in rural Cambodia in 2011. Each household was interviewed, and multilevel logistic model determined associations between household practices/meat consumption and faecal carriage of ESCE/K. CPE and ESCE/K were detected and further screened for colistin resistance genes. Results CPE/K isolates harbouring bla(OXA-48 )were identified in two humans. The community carriage of ESCE/K was 20% in humans and 23% in livestock. The same ESBL genes: bla(CTX-M-15), bla(CTX-M-14), bla(CTX-M-27), bla(CTX-M-55), bla(SHV-2), bla(SHV-12), bla(SHV-28); AmpC genes: bla(CMY-2), bla(CMY-42,) bla(DHA-1); and colistin resistance genes: mcr-1-like and mcr-3-like were detected in humans and livestock. ESCE/K was frequently detected in women, young children, pigs and poultry, which are groups in close contact. The practice of burning or burying meat waste and not collecting animal manure indoors and outdoors daily were identified as risk factors for faecal carriage of ESCE/K. Conclusions Faecal carriage of E. coli and K. pneumoniae harbouring extended-spectrum cephalosporinase genes are common in the Cambodian community, especially in women and young children. Exposure to animal manure and slaughter products are risk factors for intestinal colonization of ESCE/K in humans.

  • 31.
    Aubert, Salome
    et al.
    CHEO Res Inst, Canada.
    Barnes, Joel D.
    CHEO Res Inst, Canada.
    Abdeta, Chalchisa
    Haramaya Univ, Ethiopia.
    Nader, Patrick Abi
    Univ Moncton, Canada; CHU Montreal, Canada.
    Adeniyi, Ade F.
    Univ Ibadan, Nigeria; Nigerian Heart Fdn, Nigeria.
    Aguilar-Farias, Nicolas
    Univ La Frontera, Chile; Univ La Frontera, Chile.
    Andrade Tenesaca, Dolores S.
    Univ Cuenca, Ecuador.
    Bhawra, Jasmin
    Univ Waterloo, Canada.
    Brazo-Sayavera, Javier
    Univ Republ, Uruguay; Univ Republ, Uruguay.
    Cardon, Greet
    Univ Ghent, Belgium.
    Chang, Chen-Kang
    Natl Taiwan Univ Sport, Taiwan.
    Nystrom, Christine Delisle
    CHEO Res Inst, Canada; Karolinska Inst, Sweden.
    Demetriou, Yolanda
    Tech Univ Munich, Germany.
    Draper, Catherine E.
    Univ Witwatersrand, South Africa; Univ Cape Town, South Africa.
    Edwards, Lowri
    Swansea Univ, Wales.
    Emeljanovas, Arunas
    Lithuanian Sports Univ, Lithuania.
    Gaba, Ales
    Palacky Univ Olomouc, Czech Republic.
    Galaviz, Karla I.
    Emory Univ, GA 30322 USA.
    Gonzalez, Silvia A.
    CHEO Res Inst, Canada; Univ Los Andes, Colombia.
    Herrera-Cuenca, Marianella
    Univ Cent Venezuela, Venezuela; Fdn Bengoa Alimentac and Nutr, Venezuela; Observ Venezolano Salud, Venezuela.
    Huang, Wendy Y.
    Hong Kong Baptist Univ, Peoples R China.
    Ibrahim, Izzeldin A. E.
    Aspetar Orthoped and Sports Med Hosp, Qatar.
    Jurimae, Jaak
    Univ Tartu, Estonia.
    Kamppi, Katariina
    LIKES Res Ctr Phys Activ and Hlth, Finland.
    Katapally, Tarun R.
    Univ Regina, Canada.
    Katewongsa, Piyawat
    Mahidol Univ, Thailand.
    Katzmarzyk, Peter T.
    Pennington Biomed Res Ctr, LA 70808 USA.
    Khan, Asaduzzaman
    Univ Queensland, Australia.
    Korcz, Agata
    Poznan Univ Phys Educ, Poland.
    Kim, Yeon Soo
    Seoul Natl Univ, South Korea.
    Lambert, Estelle
    Univ Cape Town, South Africa.
    Lee, Eun-Young
    Queens Univ, Canada.
    Löf, Marie
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Karolinska Inst, Sweden.
    Loney, Tom
    Mohammed Bin Rashid Univ Med and Hlth Sci, U Arab Emirates.
    Lopez-Taylor, Juan
    Univ Guadalajara, Mexico.
    Liu, Yang
    Shanghai Univ Sport, Peoples R China.
    Makaza, Daga
    Natl Univ Sci and Technol, Zimbabwe.
    Manyanga, Taru
    CHEO Res Inst, Canada.
    Mileva, Bilyana
    BG Act Assoc, Bulgaria.
    Morrison, Shawnda A.
    Univ Primorska, Slovenia.
    Mota, Jorge
    Univ Porto, Portugal.
    Nyawornota, Vida K.
    Univ Ghana, Ghana.
    Ocansey, Reginald
    Univ Ghana, Ghana.
    Reilly, John J.
    Univ Strathclyde, Scotland.
    Roman-Vinas, Blanca
    Nutr Res Fdn, Spain; Univ Girona, Spain; Inst Salud Carlos III, Spain.
    Santos Silva, Diego Augusto
    Univ Fed Santa Catarina, Brazil.
    Saonuam, Pairoj
    Thai Hlth Promot Fdn ThaiHlth, Thailand.
    Scriven, John
    Jersey Sport Fdn, England.
    Seghers, Jan
    Katholieke Univ Leuven, Belgium.
    Schranz, Natasha
    Univ South Australia, Australia.
    Skovgaard, Thomas
    Univ Southern Denmark, Denmark.
    Smith, Melody
    Univ Auckland, New Zealand.
    Standage, Martyn
    Univ Bath, England.
    Starc, Gregor
    Univ Ljubljana, Slovenia.
    Stratton, Gareth
    Swansea Univ, Wales.
    Subedi, Narayan
    Tribhuvan Univ, Nepal.
    Takken, Tim
    Univ Med Ctr Utrecht, Netherlands.
    Tammelin, Tuija
    LIKES Res Ctr Phys Activ and Hlth, Finland.
    Tanaka, Chiaki
    JF Oberlin Univ, Japan.
    Thivel, David
    Univ Clermont Ferrand, France.
    Tladi, Dawn
    Univ Botswana, Botswana.
    Tyler, Richard
    Swansea Univ, Wales.
    Uddin, Riaz
    Univ Queensland, Australia; Stamford Univ Bangladesh, Bangladesh.
    Williams, Alun
    Sir Charles Froissard House, England.
    Wong, Stephen H. S.
    Chinese Univ Hong Kong, Peoples R China.
    Wu, Ching-Lin
    Natl Chung Hsing Univ, Taiwan.
    Zembura, Pawel
    Univ Warsaw, Poland.
    Tremblay, Mark S.
    CHEO Res Inst, Canada.
    Global Matrix 3.0 Physical Activity Report Card Grades for Children and Youth: Results and Analysis From 49 Countries2018Ingår i: Journal of Physical Activity and Health, ISSN 1543-3080, E-ISSN 1543-5474, Vol. 15, s. S251-S273Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Accumulating sufficient moderate to vigorous physical activity is recognized as a key determinant of physical, physiological, developmental, mental, cognitive, and social health among children and youth (aged 5-17 y). The Global Matrix 3.0 of Report Card grades on physical activity was developed to achieve a better understanding of the global variation in child and youth physical activity and associated supports. Methods: Work groups from 49 countries followed harmonized procedures to develop their Report Cards by grading 10 common indicators using the best available data. The participating countries were divided into 3 categories using the United Nations human development index (HDI) classification (low or medium, high, and very high HDI). Results: A total of 490 grades, including 369 letter grades and 121 incomplete grades, were assigned by the 49 work groups. Overall, an average grade of "C-," "D+," and "C-" was obtained for the low and medium HDI countries, high HDI countries, and very high HDI countries, respectively. Conclusions: The present study provides rich new evidence showing that the situation regarding the physical activity of children and youth is a concern worldwide. Strategic public investments to implement effective interventions to increase physical activity opportunities are needed.

  • 32.
    Bendtsen, Marcus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Tekniska fakulteten.
    Feasibility of a Fully Automated Multiple Session Alcohol Intervention to University Students, Using Different Modes of Electronic Delivery: The TOPHAT 1 Study2013Ingår i: Journal of Software Engineering and Applications, ISSN 1945-3116, E-ISSN 1945-3124, nr 6, s. 14-26Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In recent years more and more electronic health behaviour interventions have been developed in order to reach individuals with an unhealthy behaviour such as risky drinking. This is especially relevant in university students who are among those who most frequently are risky drinkers. This study explored the acceptability and feasibility, in an unselected group of university students, of a fully automated multiple session alcohol intervention offering different modes of delivery such as email, SMS and Android.

    Material and Methods: A total of 11,283 students at Linköping University in Sweden were invited to perform a single session alcohol intervention and among those accepting this (4916 students) a total of 24.7% accepted to further participate in the extended multiple intervention lasting 3 - 6 weeks. The students could choose mode of delivery, total length of the intervention (between 3 - 6 weeks) and number of messages per week (3, 5, or 7 per week). A follow-up questionnaire was applied after the intervention to which 82.7% responded.

    Results: most students wanted to receive the messages by email with the shortest intervention length (3 weeks) and as few messages as possible per week (3 messages). However, no major difference was seen regarding satisfaction with the length and frequency of the intervention despite chosen length and frequency. Most students also expressed satisfaction with the content of the messages and would recommend the intervention to a fellow student in need of reducing drinking.

    Discussion and Conclusion: Based upon feedback from the students, a multiple push-based intervention appears to be feasible to offer additional help for those who have interest after a single session alcohol intervention. In a forthcoming study we will further explore the optimal mode of delivery and length of intervention and number of messages per week.

  • 33.
    Bengtsson, Ulrika
    et al.
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Kjellgren, Karin
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hallberg, Inger
    Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Manhem, Karin
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Taft, Charles
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Links between blood pressure and life-style factors reported via a mobile phone-based self-management support system2018Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Objective: To explore relationships between patients’ self-monitoring of blood pressure and their concurrent self-reports of medication intake, wellbeing stress, physical activity and symptoms.

    Design and method: This was a prospective study exploring the eight-week effectiveness of a mobile phone based self-management support system for patients with hypertension. 50 patients undergoing treatment for hypertension, from four primary health care centers situated in urban and suburban communities in Sweden, self-reported through the system once daily during eight weeks.

    Scientific data: Associations between systolic and diastolic blood pressure and 10 self-report lifestyle-related variables.

    Results: The single strongest association was found between medication intake and systolic blood pressure, where failure to take medications was associated with an estimated 7.44 mmHg higher systolic blood pressure. To a lesser degree, medication intake was also associated with diastolic blood pressure. Wellbeing and stress were consistently associated with systolic blood pressure and diastolic blood pressure, whereas physical activity was associated with only systolic blood pressure. None of the symptoms dizziness, headache, restlessness, fatigue or palpitations were significantly associated with blood pressure.

    Conclusions: Blood pressure was associated with patients’ blood pressure management behaviors, eg drug intake and experiences of wellbeing and stress. No association was found between blood pressure and side effects. Enabling persons with hypertension to monitor and track their BP in relation to medication intake, symptoms and life-style variables may be a fruitful way to help them gain first-hand understanding of the importance of adherence and persistence to treatment recommendations.

  • 34.
    Berg, Jessica
    Swedish National Road and Transport Research Institute (VTI), Linköping, Sweden.
    Mobility changes during the first years of retirement2016Ingår i: Quality in Ageing and Older Adults, ISSN 1471-7794, Vol. 17, nr 2, s. 131-140Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose – Mobility is an important aspect of well-being, activity and participation. Retiring from paid work is a transition in later life when people need to adjust to a new daily structure and fill the day with activities other than work. Life-course transitions influence demands for mobility and choice of travel mode as people adapt to new circumstances and learning processes. The purpose of this paper is to explore how mobility strategies develop during the first years of retirement.

