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  • 1.
    Angbratt, Marianne
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Ekberg, Joakim
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Walter, Lars
    Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Timpka, Toomas
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Folkhälsovetenskapligt centrum.
    Prediction of obesity from infancy to adolescence2011Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, nr 9, s. 1249-1252Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To examine the development of childhood obesity and to determine the earliest age when estimating body mass using only weight and height data is associated with a corresponding estimate at the age of 15. less thanbrgreater than less thanbrgreater thanMethods: Subjects included are all children born in 1991 in Ostergotland County, Sweden. Weight and height data collected during regular check-ups at well-child centres and school health care assessments up to 15 years of age were assembled from health records. Correlations between childhood estimates of body mass and the body mass index (BMI) at 15 years of age were computed pairwise. Correlations with r andgt; 0.5 were defined as reliably strong. less thanbrgreater than less thanbrgreater thanResults: Complete data were available for 3579 children (62%). Fewer girls (2.6%; C.I. 1.9-3.3) than boys (4.6%; C.I. 3.7-5.5) were obese at 15 years of age. Correlations with BMI at 15 years of age were strong (significantly higher than 0.5) from 5 years of age. Only 23% of girls and 8% of boys found to be obese at 5 years of age were of normal weight at the age of 15. less thanbrgreater than less thanbrgreater thanConclusion: From 5 years of age, point estimates of body mass using only weight and height data are strongly associated with BMI at the age of 15. More data sources are needed to predict weight trajectories in younger children.

  • 2.
    Bång, Magnus
    et al.
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Tekniska högskolan.
    Prytz, Erik
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Tekniska högskolan.
    Rybing, Jonas
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Tekniska högskolan.
    Timpka, Toomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Cognitive design of a digital desk for the emergency room setting2014Ingår i: 2014 AMIA Annual Symposium / [ed] Westra, Bonnie L, Oxford University Press, 2014Konferensbidrag (Refereegranskat)
  • 3.
    Dahlström, Örjan
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Backe, Stefan
    Karlstad University, Sweden Skövde University, Sweden .
    Ekberg, Joakim
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Janson, Staffan
    Karlstad University, Sweden .
    Timpka, Toomas
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Is "Football for All" Safe for All? Cross-Sectional Study of Disparities as Determinants of 1-Year Injury Prevalence in Youth Football Programs2012Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, nr 8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Football (soccer) is endorsed as a health-promoting physical activity worldwide. When football programs are introduced as part of general health promotion programs, equal access and limitation of pre-participation disparities with regard to injury risk are important. The aim of this study was to explore if disparity with regard to parents educational level, player body mass index (BMI), and self-reported health are determinants of football injury in community-based football programs, separately or in interaction with age or gender. less thanbrgreater than less thanbrgreater thanMethodology/Principal Findings: Four community football clubs with 1230 youth players agreed to participate in the cross-sectional study during the 2006 season. The study constructs (parents educational level, player BMI, and self-reported health) were operationalized into questionnaire items. The 1-year prevalence of football injury was defined as the primary outcome measure. Data were collected via a postal survey and analyzed using a series of hierarchical statistical computations investigating associations with the primary outcome measure and interactions between the study variables. The survey was returned by 827 (67.2%) youth players. The 1-year injury prevalence increased with age. For youths with parents with higher formal education, boys reported more injuries and girls reported fewer injuries than expected; for youths with lower educated parents there was a tendency towards the opposite pattern. Youths reporting injuries had higher standardized BMI compared with youths not reporting injuries. Children not reporting full health were slightly overrepresented among those reporting injuries and underrepresented for those reporting no injury. less thanbrgreater than less thanbrgreater thanConclusion: Pre-participation disparities in terms of parents educational level, through interaction with gender, BMI, and self-reported general health are associated with increased injury risk in community-based youth football. When introduced as a general health promotion, football associations should adjust community-based youth programs to accommodate children and adolescents with increased pre-participation injury risk.