    Design/methodology/approach – A qualitative analysis based on initial interviews with a total of 27 retired people during their first year of retirement and again, about three years later.

    Findings – Important changes during the first years of retirement included illness or a decline in physical health. Mobility had become a means of achieving certain goals after an illness, such as learning to walk, being able to drive or enjoying the time that was left. While some enjoyed not having commitments, others experienced difficulties in filling the day. The results indicate four dimensions of mobility: means of carrying out activities which are needed and desired; resources for creating activities; a leisure activity in itself; and subordinate to staying at home.

    Originality/value – Gives a deeper understanding of the mobility challenges people ultimately face in later life, and how these are managed, which is important for transport planning and public health policy aimed at improving mobility, activity participation and well-being in later life.

  • 35.
    Berggren, Martina
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier.
    Otillräcklighetens diagnoser: Kvinnors upplevelser av att leva med stressrelaterad ohälsa.2008Självständigt arbete på avancerad nivå (magisterexamen), 20 poäng / 30 hpStudentuppsats
    Abstract [en]

    This essay discusses the problems with the high rate of long-term sickness leave among women in Sweden. It is based on interviews with six women suffering from stress-related illness. The results show that these women hardly ever recieved an explicit diagnosis and therefore did not feel that their illness was acknowledged. In the abscense of measurable symptoms they were sometimes stigmatisized and accused of simulating their problems. From this position they tried to legitimize their situation by presenting themselves as respectable women. They seemed to be trapped between two roles, taking an active part in the labour market and struggling to be a good mother and wife. The illness can therefore, I argue, be seen as a result of the subordination of women in the Swedish society.

  • 36.
    Bergström, G
    et al.
    University of Gothenburg / Sahlgrenska University Hospital.
    Berglund, G
    Lund University.
    Blomberg, A
    Umeå University.
    Brandberg, J
    Sahlgrenska University Hospital / University of Gothenburg.
    Engström, G
    Lund University.
    Engvall, Jan
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning.
    Eriksson, M
    Karolinska University Hospital, Stockholm.
    de Faire, U
    Karolinska Institutet, Stockholm / Karolinska University Hospital, Stockholm.
    Flinck, A
    Sahlgrenska University Hospital, Stockholm / University of Gothenburg.
    Hansson, M G
    Uppsala University.
    Hedblad, B
    Lund University.
    Hjelmgren, O
    University of Gothenburg / Sahlgrenska University Hospital, Gothenburg.
    Janson, C
    Uppsala University.
    Jernberg, T
    Karolinska University Hospital, Stockholm / Karolinska Institutet, Stockholm.
    Johnsson, Å
    Sahlgrenska University Hospital, Gothenburg / University of Gothenburg.
    Johansson, L
    Unit of Radiology.
    Lind, L
    Uppsala University.
    Löfdahl, C-G
    Lund University / Lund University Hospital.
    Melander, O
    Lund University / Skåne University Hospital, Malmö.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Primärvården i västra länsdelen.
    Persson, Anders
    Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Röntgenkliniken i Linköping.
    Persson, M
    Lund University / Skåne University Hospital, Malmö.
    Sandström, A
    Umeå University.
    Schmidt, C
    University of Gothenburg.
    Söderberg, S
    Umeå University.
    Sundström, J
    Uppsala University / Uppsala Clinical Resarch Centre.
    Toren, K
    University of Gothenburg.
    Waldenström, A
    Umeå University Hospital.
    Wedel, H
    Nordic School of Public Health, Gothenburg.
    Vikgren, J
    Sahlgrenska University Hospital, Gothenburg / University of Gothenburg.
    Fagerberg, B
    University of Gothenburg.
    Rosengren, A
    University of Gothenburg.
    The Swedish CArdioPulmonary BioImage Study: objectives and design2015Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 278, nr 6, s. 645-659Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Cardiopulmonary diseases are major causes of death worldwide, but currently recommended strategies for diagnosis and prevention may be outdated because of recent changes in risk factor patterns. The Swedish CArdioPulmonarybioImage Study (SCAPIS) combines the use of new imaging technologies, advances in large-scale 'omics' and epidemiological analyses to extensively characterize a Swedish cohort of 30 000 men and women aged between 50 and 64 years. The information obtained will be used to improve risk prediction of cardiopulmonary diseases and optimize the ability to study disease mechanisms. A comprehensive pilot study in 1111 individuals, which was completed in 2012, demonstrated the feasibility and financial and ethical consequences of SCAPIS. Recruitment to the national, multicentre study has recently started.

  • 37.
    Bernfort, Lars
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Gerdle, Björn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Husberg, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    People in states worse than dead according to the EQ-5D UK value set: would they rather be dead?2018Ingår i: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 27, nr 7, s. 1827-1833Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Quality-adjusted life years (QALYs) measure health by combining length and quality of life. QALYs constitute the effect side of incremental cost-effectiveness ratios, describing the results of health economic evaluations. The objectives of this study were to (1) investigate the prevalence of states worse than dead (SWD) when using the EuroQol-5D UK value set, and (2) to study to what extent SWDs are reasonable with a starting point in experience-based valuations of health states. Data from a Swedish cross-sectional population survey were used. The survey was directed to 10,000 persons 65 years and older and its primary aim was to investigate the prevalence and consequences of chronic pain. The survey included questions reflecting life situation and well-being. Some of these were used in order to characterise people in SWD. SWD were found in 1.8% of the 6611 respondents. The prevalence of SWD increased with advancing age and was more common among women than men. The control questions used indicated that most of the persons being in SWD according to the EQ-5D UK value set most probably would not judge themselves to be in a SWD. Though negative QALY-weights are not very common, they constitute a non-negligible part of health states in a Swedish population 65 years and older. Prevalence of SWD is higher among women than men and increases with age. From responses to other questions on well-being and life situation, there is reason to doubt the reasonableness of experience-based negative QALY-weights in many cases.

  • 38.
    Bernhardsson, Magnus
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten.
    Healing Processes in Cancellous Bone2018Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Most of what is known about the biological response during fracture healing comes from numerous animal studies with shaft fractures in the long bone. However, most patients suffer from fractures closer to the ends of the long bones, in the hip, or in the vertebrae. These types of fractures mainly involve cancellous bone, while shaft fractures concern cortical bone. Compared to cortical bone whose structure is dense and compact, cancellous bone is of spongy and porous structure. A growing number of studies point towards that cortical and cancellous bone heal differently. To even this imbalance in knowledge between these two types of bone tissue, further studies in cancellous bone are justified.

    In this thesis we delved into the quiet unknown processes behind cancellous bone healing.

    In the first study we characterized and compared two models for cancellous bone healing in mice and rats: the first model can be used to analyze the morphology and morphometry of the regenerating bone; the second model can measure the mechanical properties of cancellous bone. The two models correspond in their developing patterns during the first week before they diverge. This suggests that these models can be utilized together to evaluate the initial healing in cancellous bone. Furthermore, we saw in the drill hole model that the bone formation is strictly restricted to the traumatized region, with a distinct interface to the adjacent uninjured tissue.

    The second study characterized the cellular response during the initial healing phase in cancellous bone. The focus was to follow the spatial location of inflammatory and osteogenic cells over time in a cancellous bone injury. In contrast to shaft fractures (cortical bone), where healing is described as sequential events where inflammatory cells are the first to arrive to the trauma before osteogenic cells are recruited and initiate healing, we could see how inflammatory and osteogenic cells appeared early, simultaneously after a cancellous bone injury. This study showed that cancellous bone differs from how fracture healing is normally described.

    In the third study we explored the role of a subpopulation of lymphocytes (CD8 positive cells), earlier studied in shaft fractures. We wanted to see how their absence would affect the healing in a cancellous bone injury. Without CD8+ cells, cancellous bone healing was impaired as expressed via poorer mechanical properties of the regenerated bone tissue.

    The fourth and last study issued the influence of uninjured bone marrow on cortical bone healing. We developed a cortical defect model which blocked uninjured marrow from reaching the defect. Without the presence of marrow, the cortical defects ability to regenerate was significantly impaired. This implies that the marrow is important for cortical bone healing.

    In conclusion, cancellous bone healing is different from its cortical counterpart and the general perception of fracture healing. We have briefly discerned healing mechanisms in cancellous bone that might be of clinical importance: the restricted cancellous bone formation is something to take into consideration when performing arthrodeses; and importance of marrow in skeletal defects (e.g. pseudarthroses). With this thesis, we hope to promote that further investigating on cancellous bone healing is necessary.

    Delarbeten
    1. Experimental models for cancellous bone healing in the rat Comparison of drill holes and implanted screws
    Öppna denna publikation i ny flik eller fönster >>Experimental models for cancellous bone healing in the rat Comparison of drill holes and implanted screws
    2015 (Engelska)Ingår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 86, nr 6, s. 745-750Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background and purpose - Cancellous bone appears to heal by mechanisms different from shaft fracture healing. There is a paucity of animal models for fractures in cancellous bone, especially with mechanical evaluation. One proposed model consists of a screw in the proximal tibia of rodents, evaluated by pull-out testing. We evaluated this model in rats by comparing it to the healing of empty drill holes, in order to explain its relevance for fracture healing in cancellous bone. To determine the sensitivity to external influences, we also compared the response to drugs that influence bone healing. Methods - Mechanical fixation of the screws was measured by pull-out test and related to the density of the new bone formed around similar, but radiolucent, PMMA screws. The pull-out force was also related to the bone density in drill holes at various time points, as measured by microCT. Results - The initial bone formation was similar in drill holes and around the screw, and appeared to be reflected by the pull-out force. Both models responded similarly to alendronate or teriparatide (PTH). Later, the models became different as the bone that initially filled the drill hole was resorbed to restore the bone marrow cavity, whereas on the implant surface a thin layer of bone remained, making it change gradually from a trauma-related model to an implant fixation model. Interpretation - The similar initial bone formation in the different models suggests that pull-out testing in the screw model is relevant for assessment of metaphyseal bone healing. The subsequent remodeling would not be of clinical relevance in either model.

    Ort, förlag, år, upplaga, sidor
    TAYLOR & FRANCIS LTD, 2015
    Nationell ämneskategori
    Klinisk medicin
    Identifikatorer
    urn:nbn:se:liu:diva-123812 (URN)000365484500019 ()26200395 (PubMedID)
    Anmärkning

    Funding Agencies|Swedish Research Council [2031-47-5]; AFA insurance company; EU [279239]; Linkoping University; Eli Lilly and Company

    DOI does not work: 10.3109/17453674.2015.1075705

    Tillgänglig från: 2016-01-11 Skapad: 2016-01-11 Senast uppdaterad: 2018-10-29
    2. Osteoblast precursors and inflammatory cells arrive simultaneously to sites of a trabecular-bone injury
    Öppna denna publikation i ny flik eller fönster >>Osteoblast precursors and inflammatory cells arrive simultaneously to sites of a trabecular-bone injury
    2018 (Engelska)Ingår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 89, nr 4, s. 457-461Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background and purpose - Fracture healing in the shaft is usually described as a sequence of events, starting with inflammation, which triggers mesenchymal tissue formation in successive steps. Most clinical fractures engage cancellous bone. We here describe fracture healing in cancellous bone, focusing on the timing of inflammatory and mesenchymal cell type appearance at the site of injury. Material and methods - Rats received a proximal tibial drill hole, A subgroup received clodronate-containing liposomes before or after surgery. The tibiae were analyzed with micro-CT and immunohistochemistry 1 to 7 days after injury. Results - Granulocytes (myeloperoxidase) appeared in moderate numbers within the hole at day 1 and then gradually disappeared. Macrophage expression (CD68) was seen on day 1, increased until day 3, and then decreased. Mesenchymal cells (vimentin) had already accumulated in the periphery of the hole on day 1. Mesenchymal cells dominated in the entire lesion on day 3, now producing extracellular matrix. A modest number of preosteoblasts (RUNX2) were seen on day 1 and peaked on day 4. Osteoid was seen on day 4 in the traumatized region, with a distinct border to the uninjured surrounding marrow. Clodronate liposomes given before the injury reduced the volume of bone formation at day 7, but no reduction in macrophage numbers could be detected. Interpretation - The typical sequence of events in shaft fractures was not seen. Mesenchymal cells appeared simultaneously with granulocyte and macrophage arrival. Clodronate liposomes, known to reduce macrophage numbers, seemed to be associated with the delineation of the volume of tissue to be replaced by bone.

    Ort, förlag, år, upplaga, sidor
    TAYLOR & FRANCIS LTD, 2018
    Nationell ämneskategori
    Ortopedi
    Identifikatorer
    urn:nbn:se:liu:diva-150316 (URN)10.1080/17453674.2018.1481682 (DOI)000439704100018 ()29865916 (PubMedID)
    Tillgänglig från: 2018-08-16 Skapad: 2018-08-16 Senast uppdaterad: 2019-05-02
    3. Marrow compartment contribution to cortical defect healing
    Öppna denna publikation i ny flik eller fönster >>Marrow compartment contribution to cortical defect healing
    Visa övriga...
    2018 (Engelska)Ingår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 89, nr 1, s. 119-123Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background and purpose - Healing of shaft fractures is commonly described as regards external callus. We wanted to clarify the role of the bone marrow compartment in the healing of stable shaft fractures. Patients and methods - A longitudinal furrow was milled along the longitudinal axis of the femoral shaft in mice. The exposed bone marrow under the furrow was scooped out. The mice were then randomized to no further treatment, or to receiving 2 silicone plugs in the medullary canal distal and proximal to the defect. The plugs isolated the remaining marrow from contact with the defect. Results were studied with histology and flow cytometry. Results - Without silicone plugs, the marrow defect was filled with new bone marrow-like tissue by day 5, and new bone was seen already on day 10. The new bone was seen only at the level of the cortical injury, where it seemed to form simultaneously in the entire region of the removed cortex. The new bone seemed not to invade the marrow compartment, and there was a sharp edge between new bone and marrow. The regenerated marrow was similar to uninjured marrow, but contained considerably more cells. In the specimens with plugs, the marrow compartment was either filled with loose scar tissue, or empty, and there was only minimal bone formation, mainly located around the edges of the cortical injury. Interpretation - Marrow regeneration in the defect seemed to be a prerequisite for normal cortical healing. Shaft fracture treatment should perhaps pay more attention to the local bone marrow.

    Ort, förlag, år, upplaga, sidor
    TAYLOR & FRANCIS LTD, 2018
    Nationell ämneskategori
    Ortopedi
    Identifikatorer
    urn:nbn:se:liu:diva-145120 (URN)10.1080/17453674.2017.1382280 (DOI)000423474000020 ()28946782 (PubMedID)
    Tillgänglig från: 2018-02-19 Skapad: 2018-02-19 Senast uppdaterad: 2019-05-27
  • 39.
    Bernhardsson, Susanne
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Advancing evidence-based practice in primary care physiotherapy: Guideline implementation, clinical practice, and patient preferences2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Research on physiotherapy treatment interventions has increased dramatically in the past 25 years and it is a challenge to transfer research findings into clinical practice, so that patients benefit from effective treatment. Development of clinical practice guidelines is a potentially useful strategy to implement research evidence into practice. However, the impact of guideline implementation in Swedish primary care physiotherapy is unknown. To achieve evidence-based practice (EBP), research evidence should be integrated with clinical expertise and patient preferences, but knowledge is limited about these factors in Swedish primary care physiotherapy.

    The overall aim of this thesis was to increase understanding of factors of importance for the implementation of EBP in Swedish primary care physiotherapy. Specific aims were: to translate and adapt a questionnaire for the measurement of EBP and guidelines; to investigate physiotherapists’ attitudes, knowledge and behaviour related to EBP and guidelines; to examine clinical practice patterns; to evaluate the effects of a tailored guideline implementation strategy; and to explore patients’ preferences for physiotherapy.

    The thesis comprises four studies (A-D), reported in five papers. In Study A, a questionnaire for the measurement of EBP and guidelines was translated, cross-culturally adapted, and tested for validity (n=10) and reliability (n=42). Study B was a cross-sectional study in which this questionnaire was used to survey primary care physiotherapists in the county council Region Västra Götaland (n=271). In Study C, a strategy for the implementation of guidelines was developed and evaluated, using the same questionnaire (n=271 at baseline, n=256 at follow-up), in a prospective controlled trial. The strategy was based on an implementation model, was tailored to address the determinants of guideline use identified in Study B, and comprised several components including an educational seminar. Study D was an exploratory qualitative study of patients with musculoskeletal disorders (n=20), using qualitative content analysis.

    The validity and reliability of the questionnaire was found to be satisfactory. Most physiotherapists have a positive regard for EBP and guidelines, although these attitudes are not fully reflected in the reported use of guidelines. The most important determinants of  guideline use were considering guidelines important to facilitate practice and knowing how to integrate patient preferences with guidelines. The tailored, multi-component guideline implementation significantly affected awareness of, knowledge of, and access to guidelines. Use of guidelines was significantly affected among those who attended an implementation seminar. Clinical practice for common musculoskeletal conditions included interventions supported by evidence of various strengths as well as interventions with insufficient research evidence. The most frequently reported interventions were advice and exercise therapy. The interviewed patients expressed trust and confidence in the professionalism of physiotherapists and in the therapists’ ability to choose appropriate treatment, rendering treatment preferences subordinate. This trust seemed to foster active engagement in their physiotherapy.

    In conclusion: The adapted questionnaire can be used to reliably measure EBP in physiotherapy. The positive attitudes found do not necessarily translate to guideline use, due to several perceived barriers. The tailored guideline implementation strategy used can be effective to reduce barriers and contribute to increased use of guidelines. The clinical practice patterns identified suggest that physiotherapists rely both on research evidence and their clinical expertise when choosing treatment methods. Patients’ trust in their physiotherapist’s competence and preference for active engagement in their therapy need to be embraced by the clinician and, together with the therapist’s clinical expertise, integrated with guideline use in the clinical decision making. Further research is needed on how the EBP components and different knowledge sources can be integrated in physiotherapy practice, as well as on implementation effects on patient outcomes.

    Delarbeten
    1. Measuring Evidence-Based Practice in Physical Therapy: Translation, Adaptation, Further Development, Validation, and Reliability Test of a Questionnaire
    Öppna denna publikation i ny flik eller fönster >>Measuring Evidence-Based Practice in Physical Therapy: Translation, Adaptation, Further Development, Validation, and Reliability Test of a Questionnaire
    2013 (Engelska)Ingår i: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 93, nr 6, s. 819-832Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background. Evidence-based practice (EBP) and evidence-based clinical practice guidelines are becoming increasingly important in physical therapy. For the purpose of meeting the goals of designing, implementing, and evaluating strategies to facilitate the development of more EBP in primary care physical therapy, a valid and reliable questionnaire for measuring attitudes, knowledge, behavior, prerequisites, and barriers related to EBP and guidelines is needed. less thanbrgreater than less thanbrgreater thanObjective. The 3 objectives of this study were: (1) to translate and cross-culturally adapt a questionnaire to a Swedish primary care context for the purpose of measuring various aspects of EBP and guidelines in physical therapy, (2) to further develop the questionnaire to examine more aspects of guidelines, and (3) to test the validity and reliability of the adapted Swedish questionnaire. less thanbrgreater than less thanbrgreater thanDesign. This was an instrument development study with validity and reliability testing. less thanbrgreater than less thanbrgreater thanMethods. A previously used questionnaire about EBP was translated and cross-culturally adapted to a Swedish primary care physical therapy context. Additional items were constructed. A draft version was pilot tested for content validity (n=10), and a revised version was tested for test-retest reliability (n=42). The percentage of agreement between the 2 tests was analyzed. less thanbrgreater than less thanbrgreater thanResults. The development process resulted in a first questionnaire draft containing 48 items. The validation process resulted in a second draft with acceptable content validity and consisting of 38 items. The test-retest analysis showed that the median percentage of agreement was 67% (range=41%-81%). After removal or revision of items with poor agreement, the final questionnaire included 31 items. less thanbrgreater than less thanbrgreater thanLimitations. Only face validity and content validity were tested. less thanbrgreater than less thanbrgreater thanConclusions. The final translated and adapted questionnaire was determined to have good face and content validity and acceptable reliability for measuring self-reported attitudes, knowledge, behavior, prerequisites, and barriers related to EBP and guidelines among physical therapists in primary care settings.

    Ort, förlag, år, upplaga, sidor
    American Physical Therapy Association (APTA), 2013
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-95503 (URN)10.2522/ptj.20120270 (DOI)000319546800010 ()
    Tillgänglig från: 2013-07-05 Skapad: 2013-07-05 Senast uppdaterad: 2017-12-06
    2. Determinants of Guideline Use in Primary Care Physical Therapy: A Cross-Sectional Survey of Attitudes, Knowledge, and Behavior
    Öppna denna publikation i ny flik eller fönster >>Determinants of Guideline Use in Primary Care Physical Therapy: A Cross-Sectional Survey of Attitudes, Knowledge, and Behavior
    Visa övriga...
    2014 (Engelska)Ingår i: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 94, nr 3, s. 343-354Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background. Understanding of attitudes, knowledge, and behavior related to evidence-based practice (ESP) and use of evidence-based clinical practice guidelines in primary care physical therapy is limited. Objectives. The objectives of this study were: (1) to investigate self-reported attitudes, knowledge, behavior, prerequisites, and barriers related to EBP and guideline use among physical therapists in primary care and (2) to explore associations of self-reported use of guidelines with these social cognitive factors along with demographic and workplace characteristics. Design. This was a cross-sectional survey. Methods. A web-based survey of 419 physical therapists in primary care in western Sweden was performed. Multiple logistic regression analysis was performed to examine factors associated with guideline use. Results. The response rate was 64.7%. Most respondents had positive attitudes toward EBP and guidelines: 90% considered EBP necessary, and 96% considered guidelines important. Approximately two thirds reported confidence in finding and using evidence. One third reported being aware of guidelines. Thirteen percent knew where to find guidelines, and only 9% reported having easy access to guidelines. Fewer than half reported using guidelines frequently. The most important barriers to using guidelines were lack of time, poor availability, and limited access to guidelines. Young age and brief work experience were associated with positive attitudes toward EBP. A postgraduate degree was associated with higher application of EBP. Positive attitudes, awareness of guidelines, considering guidelines to facilitate practice, and knowing how to integrate patient preferences with guideline use were associated with frequent use of guidelines. Limitations. Data were self-reported, which may have increased the risk of social.desirability bias. Conclusions. Use of guidelines was not as frequent as could be expected in view of the positive attitudes toward EBP and guidelines among physical therapists. Awareness of and perceived access to guidelines were limited. The identified determinants can be addressed when developing guideline implementation strategies.