  • 4.
    Dalal, Koustuv
    et al.
    University of Örebro, Sweden .
    Dahlström, Örjan
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Timpka, Toomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Interactions between microfinance programmes and non-economic empowerment of women associated with intimate partner violence in Bangladesh: a cross-sectional study2013Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, nr 12, s. 2941-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: This study aims to examine the associations between microfinance programme membership and intimate partner violence (IPV) in different socioeconomic strata of a nationally representative sample of women in Bangladesh. Methods: The cross-sectional study was based on a nationally representative interview survey of 11 178 ever-married women of reproductive age (15-49 years). A total of 4465 women who answered the IPV-related questions were analysed separately using chi(2) tests and Cramers V as a measure of effect size to identify the differences in proportions of exposure to IPV with regard to microfinance programme membership, and demographic variables and interactions between microfinance programme membership and factors related to non-economic empowerment were considered. Results: Only 39% of women were members of microfinance programmes. The prevalence of a history of IPV was 48% for moderate physical violence, 16% for severe physical violence and 16% for sexual violence. For women with secondary or higher education, and women at the two wealthiest levels of the wealth index, microfinance programme membership increased the exposure to IPV two and three times, respectively. The least educated and poorest groups showed no change in exposure to IPV associated with microfinance programmes. The educated women who were more equal with their spouses in their family relationships by participating in decision-making increased their exposure to IPV by membership in microfinance programmes. Conclusions: Microfinance plans are associated with an increased exposure to IPV among educated and empowered women in Bangladesh. Microfinance firms should consider providing information about the associations between microfinance and IPV to the women belonging to the risk groups.

  • 5.
    Delisle, Christine
    et al.
    Karolinska Institute, Sweden.
    Sandin, Sven
    Karolinska Institute, Sweden.
    Forsum, Elisabet
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Henriksson, Hanna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Karolinska Institute, Sweden.
    Trolle-Lagerros, Ylva
    Karolinska Institute, Sweden.
    Larsson, Christel
    University of Gothenburg, Sweden.
    Maddison, Ralph
    University of Auckland, New Zealand.
    Ortega, Francisco B.
    University of Granada, Spain.
    Ruiz, Jonatan R.
    University of Granada, Spain.
    Silfvernagel, Kristin
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Timpka, Toomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Löf, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Karolinska Institute, Sweden.
    A web- and mobile phone-based intervention to prevent obesity in 4-year-olds (MINISTOP): a population-based randomized controlled trial2015Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, nr 95Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Childhood obesity is an increasing health problem globally. Overweight and obesity may be established as early as 2-5 years of age, highlighting the need for evidence-based effective prevention and treatment programs early in life. In adults, mobile phone based interventions for weight management (mHealth) have demonstrated positive effects on body mass, however, their use in child populations has yet to be examined. The aim of this paper is to report the study design and methodology of the MINSTOP (Mobile-based Intervention Intended to Stop Obesity in Preschoolers) trial. Methods/Design: A two-arm, parallel design randomized controlled trial in 300 healthy Swedish 4-year-olds is conducted. After baseline measures, parents are allocated to either an intervention-or control group. The 6-month mHealth intervention consists of a web-based application (the MINSTOP app) to help parents promote healthy eating and physical activity in children. MINISTOP is based on the Social Cognitive Theory and involves the delivery of a comprehensive, personalized program of information and text messages based on existing guidelines for a healthy diet and active lifestyle in pre-school children. Parents also register physical activity and intakes of candy, soft drinks, vegetables as well as fruits of their child and receive feedback through the application. Primary outcomes include body fatness and energy intake, while secondary outcomes are time spent in sedentary, moderate, and vigorous physical activity, physical fitness and intakes of fruits and vegetables, snacks, soft drinks and candy. Food and energy intake (Tool for Energy balance in Children, TECH), body fatness (pediatric option for BodPod), physical activity (Actigraph wGT3x-BT) and physical fitness (the PREFIT battery of five fitness tests) are measured at baseline, after the intervention (six months after baseline) and at follow-up (12 months after baseline). Discussion: This novel study will evaluate the effectiveness of a mHealth program for mitigating gain in body fatness among 4-year-old children. If the intervention proves effective it has great potential to be implemented in child-health care to counteract childhood overweight and obesity.

  • 6.
    Ekberg, Joakim
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Angbratt, Marianne
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Valter, L.
    Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Nordwall, Maria
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Pediatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Norrköping.
    Timpka, Toomas
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    History matters: childhood weight trajectories as a basis for planning community-based obesity prevention to adolescents2012Ingår i: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 36, nr 4, s. 524-528Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To use epidemiological data and a standardized economic model to compare projected costs for obesity prevention in late adolescence accrued using a cross-sectional weight classification for selecting adolescents at age 15 years compared with a longitudinal classification. less thanbrgreater than less thanbrgreater thanMETHODS: All children born in a Swedish county (population 440 000) in 1991 who participated in all regular measurements of height and weight at ages 5, 10 and 15 years (n=4312) were included in the study. The selection strategies were compared by calculating the projected financial load resulting from supply of obesity prevention services from providers at all levels in the health care system. The difference in marginal cost per 1000 children was used as the primary end point for the analyses. less thanbrgreater than less thanbrgreater thanRESULTS: Using the cross-sectional selection strategy, 3.8% of adolescents at age 15 years were selected for evaluation by a pediatric specialist, and 96.2% were chosen for population-based interventions. In the trajectory-based strategy, 2.4% of the adolescents were selected for intensive pediatric care, 1.4% for individual clinical interventions in primary health care, 14.0% for individual primary obesity prevention using the Internet and 82.1% for population-based interventions. Costs for the cross-sectional selection strategy were projected to USD463 581 per 1000 adolescents and for the trajectory-based strategy were USD 302 016 per 1000 adolescents. less thanbrgreater than less thanbrgreater thanCONCLUSIONS: Using projections from epidemiological data, we found that by basing the selection of adolescents for obesity prevention on weight trajectories, the load on highly specialized pediatric care can be reduced by one-third and total health service costs for obesity management among adolescents reduced by one-third. Before use in policies and prevention program planning, our findings warrant confirmation in prospective cost-benefit studies.

  • 7.
    Ekberg, Joakim
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Gursky, Elin A.
    Analytic Services Inc., Arlington, VA, USA.
    Timpka, Toomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Pre-launch evaluation checklist for online health-promoting communities2014Ingår i: Journal of Biomedical Informatics, ISSN 1532-0464, E-ISSN 1532-0480, Vol. 47, s. 11-17Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Despite the apparent potential of online health-promoting communities (OHPC), there is limited guidance available for developers on the basic design features that contribute to successful applications. The aim of this study was to develop a checklist for a pre-launch evaluation of OHPCs incorporating the perspectives of both the user and the health services communities.

    METHODS:

    The study was based on an action research design. Constructs previously applied to evaluate information system success were used as the basis for checklist development. The constructs were adapted for the OHPC context and formatively evaluated in a case study project. Evaluation data were collected from participatory observations and analyzed using qualitative methods.

    RESULTS:

    The initial OHPC checklist included the constructs information quality, service quality, and subjective norms. The contextual adaptation of the information quality construct resulted in items for content area, trust, and format; the adaptation of the service quality construct in items for staff competence, prompt service and empathy; and the adaptation of the subject norms construct in items for social facilitation, interconnectivity and communication. The formative evaluation demonstrated the critical need to balance the autonomy of the online community with the professional control of health services quality expressed in the information and service quality constructs.

    CONCLUSIONS:

    A pre-launch OHPC evaluation checklist has been designed for use in practical development of health promotion web resources. Research on instruments for OHPC evaluations is warranted.