    Ort, förlag, år, upplaga, sidor
    American Physical Therapy Association (APTA), 2014
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-106033 (URN)10.2522/ptj.20130147 (DOI)000332351300008 ()
    Tillgänglig från: 2014-04-17 Skapad: 2014-04-17 Senast uppdaterad: 2017-12-05
    3. Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial.
    Öppna denna publikation i ny flik eller fönster >>Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial.
    Visa övriga...
    2014 (Engelska)Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, nr 1, s. 105-Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    BACKGROUND:

    Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence-based practice (EBP). There is a paucity of knowledge about the impact of guideline implementation strategies in primary care physical therapy. The aim of this study was to evaluate the effect of a guideline implementation intervention in primary care physical therapy in western Sweden.

    METHODS:

    An implementation strategy based on theory and current evidence was developed. A tailored, multi-component implementation intervention, addressing earlier identified determinants, was carried out in three areas comprising 28 physical therapy practices including 277 physical therapists (PTs) (intervention group). In two adjacent areas, 171 PTs at 32 practices received no intervention (control group). The core component of the intervention was an implementation seminar with group discussions. Among other components were a website and email reminders. Data were collected at baseline and follow-up with a web-based questionnaire. Primary outcomes were the self-reported awareness of, knowledge of, access to, and use of guidelines. Secondary outcomes were self-reported attitudes toward EBP and guidelines. Analyses were performed using Pearson's χ2 test and approximative z-test.

    RESULTS:

    168 PTs (60.6%) in the intervention group and 88 PTs (51.5%) in the control group responded to the follow-up questionnaire. 186/277 PTs (67.1%) participated in the implementation seminars, of which 97 (52.2%) responded. The proportions of PTs reporting awareness of (absolute difference in change 20.6%, p = 0.023), knowledge where to find (20.4%, p = 0.007), access to (21.7%, p < 0.001), and frequent use of (9.5%, NS) guidelines increased more in the intervention group than in the control group. The proportion of PTs reporting frequent guideline use after participation in the implementation seminar was 15.2% (p = 0.043) higher than the proportion in the control group. A higher proportion considered EBP helpful in decision making (p = 0.018). There were no other significant differences in secondary outcomes.

    CONCLUSIONS:

    A tailored, theory- and evidence-informed, multi-component intervention for the implementation of clinical practice guidelines had a modest, positive effect on awareness of, knowledge of, access to, and use of guidelines, among PTs in primary care in western Sweden. In general, attitudes to EBP and guidelines were not affected.

    Ort, förlag, år, upplaga, sidor
    BioMed Central, 2014
    Nyckelord
    Implementation; Physical therapy; Evidence-based practice; Practice guidelines
    Nationell ämneskategori
    Sjukgymnastik
    Identifikatorer
    urn:nbn:se:liu:diva-105610 (URN)10.1186/1472-6963-14-105 (DOI)000333535400002 ()24589291 (PubMedID)
    Tillgänglig från: 2014-03-28 Skapad: 2014-03-28 Senast uppdaterad: 2017-12-05
    4. Clinical practice in line with evidence?: A survey among primary care physiotherapists in western Sweden
    Öppna denna publikation i ny flik eller fönster >>Clinical practice in line with evidence?: A survey among primary care physiotherapists in western Sweden
    Visa övriga...
    2015 (Engelska)Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 21, nr 6, s. 1169-1177Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Rationale, aims and objectives

    Evidence-based practice is becoming increasingly important in primary care physiotherapy. Clinical practice needs to reflect current best evidence and be concordant with evidence-based clinical guidelines. There is limited knowledge about therapeutic interventions used in primary care physiotherapy in Sweden. The objectives were to examine preferred treatment interventions reported by publicly employed physiotherapists in primary care for three common musculoskeletal disorders (low back pain, neck pain and subacromial pain), the extent to which these interventions were supported by evidence, and associations with demographic variables.

    Methods

    419 physiotherapists in primary care in western Sweden were surveyed using a validated web-based questionnaire.

    Results

    The survey was completed by 271 respondents (65%). Median number of interventions reported was 7 (range 1–16). The most common treatment interventions across the three conditions were advice on posture (reported by 82–94%), advice to stay active (86–92%), and different types of exercise (65–92%). Most of these interventions were supported by evidence. However, interventions with insufficient evidence, such as advice on posture, TENS and aquatic exercise, were also used by 29–96%. Modalities such as laser therapy and ultrasound were sparingly used (<5%), which is in line with evidence. For neck pain, use of evidence-based interventions was associated with gender and for subacromial pain, with work experience.

    Conclusions

    Advice and exercise therapy were the interventions most frequently reported across the three diagnoses, illustrating an active treatment strategy. While most reported interventions are supported by evidence, interventions with unclear or no evidence of effect were also used to a high extent.

    Ort, förlag, år, upplaga, sidor
    John Wiley & Sons, 2015
    Nyckelord
    clinical practice, evidence, evidence-based practice, interventions, physical therapy, treatment
    Nationell ämneskategori
    Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi Allmänmedicin
    Identifikatorer
    urn:nbn:se:liu:diva-122555 (URN)10.1111/jep.12380 (DOI)000371414500032 ()25988993 (PubMedID)
    Anmärkning

    Funding agencies: local Research and Development Board for Gothenburg and Sodra Bohuslan; Linkoping University

    Tillgänglig från: 2015-11-09 Skapad: 2015-11-09 Senast uppdaterad: 2018-01-10Bibliografiskt granskad
    5. “In the physio we trust”: A qualitative study on patients’ preferences for physiotherapy
    Öppna denna publikation i ny flik eller fönster >>“In the physio we trust”: A qualitative study on patients’ preferences for physiotherapy
    2017 (Engelska)Ingår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 33, nr 7, s. 535-549Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background: Patient preferences are suggested to be incorporated in clinical decision making, but little is known about preferences for physiotherapy treatment of patients with musculoskeletal pain. This study aimed to explore preferences regarding physiotherapy treatment and participation in decision making, of patients who seek primary care physiotherapy for pain in the back, neck or shoulder.

    Methods: A qualitative study set in an urban physiotherapy clinic in Sweden. Individual, semi-structured interviews were conducted with a purposeful sample of 20 individuals who sought physiotherapy for back, neck or shoulder pain. The interviews were digitally recorded, transcribed verbatim and analysed with qualitative content analysis.

    Results: An overarching theme, embracing six categories, was conceptualised: Trust in the physiotherapist fosters active engagement in therapy. Most informants preferred active treatment strategies such as exercise and advice for self-management, allowing them to actively engage in their therapy. Some preferred passive treatments, primarily acupuncture (because they had heard that it works well) or massage therapy (because “it feels good”). Preferences were consistent across the three musculoskeletal conditions. Key influencers on treatment preferences were previous experiences and media. All informants wanted to be involved in the clinical decision making, but to varying extents. Some expressed a preference for an active role and wanting to share decisions while others were content with a passive role. Expectations for a professional management were reflected in trust and confidence in physiotherapists’ skills and competence, expectations for good outcomes, and believing that treatment methods should be evidence-based.

    Conclusions: Trust in the physiotherapist’s ability to choose appropriate treatment and confidence in the professional skills and competence of physiotherapists, as well as a desire to participate in clinical decision making, fostered active engagement in physiotherapy. Preferences for particular interventions were subordinate, although a preference for active treatments dominated. Preferences for active engagement need to be embraced by the physiotherapist. Awareness of these preferences can facilitate clinical decision making and contribute to increased quality of care for patients with musculoskeletal pain.

    Ort, förlag, år, upplaga, sidor
    Taylor & Francis, 2017
    Nyckelord
    Physical therapy, patient preferences, shared decision making, primary care, guidelines
    Nationell ämneskategori
    Sjukgymnastik Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
    Identifikatorer
    urn:nbn:se:liu:diva-122556 (URN)10.1080/09593985.2017.1328720 (DOI)000403937700003 ()
    Anmärkning

    Funding agencies: Local Research and Development Board for Gothenburg; Local Research and Development Board for Sodra Bohuslan

    Previous status of this publication was Manuscript

    Tillgänglig från: 2015-11-09 Skapad: 2015-11-09 Senast uppdaterad: 2017-07-07Bibliografiskt granskad
  • 40.
    Bernhardsson, Susanne
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Larsson, Maria E. H.
    Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden / The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    “In the physio we trust”: A qualitative study on patients’ preferences for physiotherapy2017Ingår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 33, nr 7, s. 535-549Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Patient preferences are suggested to be incorporated in clinical decision making, but little is known about preferences for physiotherapy treatment of patients with musculoskeletal pain. This study aimed to explore preferences regarding physiotherapy treatment and participation in decision making, of patients who seek primary care physiotherapy for pain in the back, neck or shoulder.

    Methods: A qualitative study set in an urban physiotherapy clinic in Sweden. Individual, semi-structured interviews were conducted with a purposeful sample of 20 individuals who sought physiotherapy for back, neck or shoulder pain. The interviews were digitally recorded, transcribed verbatim and analysed with qualitative content analysis.

    Results: An overarching theme, embracing six categories, was conceptualised: Trust in the physiotherapist fosters active engagement in therapy. Most informants preferred active treatment strategies such as exercise and advice for self-management, allowing them to actively engage in their therapy. Some preferred passive treatments, primarily acupuncture (because they had heard that it works well) or massage therapy (because “it feels good”). Preferences were consistent across the three musculoskeletal conditions. Key influencers on treatment preferences were previous experiences and media. All informants wanted to be involved in the clinical decision making, but to varying extents. Some expressed a preference for an active role and wanting to share decisions while others were content with a passive role. Expectations for a professional management were reflected in trust and confidence in physiotherapists’ skills and competence, expectations for good outcomes, and believing that treatment methods should be evidence-based.

    Conclusions: Trust in the physiotherapist’s ability to choose appropriate treatment and confidence in the professional skills and competence of physiotherapists, as well as a desire to participate in clinical decision making, fostered active engagement in physiotherapy. Preferences for particular interventions were subordinate, although a preference for active treatments dominated. Preferences for active engagement need to be embraced by the physiotherapist. Awareness of these preferences can facilitate clinical decision making and contribute to increased quality of care for patients with musculoskeletal pain.

  • 41.
    Bi, Z.
    et al.
    Shandong Ctr Dis Control and Prevent, Peoples R China.
    Sun, C.
    China Agr Univ, Peoples R China.
    Borjesson, S.
    Natl Vet Inst SVA, Sweden.
    Chen, B.
    Shandong Ctr Dis Control and Prevent, Peoples R China.
    Ji, X.
    China Agr Univ, Peoples R China.
    Berglund, Björn
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten.
    Wang, M.
    Shandong Ctr Dis Control and Prevent, Peoples R China.
    Nilsson, Maud
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten.
    Yin, Hong
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten.
    Sun, Q.
    Shandong Univ, Peoples R China; Shandong Univ, Peoples R China.
    Hulth, A.
    Publ Hlth Agcy Sweden, Sweden.
    Wang, Y.
    China Agr Univ, Peoples R China.
    Wu, C.
    China Agr Univ, Peoples R China.
    Bi, Z.
    Shandong Ctr Dis Control and Prevent, Peoples R China.
    Nilsson, Lennart E
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten.
    Identical genotypes of community-associated MRSA (ST59) and livestock-associated MRSA (ST9) in humans and pigs in rural China2018Ingår i: Zoonoses and Public Health, ISSN 1863-1959, E-ISSN 1863-2378, Vol. 65, nr 3, s. 367-371Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study investigated the prevalence of MRSA in samples taken in households, with and without backyard pigs in villages in a rural area of Shandong Province, China. Community-associated MRSA and livestock-associated MRSA, belonging to ST59 and ST9, respectively, were identified in both humans and pigs. The genotypic and phenotypic comparison of isolates indicates that bidirectional transmission of MRSA has occurred between humans and pigs in the villages.