  • 8.
    Eriksson, Iréne
    et al.
    Jönköping University.
    Aronsson, Kerstin
    Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Cedersund, Elisabet
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, NISAL - Nationella institutet för forskning om äldre och åldrande. Jönköping University.
    Hugoson, Anders
    Jönköping University.
    Jonsson, Margareta
    County Council of Jönköping.
    Wärnberg Gerdin, Elisabeth
    Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    The meaning of oral health-related quality of life for elderly persons with dementia2009Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 67, nr 4, s. 212-221Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. Studies of oral health developments increasingly include self-reported assessments of how oral health affects quality of life (QoL), referred to as “oral health-related QoL”. People with dementia are often excluded in studies of oral health-related QoL and thus our aim in this study was to explore this area in elderly persons with dementia. Material and methods. Eighteen elderly individuals (aged between 78 and 94 years) with dementia of varying degrees of severity were interviewed with the aid of an interview guide; pictures and objects were used as stimulus material (triggers). The material was analyzed using grounded theory as point of departure, and a professional assessment of the oral health of the participants was used as reference. Results. Four categories were identified: the ability to chew and eat, independence, oral problems, and teeth are important. These factors are largely consistent with those that have emerged in earlier studies of the elderly, but in some cases less pronounced in persons with dementia. Conclusion. The use of triggers is a positive way to communicate oral health-related QoL among persons suffering from dementia, although the material used in this study needs further evaluation and development.

  • 9.
    Karlsson, David
    et al.
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Tekniska högskolan.
    Ekberg, Joakim
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Spreco, Armin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Eriksson, Henrik
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Tekniska högskolan.
    Timpka, Toomas
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Visualization of infectious disease outbreaks in routine practice2013Ingår i: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 192, s. 697-701Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Throughout the history of epidemiology, visualizations have been used as the interface between public-health professionals and epidemiological data. The aim of this study was to examine the impact of the level of abstraction when using visualizations on routine infectious disease control. We developed three interactive visualization prototypes at increasing levels of abstraction to communicate subsets of influenza outbreak surveillance information. The visualizations were assessed through workshops in an exploratory evaluation with infectious disease epidemiologists. The results show that despite the potential of processed, abstract, and information-dense representations, increased levels of abstraction decreased epidemiologists understanding and confidence in visualizations. Highly abstract representations were deemed not applicable in routine practice without training. Infectious disease epidemiologists work routines and decision-making need to be further studied in order to develop visualizations that meet both the quality requirements imposed by policy-makers and the contextual nature of work practice.

  • 10.
    Rutberg, Hans
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Patientsäkerhet.
    Borgstedt Risberg, Madeleine
    Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Sjödahl, Rune
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Nordqvist, Pernilla
    Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Patientsäkerhet.
    Valter, Lars
    Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Nilsson, Lena
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    Characterisations of adverse events detected in a university hospital: a 4-year study using the Global Trigger Tool method2014Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, nr 5, s. 004879-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To describe the level, preventability and categories of adverse events (AEs) identified by medical record review using the Global Trigger Tool (GTT). To estimate when the AE occurred in the course of the hospital stay and to compare voluntary AE reporting with medical record reviewing. Design: Two-stage retrospective record review. Setting: 650-bed university hospital. Participants: 20 randomly selected medical records were reviewed every month from 2009 to 2012. Primary and secondary outcome measures: AE/1000 patient-days. Proportion of AEs found by GTT found also in the voluntary reporting system. AE categorisation. Description of when during hospital stay AEs occur. Results: A total of 271 AEs were detected in the 960 medical records reviewed, corresponding to 33.2 AEs/1000 patient-days or 20.5% of the patients. Of the AEs, 6.3% were reported in the voluntary AE reporting system. Hospital-acquired infections were the most common AE category. The AEs occurred and were detected during the hospital stay in 65.5% of cases; the rest occurred or were detected within 30 days before or after the hospital stay. The AE usually occurred early during the hospital stay, and the hospital stay was 5 days longer on average for patients with an AE. Conclusions: Record reviewing identified AEs to a much larger extent than voluntary AE reporting. Healthcare organisations should consider using a portfolio of tools to gain a comprehensive picture of AEs. Substantial costs could be saved if AEs were prevented.

  • 11.
    Skagerström, Janna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Johansson, Anne Lie
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Holmqvist, Marika
    Swedish National Board Health and Welfare, Stockholm, Sweden.
    Envall, Eva-Karin
    Swedish National Institute of Public Health, Östersund, Sweden.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    Towards improved alcohol prevention in Swedish antenatal care?2012Ingår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, nr 3, s. 314-320Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: to evaluate an education effort and revised alcohol-preventive routine in Swedish antenatal care; to generate more knowledge for further development of alcohol issues in antenatal care. less thanbrgreater than less thanbrgreater thanDesign: two national cross-sectional surveys of Swedish midwives were conducted. Baseline data were collected in 2006 and follow-up data in 2009. less thanbrgreater than less thanbrgreater thanSetting: antenatal care centres in Sweden. less thanbrgreater than less thanbrgreater thanParticipants: 974 midwives in 2006 and 1108 midwives in 2009. less thanbrgreater than less thanbrgreater thanMeasurement: amount and content of continuing professional education, work with alcohol-related issues, identification of women with risky consumption of alcohol, and action after identifying women with risky consumption. less thanbrgreater than less thanbrgreater thanFindings: the amount of continuing professional education undertaken by midwives on handling risky drinking increased significantly between 2006 and 2009. The routine to detect risky drinking changed between the baseline and follow-up data collection, as nearly all midwives reported the use of an alcohol screening questionnaire in 2009. The most confident midwives in 2009 had taken part in more days of education, more often stated it was their own initiative to participate, and had more often taken part in education regarding MI, provision of advice and information on the health risks associated with alcohol and, screening. less thanbrgreater than less thanbrgreater thanKey conclusions: our results indicate that a broad, national education effort can be successful in enhancing knowledge and changing antenatal care practice. However, generalisation to other countries or cultures may be limited because the usage of new routines is affected by many organisational and contextual factors.

  • 12.
    Stark Ekman, Diana
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Andersson, Agneta
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Ståhlbrandt, Henriettae
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Johansson, Anne Lie
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Bendtsen, Preben
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Akutkliniken. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Medicinska specialistkliniken .
    Electronic screening and brief intervention for risky drinking in Swedish university students - A randomized controlled trial2011Ingår i: Addictive Behaviours, ISSN 0306-4603, E-ISSN 1873-6327, Vol. 36, nr 6, s. 654-659Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The limited number of electronic screening and brief intervention (e-SBI) projects taking place in young adult student populations has left knowledge gaps about the specific methods needed to motivate reduced drinking. The aim of the present study was to compare differences in alcohol consumption over time after a series of e-SBIs was conducted with two groups of young adult students who were considered risky drinkers. The intervention group (IC) (n = 80) received extensive normative feedback; the control group (CG) (n = 78) received very brief feedback consisting of only three statements. Method: An e-SBI project was conducted in naturalistic settings among young adult students at a Swedish university. This study used a randomized controlled trial design, with respondents having an equal chance of being assigned to either the IC or the CG. The study assessed changes comparing the IC with the CG on four alcohol-related measurements: proportion with risky alcohol consumption, average weekly alcohol consumption, frequency of heavy episodic drinking (HED) and peak blood alcohol concentration (BAC). Follow-up was performed at 3 and 6 months after baseline. Results: The study documented a significant decrease in the average weekly consumption for the IC over time but not for the CG, although the differences between the groups were non-significant. The study also found that there were significant decreases in HED over time within both groups: the differences were about equal in both groups at the 6-month follow-up. The proportion of risky drinkers decreased by about a third in both the CG and IC at the 3- and 6-month follow-ups. Conclusions: As the differences between the groups at 6 months for all alcohol-related outcome variables were not significant, the shorter, generic brief intervention appears to be as effective as the longer one including normative feedback. However, further studies in similar naturalistic settings are warranted with delayed assessment groups as controls in order to increase our understanding of reactivity assessment in email-based interventions among students.