  • 42.
    Bjälke, Christer
    et al.
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Barn- och ungdomspsykiatriska kliniken NSÖ.
    Widén, Lars
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Barn- och ungdomspsykiatriska kliniken NSÖ.
    BOF (Barnorienterad familjeterapi): symtomens arena?1999Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Barnorienterad familjeterapi - BOF, en terapiform där barn och föräldrar leker tillsammans i en sandlåda med ett material av dockor, djur, träd, staket, etc. I studien undersöker vi om man med ledning av det som sker i leken, samhandlingen, kan se och förstå barnets problem, dvs det symtom familjen sökte till BUP för.

    Vi valde att dela in symtomen i tre huvudgrupper; externaliserande, dvs. utagerande symtom, internaliserande symtom, dvs mer inåtvända symtom som oro, ledsenhet samt somatiserande, där symtomen tar sig kroppsliga uttryck.

    Nio familjer som inledde en BOF-terapi vid BUP, Vrinnevisjukhuset under 1997-98 kom att ingå i undersökningen.

    Innan terapin påbörjades fyllde föräldrarna i ett CBCL -formulär om barnets symtom. BOF-terapin utfördes på vanligt sätt med filmning av sessionerna och samtal i familjen om filmerna. Därefter fick vi tillgång till filmerna. Vi fick ej veta något om symtom eller problematik. I ett fall kände vi anmälningsorsaken. Familjesammansättningen var också okänd för oss.

    Vi har studerat den första terapiomgången med barn, föräldrar och terapeut vid sandlådan. Filmen har transkriberats vilket innebär att varje  sammanhållen handling och verbal tur, dvs. yttrande, har dikterats in på band. Ex, Pojke gör: Tar bilen, Mamma säger: "Kom hit" Transkriptionen har skrivits ut och analyserats. Vi har sorterat och räknat antal handlingar och yttranden och för varje aktör. För att få veta intensiteten i leken har vi sedan delat antalet med lekens längd. Vi antog att intensivare lek kan tyda på utagerande problematik.

    Vi har läst materialet och försökt beskriva terapiomgångarna globalt avseende innehåll och teman i leken, gränser och aktivitet i sandlådan samt terapeutens agerande.

    I utskrifterna har vi även försökt finna handlingar och yttranden som visar på gränsergränssättning, aggressivitet, omsorg, oro-ängslan, sjukdom-skada, ledsenhet, att bli sedd etc. Vi har även försökt se till samspelet ur olika aspekter.

    De olika kategorierna har markerats i skriften, förts in i ett protokoll och räknats samman. Vi har jämfört de olika resultaten och ställt en hypotes om barnets symtom.

    Våra antaganden om varje barns symtom har jämförts med resultatet av CBCL-skattningen. Vi fann, att vi vid åtta av nio barn hamnat inom samma huvudgrupp av symtom som CBCL. Pojken som avvek hade, liksom flertalet av barnen, en dubbel problematik med både internaliserande och externaliserande symtom. I gruppen ingick inget barn med starka somatiserande symtom varför vi ej kan uttala oss om giltigheten för den gruppen.

    Vår slutsats är att barnets symtom syns i samleken och att BOF-sandlådan verkligen är symtomets arena.

  • 43.
    Björnevik, Kjetil
    et al.
    University of Bergen, Norway; Haukeland Hospital, Norway.
    Riise, Trond
    University of Bergen, Norway; Haukeland Hospital, Norway.
    Boström, Inger
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Casetta, Ilaria
    University of Ferrara, Italy.
    Cortese, Marianna
    University of Bergen, Norway; Haukeland Hospital, Norway.
    Granieri, Enrico
    University of Ferrara, Italy.
    Holmoy, Trygve
    University of Oslo, Norway; Akershus University Hospital, Norway.
    Kampman, Margitta T.
    University Hospital North Norway, Norway.
    Landtblom, Anne-Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Neurologiska kliniken. Uppsala University, Sweden.
    Magalhaes, Sandra
    McGill University, Canada.
    Pugliatti, Maura
    University of Bergen, Norway; University of Ferrara, Italy.
    Wolfson, Christina
    McGill University, Canada; McGill University, Canada.
    Myhr, Kjell-Morten
    University of Bergen, Norway; Haukeland Hospital, Norway.
    Negative interaction between smoking and EBV in the risk of multiple sclerosis: The EnvIMS study2017Ingår i: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 23, nr 7, s. 1018-1024Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Results from previous studies on a possible interaction between smoking and Epstein-Barr virus (EBV) in the risk of multiple sclerosis (MS) are conflicting. Objectives: To examine the interaction between smoking and infectious mononucleosis (IM) in the risk of MS. Methods: Within the case-control study on Environmental Factors In Multiple Sclerosis (EnvIMS), 1904 MS patients and 3694 population-based frequency-matched healthy controls from Norway, Italy, and Sweden reported on prior exposure to smoking and history of IM. We examined the interaction between the two exposures on the additive and multiplicative scale. Results: Smoking and IM were each found to be associated with an increased MS risk in all three countries, and there was a negative multiplicative interaction between the two exposures in each country separately as well as in the pooled analysis (p=0.001). Among those who reported IM, there was no increased risk associated with smoking (odds ratio (OR): 0.95, 95% confidence interval (CI): 0.66-1.37). The direction of the estimated interactions on the additive scale was consistent with a negative interaction in all three countries (relative excess risk due to interaction (RERI): -0.98, 95% CI: -2.05-0.15, p=0.09). Conclusion: Our findings indicate competing antagonism, where the two exposures compete to affect the outcome.

  • 44.
    Bolic Baric, Vedrana
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten.
    Support in school and the occupational transition process: Adolescents and young adults with neuropsychiatric disabilities2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The overall aim of this thesis was to describe and explore the experiences of support in school of adolescents and young adults with neuropsychiatric disabilities. Furthermore, the aim was to explore support that influences the occupational transition to upper secondary school, further education and work. The two first studies investigated computer use in educational activities and during leisure activities by adolescents with attention deficit hyperactivity disorder (ADHD). Study II also aimed to explore how traditional leisure activities and Internet activities interrelate among adolescents with ADHD. In Studies I and II data was collected using a questionnaire focusing on information and communication technology (ICT) use in school and leisure. Adolescents with ADHD (n = 102) aged 12-18 years were compared with adolescents with physical disabilities (Study I) and adolescents from the general population (Studies I and II). In Study III the aim was to describe the experiences of support at school among young adults with AS and ADHD, and to explore what support they, in retrospect, described as influencing learning. Study IV aimed to describe the occupational transition process to upper secondary school, further education and/or work and to explore what support influenced the process from the perspectives of young adults with AS or ADHD. Studies III (n=13) and IV (n=15) used qualitative semi-structured interviews with young adults with AS or ADHD, aged 18-30 years and were analysed using hermeneutics according to Gadamer.

    The findings of Study I showed that students with ADHD reported significantly less frequent use of computers for almost all educational activities compared with students with physical disabilities and students from the general population. They reported low satisfaction with computer use in school and a desire to use computers more often and for more activities in school compared with students with physical disabilities. Study II showed that Internet activities among adolescents with ADHD during leisure, tended to focus on online games. Furthermore, analysis demonstrated that Internet activities were broadening leisure activities among adolescents with ADHD, rather than being a substitute for traditional leisure activities. Study III found that young adults with AS or ADHD experienced difficulties at school that included academic, social, and emotional aspects, all of which influenced learning. Support addressing difficulties with academic performance was described as insufficient and only occasionally provided in school. In conclusion, support for learning among students with AS or ADHD needs to combine academic and psychosicial support. The findings of Study IV identified three different pathways following compulsory school. Support influencing the occupational transition process included: occupational transition preparation in compulsory school, practical work experience in a safe environment, and support beyond the workplace. Support from community-based day centres was described both as an important step towards work in the regular labour market, as well as being too far away from the regular labour market.

    In conclusion, this thesis revealed that support in school among students with AS or ADHD needs to combine academic and psychosocial support. Despite being regarded as facilitating learning, individuals with ADHD or AS reported limited computer and Internet use in school. Based on the results it is suggested that Internet activities may provide adolescents with neuropsychiatric disabilities with new opportunities for social interaction and educational activities. On the basis of the results it is suggested that the occupational transition process should be viewed as a longitudinal one, starting in compulsory school and continuing on until young adults obtain and are able to remain in work or further education. This thesis revealed that extended transition planning, inter-service collaboration and support from communitybased day centres were aspects of the environment that influenced the occupational transition process.

    Delarbeten
    1. Computer use in educational activities by students with ADHD
    Öppna denna publikation i ny flik eller fönster >>Computer use in educational activities by students with ADHD
    Visa övriga...
    2013 (Engelska)Ingår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 20, nr 5, s. 357-364Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Aim: The aim of this study was to investigate computer use in educational activities by students with attention deficit hyperactivity disorder (ADHD) in comparison with that of students with physical disabilities and students from the general population.

    Methods: The design of the study was cross-sectional with group comparison. Students with ADHD (n = 102) were pair-matched in terms of age and sex with students with physical disabilities and students from the general population (n = 940) were used as a reference group.

    Results: The study showed that less than half of the students with ADHD had access to a computer in the classroom. Students with ADHD reported significantly less frequent use of computers for almost all educational activities compared with students with physical disabilities and students from the general population. Students with ADHD reported low satisfaction with computer use in school. In addition, students with ADHD reported a desire to use computers more often and for more activities in school compared with students with physical disabilities.

    Conclusions: These results indicate that occupational therapists should place more emphasize on how to enable students with ADHD to use computers in educational activities in school.

    Ort, förlag, år, upplaga, sidor
    Informa Healthcare, 2013
    Nyckelord
    Information and communication technology (ICT), computer access, school-based practice, physical disabilities
    Nationell ämneskategori
    Arbetsterapi
    Identifikatorer
    urn:nbn:se:liu:diva-86782 (URN)10.3109/11038128.2012.758777 (DOI)000323943600006 ()
    Tillgänglig från: 2013-01-04 Skapad: 2013-01-04 Senast uppdaterad: 2017-12-06Bibliografiskt granskad
    2. Internet Activities During Leisure: A Comparison Between Adolescents With ADHD and Adolescents From the General Population
    Öppna denna publikation i ny flik eller fönster >>Internet Activities During Leisure: A Comparison Between Adolescents With ADHD and Adolescents From the General Population
    2018 (Engelska)Ingår i: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246, Vol. 22, nr 12, s. 1131-1139Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objective: Adolescents’ leisure activities are increasingly focusing on Internet activities, and today, these coexist with traditional leisure activities such as sport and meeting friends. The purpose of the present study was to investigate leisure activities, particularly Internet activities, among boys and girls with ADHD, and compare these with boys and girls from the general population. The objective was also to explore how traditional leisure activities and Internet activities interrelate among adolescents with ADHD. 

    Method: Adolescents with ADHD (n = 102) were compared with adolescents from the general population on leisure activities and Internet use. 

    Results: Leisure activities among adolescents with ADHD tended to focus on Internet activities, particularly online games. Internet activities were broadening leisure activities among adolescents with ADHD, rather than being a substitute for traditional leisure activities. 

    Conclusion: Internet activities may provide adolescents with ADHD accessible means of social interaction.