  • 13.
    Timpka, Toomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Alonso, Juan-Manuel
    International Association of Athletics Federations (IAAF) Medical and Anti-doping Commission, Montecarlo, Monaco; Sports Medicine Department, Aspetar, Qatar Orthopedics and Sports Medicine Hospital, Doha, Qatar.
    Jacobsson, Jenny
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Swedish Athletics Association, Stockholm, Sweden .
    Junge, Astrid
    FIFA Medical Assessment and Research Centre (F-MARC), Zurich, Switzerland; Schulthess Klinik, Zurich, Switzerland; Medical School Hamburg (MSH), Germany .
    Branco, Pedro
    International Association of Athletics Federations (IAAF) Medical and Anti-doping Commission, Montecarlo, Monaco; European Athletics Medical & Anti-Doping Commission, European Athletics Association (EAA), Lausanne, Switzerland .
    Clarsen, Ben
    Oslo Sports Trauma Research Centre, Norway; Olympic Elite Sports Program (Olympiatoppen), Oslo, Norway .
    Kowalski, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Swedish Athletics Association, Stockholm, Sweden; Diamond League, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden .
    Mountjoy, Margo
    International Olympic Committee (IOC) Medical Commission, Lausanne, Switzerland; Department of Sports Medicine, FINA Bureau, Lausanne, Switzerland; McMaster University School of Medicine, Hamilton, Ontario, Canada .
    Nilsson, Sverker
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Swedish Athletics Association, Stockholm, Sweden .
    Pluim, Babette
    Royal Netherlands Lawn Tennis Association, Amersfoort, The Netherlands .
    Renström, Per
    Karolinska Institutet, Stockholm, Sweden; International Olympic Committee (IOC) Medical Commission, Lausanne, Switzerland .
    Rønsen, Ola
    International Association of Athletics Federations (IAAF) Medical and Anti-doping Commission, Montecarlo, Monaco; Olympic Elite Sports Program (Olympiatoppen), Oslo, Norway .
    Steffen, Kathrin
    Oslo Sports Trauma Research Centre, Norway .
    Edouard, Pascal
    University Hospital of Saint-Etienne, France; University of Lyon, France.
    Injury and illness definitions and data collection procedures for use in epidemiological studies in Athletics (track and field): Consensus statement2014Ingår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, nr 7, s. 483-490Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Movement towards sport safety in Athletics through the introduction of preventive strategies requires consensus on definitions and methods for reporting epidemiological data in the various populations of athletes.

    OBJECTIVE:

    To define health-related incidents (injuries and illnesses) that should be recorded in epidemiological studies in Athletics, and the criteria for recording their nature, cause and severity, as well as standards for data collection and analysis procedures.

    METHODS:

    A 1-day meeting of 14 experts from eight countries representing a range of Athletics stakeholders and sport science researchers was facilitated. Definitions of injuries and illnesses, study design and data collection for epidemiological studies in Athletics were discussed during the meeting. Two members of the group produced a draft statement after this meeting, and distributed to the group members for their input. A revision was prepared, and the procedure was repeated to finalise the consensus statement.

    RESULTS:

    Definitions of injuries and illnesses and categories for recording of their nature, cause and severity were provided. Essential baseline information was listed. Guidelines on the recording of exposure data during competition and training and the calculation of prevalence and incidences were given. Finally, methodological guidance for consistent recording and reporting on injury and illness in athletics was described.

    CONCLUSIONS:

    This consensus statement provides definitions and methodological guidance for epidemiological studies in Athletics. Consistent use of the definitions and methodological guidance would lead to more reliable and comparable evidence.

  • 14.
    Timpka, Toomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Eriksson, Henrik
    Linköpings universitet, Institutionen för datavetenskap, MDALAB - Human Computer Interfaces. Linköpings universitet, Tekniska högskolan.
    Gursky, Elin A
    ANSER Analyt Serv Inc.
    Stromgren, Magnus
    Umea University.
    Holm, Einar
    Umea University.
    Ekberg, Joakim
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Eriksson, Olle
    Linköpings universitet, Institutionen för datavetenskap, Statistik. Linköpings universitet, Filosofiska fakulteten.
    Grimvall, Anders
    Linköpings universitet, Institutionen för datavetenskap, Statistik. Linköpings universitet, Filosofiska fakulteten.
    Valter, Lars
    Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Nyce, James M
    Ball State University.
    Requirements and Design of the PROSPER Protocol for Implementation of Information Infrastructures Supporting Pandemic Response: A Nominal Group Study2011Ingår i: PLOS ONE, ISSN 1932-6203, Vol. 6, nr 3, s. 0017941-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Advanced technical systems and analytic methods promise to provide policy makers with information to help them recognize the consequences of alternative courses of action during pandemics. Evaluations still show that response programs are insufficiently supported by information systems. This paper sets out to derive a protocol for implementation of integrated information infrastructures supporting regional and local pandemic response programs at the stage(s) when the outbreak no longer can be contained at its source. Methods: Nominal group methods for reaching consensus on complex problems were used to transform requirements data obtained from international experts into an implementation protocol. The analysis was performed in a cyclical process in which the experts first individually provided input to working documents and then discussed them in conferences calls. Argument-based representation in design patterns was used to define the protocol at technical, system, and pandemic evidence levels. Results: The Protocol for a Standardized information infrastructure for Pandemic and Emerging infectious disease Response (PROSPER) outlines the implementation of information infrastructure aligned with pandemic response programs. The protocol covers analyses of the community at risk, the response processes, and response impacts. For each of these, the protocol outlines the implementation of a supporting information infrastructure in hierarchical patterns ranging from technical components and system functions to pandemic evidence production. Conclusions: The PROSPER protocol provides guidelines for implementation of an information infrastructure for pandemic response programs both in settings where sophisticated health information systems already are used and in developing communities where there is limited access to financial and technical resources. The protocol is based on a generic health service model and its functions are adjusted for community-level analyses of outbreak detection and progress, and response program effectiveness. Scientifically grounded reporting principles need to be established for interpretation of information derived from outbreak detection algorithms and predictive modeling.

  • 15.
    Timpka, Toomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Eriksson, Olle
    Linköpings universitet, Institutionen för datavetenskap, Statistik. Linköpings universitet, Filosofiska fakulteten.
    Spreco, Armin
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Gursky, Elin A
    National Strategies Support Directorate, ANSER/Analytic Services Inc, Arlington, Virginia, USA.
    Strömgren, Magnus
    Umeå University.
    Holm, Einar
    Umeå University.
    Ekberg, Joakim
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Dahlström, Örjan
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Valter, Lars
    Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Eriksson, Henrik
    Linköpings universitet, Institutionen för datavetenskap, MDALAB - Human Computer Interfaces. Linköpings universitet, Tekniska högskolan.
    Age as a determinant for dissemination of seasonal and pandemic influenza: an open cohort study of influenza outbreaks in Östergötland County, Sweden2012Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, nr 2, s. e31746-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    An understanding of the occurrence and comparative timing of influenza infections in different age groups is important for developing community response and disease control measures. This study uses data from a Scandinavian county (population 427.000) to investigate whether age was a determinant for being diagnosed with influenza 2005-2010 and to examine if age was associated with case timing during outbreaks. Aggregated demographic data were collected from Statistics Sweden, while influenza case data were collected from a county-wide electronic health record system. A logistic regression analysis was used to explore whether case risk was associated with age and outbreak. An analysis of variance was used to explore whether day for diagnosis was also associated to age and outbreak. The clinical case data were validated against case data from microbiological laboratories during one control year. The proportion of cases from the age groups 10-19 (p<0.001) and 20-29 years old (p<0.01) were found to be larger during the A pH1N1 outbreak in 2009 than during the seasonal outbreaks. An interaction between age and outbreak was observed (p<0.001) indicating a difference in age effects between circulating virus types; this interaction persisted for seasonal outbreaks only (p<0.001). The outbreaks also differed regarding when the age groups received their diagnosis (p<0.001). A post-hoc analysis showed a tendency for the young age groups, in particular the group 10-19 year olds, led outbreaks with influenza type A H1 circulating, while A H3N2 outbreaks displayed little variations in timing. The validation analysis showed a strong correlation (r = 0.625;p<0.001) between the recorded numbers of clinically and microbiologically defined influenza cases. Our findings demonstrate the complexity of age effects underlying the emergence of local influenza outbreaks. Disentangling these effects on the causal pathways will require an integrated information infrastructure for data collection and repeated studies of well-defined communities.