    Ort, förlag, år, upplaga, sidor
    Sage Publications, 2018
    Nyckelord
    adolescent ADHD, computer games, principal components analysis, peer relationships
    Nationell ämneskategori
    Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi Tvärvetenskapliga studier inom samhällsvetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-123871 (URN)10.1177/1087054715613436 (DOI)000444488700005 ()26610742 (PubMedID)
    Tillgänglig från: 2016-01-12 Skapad: 2016-01-12 Senast uppdaterad: 2018-09-27Bibliografiskt granskad
    3. Support for learning- goes beyond academic support: voices of students with Asperger’s disorder and ADHD
    Öppna denna publikation i ny flik eller fönster >>Support for learning- goes beyond academic support: voices of students with Asperger’s disorder and ADHD
    2016 (Engelska)Ingår i: Autism, ISSN 1362-3613, E-ISSN 1461-7005, Vol. 20, nr 2, s. 183-195Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The purpose of this study was to describe and explore the experiences of support at school among young adults with Asperger’s disorder (AS) and attention-deficit/hyperactivity disorder (ADHD), and also to examine what support they, in retrospect, described as influencing learning. Purposive sampling was used to enroll participants. Data were collected through semi-structured interviews with thirteen young adults aged between 20-29 years. A qualitative analysis, based on interpreting people’s experiences was conducted by grouping and searching for patterns in data. The findings indicate that the participants experienced difficulties at school that included academic, social and emotional conditions, all of which could influence learning. Support for learning included small groups, individualized teaching methods, teachers who cared, and practical and emotional support. These clusters together confirm the overall understanding that support for learning aligns academic and psychosocial support. In conclusion, academic support combined with psychosocial support at school seems to be crucial for learning among students with AS and ADHD.

    Ort, förlag, år, upplaga, sidor
    Sage Publications, 2016
    Nyckelord
    Autism Spectrum Disorders, ADHD/ADD, psychosocial support, education, educational provision, services, qualitative research, special needs students
    Nationell ämneskategori
    Annan hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-115117 (URN)10.1177/1362361315574582 (DOI)000372880100007 ()
    Tillgänglig från: 2015-03-10 Skapad: 2015-03-09 Senast uppdaterad: 2017-04-21Bibliografiskt granskad
    4. The Occupational Transition Process to Upper Secondary School, Further Education and/or Work in Sweden: As Described by Young Adults with Asperger Syndrome and Attention Deficit Hyperactivity Disorder
    Öppna denna publikation i ny flik eller fönster >>The Occupational Transition Process to Upper Secondary School, Further Education and/or Work in Sweden: As Described by Young Adults with Asperger Syndrome and Attention Deficit Hyperactivity Disorder
    2017 (Engelska)Ingår i: Journal of autism and developmental disorders, ISSN 0162-3257, E-ISSN 1573-3432, Vol. 47, nr 3, s. 667-679Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The aim of the study was to describe the occupational transition process to upper secondary school, further education and/or work, and to discover what support influences the process from the perspectives of young adults with Asperger’s disorder (AS) or attention deficit/hyperactivity disorder (ADHD). This qualitative study comprised semi-structured interviews with 15 young adults with AS or ADHD, eight men and seven women (aged 20 to 29 years). Most of the participants were attending community-based day centres at local businesses. Analysis identified three different occupational transition pathways following compulsory school. Support influencing the occupational transition process included: occupational transition preparation in compulsory school, practical work experience in a safe environment, and support beyond the workplace. The overall understanding shows that the occupational transition process was a longitudinal one starting as early as in middle school, and continuing until the young adults with AS and ADHD obtained and were able to remain in employment or further education. Support from community-based day centres was described both as an important step towards finding employment in the regular labour market in which participants could develop practical work experience, and as being too far away from the regular labour market.

    Ort, förlag, år, upplaga, sidor
    Springer, 2017
    Nyckelord
    Attention deficit hyperactivity disorder/attention deficit disorder, autism spectrum disorders, employment, education, qualitative research, services
    Nationell ämneskategori
    Annan hälsovetenskap Neurovetenskaper
    Identifikatorer
    urn:nbn:se:liu:diva-123872 (URN)10.1007/s10803-016-2986-z (DOI)000396815400014 ()
    Tillgänglig från: 2016-01-12 Skapad: 2016-01-12 Senast uppdaterad: 2018-01-15Bibliografiskt granskad
  • 45.
    Bolic Baric, Vedrana
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för arbetsterapi. Linköpings universitet, Medicinska fakulteten.
    Hellberg, Kristina
    Linnaeus University, Växjö, Sweden .
    Kjellberg, Anette
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för arbetsterapi. Linköpings universitet, Medicinska fakulteten.
    Hemmingsson, Helena
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för arbetsterapi. Linköpings universitet, Medicinska fakulteten.
    Internet Activities During Leisure: A Comparison Between Adolescents With ADHD and Adolescents From the General Population2018Ingår i: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246, Vol. 22, nr 12, s. 1131-1139Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Adolescents’ leisure activities are increasingly focusing on Internet activities, and today, these coexist with traditional leisure activities such as sport and meeting friends. The purpose of the present study was to investigate leisure activities, particularly Internet activities, among boys and girls with ADHD, and compare these with boys and girls from the general population. The objective was also to explore how traditional leisure activities and Internet activities interrelate among adolescents with ADHD. 

    Method: Adolescents with ADHD (n = 102) were compared with adolescents from the general population on leisure activities and Internet use. 

    Results: Leisure activities among adolescents with ADHD tended to focus on Internet activities, particularly online games. Internet activities were broadening leisure activities among adolescents with ADHD, rather than being a substitute for traditional leisure activities. 

    Conclusion: Internet activities may provide adolescents with ADHD accessible means of social interaction.

  • 46.
    Boman, Erika
    et al.
    Aland University of Appl Science, Finland; University of Coll Southeast Norway, Norway.
    Lundman, Berit
    Umeå University, Sweden.
    Nygren, Bjoern
    Umeå University, Sweden.
    Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Linnaeus University, Sweden.
    Santamaki Fischer, Regina
    Umeå University, Sweden; Abo Akad University, Finland.
    Inner strength and its relationship to health threats in ageing-A cross-sectional study among community-dwelling older women2017Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, nr 11, s. 2720-2729Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To explore the relationship between inner strength and health threats among community-dwelling older women. Background: Inner strength is described as a resource that promotes experiences of health, despite adversities. Inner strength and its dimensions (i.e. connectedness, creativity, firmness and flexibility) can be assessed using the Inner Strength Scale (ISS). Exploring attributes of weaker inner strength may yield valuable information about areas to focus on in enhancing a persons inner strength and may ultimately lead to the perception of better health. Design: Cross-sectional questionnaire survey. Methods: The study is based on responses from 1270 community-dwelling older women aged 65 years and older; these were collected in the year 2010 and describe the situation that still exists today for older women. The questionnaire included the ISS, background characteristics and explanatory variables known to be health threats in ageing. Data were analysed using descriptive and inferential statistics. Results: Poorer mental health was related to weaker inner strength in total and in all the dimensions. Symptoms of depressive disorders and feeling lonely were related to three of the dimensions, except firmness and creativity respectively. Furthermore, poor physical health was associated with the dimensions firmness and flexibility. Other health threats were significantly related to only one of the dimensions, or not associated at all. Conclusion: Mental ill health has overall the strongest association with weaker inner strength. Longitudinal studies are recommended to confirm the results. However, the ISS does not only estimate inner strength but can also be a tool for discovering where (i.e. dimension) interventions may be most profitable.

  • 47.
    Boman, John
    Linköpings universitet, Institutionen för tema, Tema hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Viljan att förstå1998Samlingsverk (redaktörskap) (Övrigt vetenskapligt)
  • 48.
    Bousquet, J.
    et al.
    Montpellier University Hospital, France; European Innovat Partnership Act and Health Ageing Re, France; INSERM, France; CHRU Arnaud Villeneuve, France.
    Hellings, P. W.
    Katholieke University of Leuven, Belgium.
    Agache, I.
    Transylvania University of Brasov, Romania.
    Bedbrook, A.
    European Innovat Partnership Act and Health Ageing Re, France.
    Bachert, C.
    Ghent University Hospital, Belgium.
    Bergmann, K. C.
    Charite, Germany; Global Allergy and Asthma European Network, Germany.
    Bewick, M.
    iQ4U Consultants Ltd, England.
    Bindslev-Jensen, C.
    Odense University Hospital, Denmark.
    Bosnic-Anticevitch, S.
    Odense University Hospital, Denmark.
    Bucca, C.
    University of Sydney and Sydney Local Health Dist, Australia.
    Caimmi, D. P.
    Hospital City Health and Science Torino, Italy.
    Camargos, P. A. M.
    Montpellier University Hospital, France.
    Canonica, G. W.
    University of Federal Minas Gerais, Brazil.
    Casale, T.
    Humanitas University, Italy.
    Chavannes, N. H.
    University of S Florida, FL USA.
    Cruz, A. A.
    Leiden University, Netherlands; University of Federal Bahia, Brazil.
    De Carlo, G.
    GARD Execut Comm, Brazil.
    Dahl, R.
    Leiden University, Netherlands.
    Demoly, P.
    Hospital City Health and Science Torino, Italy; EFA European Federat Allergy and Airways Disease Patien, Belgium; INSERM, France.
    Devillier, P.
    University of Paris 06, France.
    Fonseca, J.
    Suresnes University of Versailles, France; Institute CUF Porto, Portugal.
    Fokkens, W. J.
    Hospital CUF Porto, Portugal.
    Guldemond, N. A.
    University of Porto, Portugal.
    Haahtela, T.
    Academic Medical Centre, Netherlands.
    Illario, M.
    Erasmus University, Netherlands.
    Just, J.
    Helsinki University Hospital, Finland.
    Keil, T.
    University of Naples Federico II, Italy; University of Paris 06, France.
    Klimek, L.
    Charite, Germany.
    Kuna, P.
    University of Wurzburg, Germany.
    Larenas-Linnemann, D.
    Centre Rhinol and Allergol, Germany.
    Morais-Almeida, M.
    Medical University of Lodz, Poland.
    Mullol, J.
    University of Barcelona, Spain.
    Murray, R.
    University of Chicago, IL 60637 USA.
    Naclerio, R.
    University of Chicago, IL 60637 USA.
    OHehir, R. E.
    Monash University, Australia; Monash University, Australia.
    Papadopoulos, N. G.
    Monash University, Australia; University of Manchester, England.
    Pawankar, R.
    University of Athens, Greece.
    Potter, P.
    Nippon Medical Sch, Japan.
    Ryan, D.
    University of Cape Town, South Africa; Woodbrook Medical Centre, England.
    Samolinski, B.
    University of Edinburgh, Scotland.
    Schunemann, H. J.
    Medical University of Warsaw, Poland.
    Sheikh, A.
    McMaster University, Canada.
    Simons, F. E. R.
    University of Edinburgh, Scotland.
    Stellato, C.
    University of Manitoba, Canada.
    Todo-Bom, A.
    University of Salerno, Italy.
    Tomazic, P. V.
    University of Coimbra, Portugal.
    Valiulis, A.
    Medical University of Graz, Austria; Vilnius University, Lithuania; Vilnius University, Lithuania.
    Valovirta, E.
    European Academic Paediat EAP UEMS SP, Belgium; University of Turku, Finland.
    Ventura, M. T.
    Terveystalo, Finland.
    Wickman, M.
    University of Bari, Italy; Soder Sjukhuset, Sweden.
    Young, I.
    Karolinska Institute, Sweden.
    Yorgancioglu, A.
    Queens University, North Ireland.
    Zuberbier, T.
    Charite, Germany; Global Allergy and Asthma European Network, Germany.
    Aberer, W.
    Celal Bayar University, Turkey.
    Akdis, C. A.
    Medical University of Graz, Austria.
    Akdis, M.
    Medical University of Graz, Austria.
    Annesi-Maesano, I.
    EFA European Federat Allergy and Airways Disease Patien, Belgium; INSERM, France.
    Ankri, J.
    INSERM, France.
    Ansotegui, I. J.
    University of Zurich, Switzerland.
    Anto, J. M.
    Hospital Quiron Bizkaia, Spain; Barcelona Institute Global Health ISGlobal, Spain; IMIM Hospital Mar Research Institute, Spain; CIBER Epidemiol and Salud Public CIBERESP, Spain.
    Arnavielhe, S.
    University of Pompeu Fabra, Spain.
    Asarnoj, A.
    University of Edinburgh, Scotland; Kyomed, France; Karolinska Institute, Sweden.
    Arshad, H.
    Karolinska University Hospital, Sweden.
    Avolio, F.
    David Hide Asthma and Allergy Research Centre, England.
    Baiardini, I.
    University of Federal Minas Gerais, Brazil.
    Barbara, C.
    Regional Puglia, Italy.
    Barbagallo, M.
    Portuguese National Programme Resp Disease PNDR, Portugal.
    Bateman, E. D.
    University of Palermo, Italy.
    Beghe, B.
    University of Cape Town, South Africa.
    Bel, E. H.
    University of Modena and Reggio Emilia, Italy.
    Bennoor, K. S.
    University of Amsterdam, Netherlands.
    Benson, Mikael
    Region Östergötland, Hjärt- och Medicincentrum, Allergicentrum US. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Bialoszewski, A. Z.
    University of Edinburgh, Scotland.
    Bieber, T.
    Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
    Bjermer, L.
    University of Bonn, Germany.
    Blain, H.
    Lund University Hospital, Sweden; Montpellier University Hospital, France.
    Blasi, F.
    University of Montpellier, France.
    Boner, A. L.
    University of Milan, Italy.
    Bonini, M.
    Sapienza University, Rome, Italy.
    Bonini, S.
    University of Verona Hospital, Italy; University of Roma La Sapienza, Italy.
    Bosse, I.
    University of Naples 2, Italy.
    Bouchard, J.
    Italian National Research Council, Italy.
    Boulet, L. P.
    University of Laval, Canada.
    Bourret, R.
    Montpellier University Hospital, France.
    Bousquet, P. J.
    EFA European Federat Allergy and Airways Disease Patien, Belgium.
    Braido, F.
    University of Federal Minas Gerais, Brazil.
    Briggs, A. H.
    University of Glasgow, Scotland.
    Brightling, C. E.
    University Hospital Leicester NHS Trust, England; University of Leicester, England.
    Brozek, J.
    Medical University of Warsaw, Poland.
    Buhl, R.
    Johannes Gutenberg University of Mainz, Germany.
    Bunu, C.
    University of Medical and Farm Timisoara, Romania.
    Burte, E.
    INSERM, France.
    Bush, A.
    University of Medical and Farm Timisoara, Romania; University of London Imperial Coll Science Technology and Med, England.
    Caballero-Fonseca, F.
    Centre Medical Docente Trinidad, Venezuela.
    Calderon, M. A.
    University of Medical and Farm Timisoara, Romania; University of London Imperial Coll Science Technology and Med, England; University of London Imperial Coll Science Technology and Med, England.
    Camuzat, T.
    Regional Languedoc Roussillon, France.
    Cardona, V.
    Hospital Valle De Hebron, Spain.
    Carreiro-Martins, P.
    CEDOC, Portugal; Centre Hospital Lisboa Cent, Portugal.
    Carriazo, A. M.
    Regional Minist Health Andalusia, Spain.
    Carlsen, K. H.
    Oslo University Hospital, Norway; University of Oslo, Norway; University of Oslo, Norway.
    Carr, W.
    Allergy and Asthma Associates Southern Calif, CA USA.
    Cepeda Sarabia, A. M.
    Metropolitan University, Colombia; SLaai Sociedad Latinoamer Allergia Asma and Immunol, Colombia.
    Cesari, M.
    Gerontopole Toulouse, France.
    Chatzi, L.
    University of Crete, Greece.
    Chiron, R.
    Hospital City Health and Science Torino, Italy.
    Chivato, T.
    University of CEU San Pablo, Spain.
    Chkhartishvili, E.
    Grigol Robakidze University, Rep of Georgia.
    Chuchalin, A. G.
    Pulmonolory Research Institute FMBA, Russia; GARD Execut Comm, Russia.
    Chung, K. F.
    University of London Imperial Coll Science Technology and Med, England.
    Ciprandi, G.
    IRCCS Azienda Osped University of San Martino, Italy.
    Correia de Sousa, J.
    University of Minho, Portugal.
    Cox, L.
    Nova Southeastern University, FL USA.
    Crooks, G.
    Scottish Centre Telehealth and Telecare, Scotland.
    Custovic, A.
    University of London Imperial Coll Science Technology and Med, England.
    Dahlen, S. E.
    Karolinska Institute, Sweden.
    Darsow, U.
    Technical University of Munich, Germany; Helmholtz Centre Munich, Germany.
    Dedeu, T.
    AQuAS, Spain; European Regional and Local Health Assoc, Belgium.
    Deleanu, D.
    Luliu Hatieganu University of Medical and Pharm, Romania.
    Denburg, J. A.
    McMaster University, Canada.
    De Vries, G.
    Peercode DV, Netherlands.
    Didier, A.
    Rangueil Larrey Hospital, France.
    Dinh-Xuan, A. T.
    University of Paris 05, France.
    Dokic, D.
    Ss Cyril and Methodius University, Macedonia.
    Douagui, H.
    Centre Hospital University of Beni Messous, Algeria.
    Dray, G.
    Ecole Mines, France.
    Dubakiene, R.
    Vilnius University, Lithuania.
    Durham, S. R.
    University of London Imperial Coll Science Technology and Med, England.
    Du Toit, G.
    Kings Coll London, England.
    Dykewicz, M. S.
    St Louis University, MO USA.
    Eklund, P.
    Umeå University, Sweden; Four Comp Oy, Finland.
    El-Gamal, Y.
    Ain Shams University, Egypt.
    Ellers, E.
    Odense University Hospital, Denmark.
    Emuzyte, R.
    Medical University of Graz, Austria; Vilnius University, Lithuania; Vilnius University, Lithuania.
    Farrell, J.
    Social Serv and Public Safety, North Ireland.
    Fink Wagner, A.
    Global Allergy and Asthma Platform, Austria.
    Fiocchi, A.
    Bambino Gesu Childrens Research Hospital Holy See, Italy.
    Fletcher, M.
    Educ Heatlh, England.
    Forastiere, F.
    Regional Health Serv Lazio Reg, Italy.
    Gaga, M.
    Athens Chest Hospital, Greece.
    Gamkrelidze, A.
    National Centre Disease Control and Public Health Georgia, Rep of Georgia.
    Gemicioglu, B.
    Istanbul University, Turkey.
    Gereda, J. E.
    Clin Ricardo Palma, Peru.
    Gerth van Wick, R.
    Erasmus MC, Netherlands.
    Gonzalez Diaz, S.
    University of Autonoma Nuevo Leon, Mexico.
    Grisle, I.
    Latvian Assoc Allergists, Latvia.
    Grouse, L.
    University of Washington, WA 98195 USA.
    Gutter, Z.
    University Hospital Olomouc, Czech Republic.
    Guzman, M. A.
    University of Chile, Chile.
    Hellquist-Dahl, B.
    Odense University Hospital, Denmark.
    Heinrich, J.
    German Research Centre Environm Heatlh, Germany.
    Horak, F.
    Vienna Challenge Chamber, Austria.
    Hourihane, J. O. B.
    University of Coll Cork, Ireland.
    Humbert, M.
    University of Paris 11, France; Hop Bicetre, France; INSERM, France.
    Hyland, M.
    University of Plymouth, England.
    Iaccarino, G.
    University of Salerno, Italy.
    Jares, E. J.
    Libra Fdn, Argentina.
    Jeandel, C.
    European Innovat Partnership Act and Health Ageing Re, France; University Hospital, Sweden.
    Johnston, S. L.
    University of London Imperial Coll Science Technology and Med, England; MRC and Asthma UK Centre Allerg Mech Asthma, England.
    Joos, G.
    Ghent University Hospital, Belgium.
    Jonquet, O.
    Montpellier University Hospital, France.
    Jung, K. S.
    Hallym University, South Korea.
    Jutel, M.
    Wroclaw Medical University, Poland.
    Kaidashev, I.
    Ukrainian Medical Stomatol Acad, Ukraine.
    Khaitov, M.
    Federal Medicobiol Agency, Russia.
    Kalayci, O.
    Hacettepe University, Turkey.
    Kalyoncu, A. F.
    Hacettepe University, Turkey.
    Kardas, P.
    Medical University of Lodz, Poland.
    Keith, P. K.
    McMaster University, Canada.
    Kerkhof, M.
    University of Groningen, Netherlands.
    Kerstjens, H. A. M.
    University of Groningen, Netherlands.
    Khaltaev, N.
    GARD, Switzerland.
    Kogevinas, M.
    Hospital Quiron Bizkaia, Spain; Barcelona Institute Global Health ISGlobal, Spain; IMIM Hospital Mar Research Institute, Spain; CIBER Epidemiol and Salud Public CIBERESP, Spain.
    Kolek, V.
    University Hospital Olomouc, Czech Republic.
    Koppelman, G. H.
    University of Groningen, Netherlands.
    Kowalski, M. L.
    Medical University of Lodz, Poland.
    Kuitunen, M.
    University of Helsinki, Finland.
    Kull, I.
    University of Bari, Italy; Soder Sjukhuset, Sweden.
    Kvedariene, V.
    Vilnius University, Lithuania.
    Lambrecht, B.
    University of Ghent, Belgium.
    Lau, S.
    Charite, Germany.
    Laune, D.
    University of Pompeu Fabra, Spain.
    Le, L. T. T.
    University of Medical and Pharm, Vietnam.
    Lieberman, P.
    University of Tennessee, TN USA.
    Lipworth, B.
    University of Dundee, Scotland.
    Li, J.
    Guangzhou Medical University, Peoples R China.
    Lodrup Carlsen, K. C.
    Oslo University Hospital, Norway; University of Oslo, Norway; University of Oslo, Norway.
    Louis, R.
    CHU Sart Tilman, Belgium.
    Lupinek, C.
    Medical University of Vienna, Austria.
    MacNee, W.
    University of Edinburgh, Scotland.
    Magar, Y.
    Hop St Joseph, France.
    Magnan, A.
    University of Nantes, France; University of Nantes, France.
    Mahboub, B.
    Rashid Hospital, U Arab Emirates.
    Maier, D.
    Biomax Informat AG, Germany.
    Majer, I.
    University of Bratislava, Slovakia.
    Malva, J.
    University of Coimbra, Portugal; Ageing@Coimbra EIP AHA Reference Site, Portugal.
    Manning, P.
    Bon Secours Hospital, Ireland.
    De Manuel Keenoy, E.
    Kronikgune, Spain.
    Marshall, G. D.
    University of Mississippi, MS USA.
    Masjedi, M. R.
    Iranian Anti Tobacco Assoc, Iran.
    Mathieu-Dupas, E.
    University of Pompeu Fabra, Spain.
    Maurer, M.
    Charite, Germany.
    Mavale-Manuel, S.
    Maputo Central Hospital, Mozambique.
    Melen, E.
    University of Bari, Italy; Soder Sjukhuset, Sweden.
    Melo-Gomes, E.
    Regional Puglia, Italy.
    Meltzer, E. O.
    Allergy and Asthma Medical Grp and Research Centre, CA USA.
    Mercier, J.
    University of Montpellier, France.
    Merk, H.
    Rhein Westfal TH Aachen, Germany.
    Miculinic, N.
    Croatian Pulm Soc, Croatia.
    Mihaltan, F.
    National Institute Pneumol M Nasta, Romania.
    Milenkovic, B.
    University of Belgrade, Serbia; Serbian Assoc Asthma and COPD, Serbia.
    Millot-Keurinck, J.
    Caisse Assurance Retraite and Sante Travail Langued, France.
    Mohammad, Y.
    Tishreen University, Syria.
    Momas, I.
    Paris Descartes University, France; Paris Municipal Department Social Act Childhood and Heatlh, France.
    Mosges, R.
    University of Cologne, Germany.
    Muraro, A.
    Padua Gen University Hospital, Italy.
    Namazova-Baranova, L.
    Russian Academic Medical Science, Russia.
    Nadif, R.
    INSERM, France.
    Neffen, H.
    Hospital Ninos Orlando Alassia, Argentina.
    Nekam, K.
    Hospital Hospital Bros Buda, Hungary.
    Nieto, A.
    Hospital La Fe, Spain.
    Niggemann, B.
    Charite, Germany.
    Nogueira-Silva, L.
    Suresnes University of Versailles, France; University of Porto, Portugal; Institute CUF Porto, Portugal; Centre Hospital Sao Joao, Portugal.
    Nogues, M.
    European Innovat Partnership Act and Health Ageing Re, France; Caisse Assurance Retraite and Sante Travail Langued, France.
    Nyembue, T. D.
    University Hospital Kinshasa, DEM REP CONGO.
    Ohta, K.
    Tokyo National Hospital, Japan.
    Okamoto, Y.
    Chiba University Hospital, Japan.
    Okubo, K.
    Nippon Medical Sch, Japan.
    Olive-Elias, M.
    Montpellier University Hospital, France; University of Porto, Portugal; Academic Medical Centre, Netherlands.
    Ouedraogo, S.
    Centre Hospital University of Pediatr Charles Gaulle, Burkina Faso.
    Paggiaro, P.
    University Hospital Pisa, Italy.
    Pali-Schoell, I.
    Medical University, Austria.
    Palkonen, S.
    GARD Execut Comm, Brazil.
    Panzner, P.
    Charles University of Prague, Czech Republic.
    Papi, A.
    University of Ferrara, Italy.
    Park, H. S.
    Ajou University, South Korea.
    Passalacqua, G.
    University of Federal Minas Gerais, Brazil.
    Pedersen, S.
    University of Southern Denmark, Denmark.
    Pereira, A. M.
    Suresnes University of Versailles, France; University of Porto, Portugal; Institute CUF Porto, Portugal; CUF Porto Hospital and Institute, Portugal.
    Pfaar, O.
    Charite, Germany; Heidelberg University, Germany.
    Picard, R.
    Minist Econ Ind and Numer, France.
    Pigearias, B.
    Espace Francophone Pneumol, France.
    Pin, I.
    CHU Grenoble, France.
    Plavec, D.
    Childrens Hospital Srebrnjak, Croatia; University of JJ Strossmayer, Croatia.
    Pohl, W.
    Hietzing Hospital, Austria.
    Popov, T. A.
    Medical University of Sofia, Bulgaria.
    Portejoie, F.
    European Innovat Partnership Act and Health Ageing Re, France.
    Postma, D.
    University of Groningen, Netherlands.
    Poulsen, L. K.
    Copenhagen University Hospital Gentofte, Denmark.
    Price, D.
    University of Aberdeen, Scotland; Research Real Life, England.
    Rabe, K. F.
    German Centre Lung Research DZL, Germany; University of Kiel, Germany.
    Raciborski, F.
    University of Edinburgh, Scotland.
    Roberts, G.
    Southampton University Hospital, England.
    Robalo-Cordeiro, C.
    Coimbra University Hospital, Portugal.
    Rodenas, F.
    University of Valencia, Spain.
    Rodriguez-Manas, L.
    Getafe University Hospital, Spain.
    Rolland, C.
    Assoc Asthme and Allergie, France.
    Roman Rodriguez, M.
    Institute Invest Sanitaria Palma IdisPa, Spain.
    Romano, A.
    Complesso Integrato Columbus, Italy.
    Rosado-Pinto, J.
    Hospital Luz, Portugal.
    Rosario, N.
    University of Parana, Brazil.
    Rottem, M.
    Emek Medical Centre, Israel.
    Sanchez-Borges, M.
    Centre Medical Docente Trinidad and Clin El Avila, Venezuela.
    Sastre-Dominguez, J.
    Autononous University of Madrid, Spain.
    Scadding, G. K.
    UCL, England.
    Scichilone, N.
    University of Palermo, Italy.
    Schmid-Grendelmeier, P.
    University of Zurich Hospital, Switzerland.
    Serrano, E.
    CHU Rangueil Larrey, France.
    Shields, M.
    Queens University, North Ireland; Royal Belfast Hospital Sick Children, North Ireland.
    Siroux, V.
    University of Joseph Fourier, France.
    Sisul, J. C.
    Soc Paraguaya Alergia Asma and Inmunol, Paraguay.
    Skrindo, I.
    Oslo University Hospital, Norway; University of Oslo, Norway.
    Smit, H. A.
    University of Utrecht, Netherlands.
    Sole, D.
    University of Federal Sao Paulo, Brazil.
    Sooronbaev, T.
    Euro Asian Resp Soc, Kyrgyzstan.
    Spranger, O.
    Global Allergy and Asthma Platform, Austria.
    Stelmach, R.
    University of Sao Paulo, Brazil.
    Sterk, P. J.
    University of Amsterdam, Netherlands.
    Strandberg, T.
    European Union Geriatr Medical Soc EUGMS, Finland.
    Sunyer, J.
    Hospital Quiron Bizkaia, Spain; Barcelona Institute Global Health ISGlobal, Spain; IMIM Hospital Mar Research Institute, Spain; CIBER Epidemiol and Salud Public CIBERESP, Spain.
    Thijs, C.
    Maastricht University, Netherlands.
    Triggiani, M.
    University of Manitoba, Canada.
    Valenta, R.
    Medical University of Vienna, Austria.
    Valero, A.
    IDIBAPS, Spain.
    van Eerd, M.
    Peercode DV, Netherlands.
    van Ganse, E.
    PELyon, France; University of Claude Bernard Lyon, France.
    van Hague, M.
    Kyomed, France; Karolinska Institute, Sweden; University Hospital, Sweden.
    Vandenplas, O.
    Catholic University of Louvain, Belgium.
    Varona, L. L.
    Philippines Soc Allergy Asthma and Immunol, Philippines.
    Vellas, B.
    Gerontopole Toulouse, France.
    Vezzani, G.
    Research Hospital, Italy; Regional Agency Health and Social Care, Italy.
    Vazankari, T.
    Finnish Lung Assoc FILHA, Finland.
    Viegi, G.
    CNR Institute Clin Physiol, Italy; CNR, Italy.
    Vontetsianos, T.
    Sotiria Hospital, Greece.
    Wagenmann, M.
    University of Klinikum Dusseldorf, Germany.
    Walker, S.
    Asthma UK, England.
    Wang, D. Y.
    National University of Singapore, Singapore.
    Wahn, U.
    Charite, Germany.
    Werfel, T.
    Hannover Medical Sch, Germany.
    Whalley, B.
    University of Plymouth, England.
    Williams, D. M.
    University of N Carolina, NC USA.
    Williams, S.
    IPCRG, Scotland.
    Wilson, N.
    Northern Health Alliance, England.
    Wright, J.
    Bradford Royal Infirm, England.
    Yawn, B. P.
    Olmsted Medical Centre, MN USA.
    Yiallouros, P. K.
    University of Cyprus, Cyprus.
    Yusuf, O. M.
    Allergy and Asthma Institute, Pakistan.
    Zaidi, A.
    University of Southampton, England.
    Zar, H. J.
    University of Cape Town, South Africa; University of Cape Town, South Africa.
    Zernotti, M. E.
    University of Catolica Cordoba, Argentina.
    Zhang, L.
    Beijing TongRen Hospital, Peoples R China; Beijing Institute Otolaryngol, Peoples R China.
    Zhong, N.
    Guangzhou Medical University, Peoples R China.
    Zidarn, M.
    University of Clin Resp and Allerg Disease, Slovenia.
    ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle2016Ingår i: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 6, artikel-id 47Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA-disseminated and implemented in over 70 countries globally-is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.

  • 49.
    Bouwman, Henk
    et al.
    Northwest University, South Africa.
    Bornman, Riana
    University of Pretoria, South Africa.
    van den Berg, Henk
    Wageningen University, The Netherlands.
    Kylin, Henrik
    Linköpings universitet, Institutionen för tema, Tema vatten i natur och samhälle. Linköpings universitet, Filosofiska fakulteten.
    DDT: Fifty years since silent spring2013Ingår i: Late lessons from early warnings: science, precaution, innovation, Copenhagen: European Environment Agency , 2013, , s. 291s. 272-291Kapitel i bok, del av antologi (Övrigt vetenskapligt)
    Abstract [en]

    'There was a strange stillness. The birds for example — where had they gone? Many people spoke about them, puzzled and disturbed. The feeding stations in the backyards were deserted. The few birds seen anywhere were moribund: they trembled violently and could not fly. It was a spring without voices ... only silence lay over the fields and woods and marsh.'

    The book Silent Spring by Rachel Carson is mainly about the impacts of chemicals (in particular in particular dichlorodiphenyltrichlorethane also known as DDT) on the environment and human health. Indeed, the close association between humans and birds remains very apt. Representing the only two warm-blooded groups of life on Earth, mammals and birds share the same environments and threats.

    Carson's claim that she lived in 'an era dominated by industry, in which the right to make a dollar at whatever cost is seldom challenged' still resonates strongly with the problems that societies face all over the world. One chapter heading, 'The obligation to endure', derived from the French biologist and philosopher Jean Rostand's famous observation that, 'the obligation to endure gives us the right to know'. United States President John F. Kennedy responded to the challenge posed by Carson by investigating DDT, leading to its complete ban in the US. The ban was followed by a range of institutions and regulations concerned with environmental issues in the US and elsewhere, driven by public demand for knowledge and protection.

    DDT was the primary tool used in the first global malaria eradication programme during the 1950s and 1960s. The insecticide is sprayed on the inner walls and ceilings of houses. Malaria has been successfully eliminated from many regions but remains endemic in large parts of the world. DDT remains one of the 12 insecticides — and the only organochlorine compound — currently recommended by the World Health Organization (WHO), and under the Stockholm Convention on Persistent Organic Pollutants, countries may continue to use DDT. Global annual use of DDT for disease vector control is estimated at more than 5 000 tonnes.

    It is clear that the social conscience awakened by Rachel Carson 50 years ago gave momentum to a groundswell of actions and interventions that are slowly but steadily making inroads at myriad levels. Chapter 17 of her book, 'The other road' reminds the reader of the opportunities that should have been seized much earlier. With more than 10 % of bird species worldwide now threatened in one way or another, it is clear that we missed early warnings or failed to act on them. Will we continue to miss signposts to 'other roads'? Are our obligations to endure met by our rights to know? As Carson said 50 years ago: 'The choice, after all, is ours to make.'

  • 50.
    Bouwman, Hindrik
    et al.
    North-West University, South Africa.
    Kylin, Henrik
    Linköpings universitet, Institutionen för tema, Tema Miljöförändring. Linköpings universitet, Filosofiska fakulteten.
    Bornman, Riana
    University of Pretoria, South Africa.
    Is Indoor Residual Spraying broken and what should be fixed?2015Ingår i: Proceedings of the 7th International Toxicology Symposium in Africa, 2015, s. 2-3Konferensbidrag (Refereegranskat)
    Abstract [en]

    Indoor residual spraying (IRS) has been and is still a very successful method to controlmalaria. We are concerned that not enough research attention is given to improvingIRS and that most funding goes towards modern but seemingly still ineffectualmethods. We believe that there is ample scope for improving IRS, while reducinginsecticide exposure

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