  • 16.
    Timpka, Toomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Jacobsson, Jenny
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Bickenbach, Jerome
    Queens University, Kingston, ON, Canada .
    Finch, Caroline F.
    Federation University Australia, Ballarat.
    Ekberg, Joakim
    University of Skövde, Sweden .
    Nordenfelt, Lennart
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    What is a Sports Injury?2014Ingår i: Sports Medicine, ISSN 0112-1642, E-ISSN 1179-2035, Vol. 44, nr 4, s. 423-428Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Current sports injury reporting systems lack a common conceptual basis. We propose a conceptual foundation as a basis for the recording of health problems associated with participation in sports, based on the notion of impairment used by the World Health Organization. We provide definitions of sports impairment concepts to represent the perspectives of health services, the participants in sports and physical exercise themselves, and sports institutions. For each perspective, the duration of the causative event is used as the norm for separating concepts into those denoting impairment conditions sustained instantly and those developing gradually over time. Regarding sports impairment sustained in isolated events, sports injury denotes the loss of bodily function or structure that is the object of observations in clinical examinations; sports trauma is defined as an immediate sensation of pain, discomfort or loss of functioning that is the object of athlete self-evaluations; and sports incapacity is the sidelining of an athlete because of a health evaluation made by a legitimate sports authority that is the object of time loss observations. Correspondingly, sports impairment caused by excessive bouts of physical exercise is denoted as sports disease (overuse syndrome) when observed by health service professionals during clinical examinations, sports illness when observed by the athlete in self-evaluations, and sports sickness when recorded as time loss from sports participation by a sports body representative. We propose a concerted development effort in this area that takes advantage of concurrent ontology management resources and involves the international sporting community in building terminology systems that have broad relevance.

  • 17.
    Timpka, Toomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Nordqvist, Cecilia
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Festin, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Lindqvist, Kent
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Quality indicators for implementation of safety promotion: Towards valid and reliable global certification of local programmes2012Ingår i: Global Public Health, ISSN 1744-1692, E-ISSN 1744-1706, Vol. 7, nr 6, s. 588-602Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The theoretical underpinnings of safety promotion have not yet been integrated with implementation practice to ascertain between-community programme quality. This study sets out to develop a framework for verifying of the quality of community-based safety-promotion programmes in the global context. We analysed the certification indicators deployed in the international Safe Community movement in light of systems theory. Data were collected from focus group interviews with representatives from 10 certified Swedish communities and then analysed by qualitative methods. The community representatives were found to have used the present indicators mainly for marketing the safety-promotion concept to stakeholders rather than as benchmarks for safety practice. When appraised in regard to systems theory, it was found that the indicators did not cover important aspects of health-services implementation. Attainment of outcomes at the population level was not included. Consequently, that information about programme effects in high-risk groups and in risk environments could be neglected. We conclude that programme processes and outcomes at both organisational and population levels must be assessed when the quality of safety-promotion programmes is being certified. A revised set of indicators for certification of safety-promotion programmes fulfilling these criteria is presented.

  • 18.
    Timpka, Toomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Spreco, Armin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Dahlström, Örjan
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Eriksson, Henrik
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Tekniska högskolan.
    Gursky, Elin
    ANSER/Analytic Services Inc, Arlington, Virginia, USA.
    Ekberg, Joakim
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Blomqvist, Eva
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Filosofiska fakulteten.
    Strömgren, Magnus
    Umeå University, Sweden.
    Karlsson, David
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Tekniska högskolan.
    Eriksson, Henrik
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Tekniska högskolan.
    Nyce, Jim
    Ball State University, Muncie, IN, USA.
    Hinkula, Jorma
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Hälsouniversitetet.
    Holm, Einar
    Umeå University, Sweden.
    Performance of eHealth data sources in local influenza surveillance: a 5-year open cohort study using data from Google Flu Trends, telenursing call centres, health service provider web-pages, and mass media coverage2013Konferensbidrag (Övrigt vetenskapligt)
  • 19.
    Timpka, Toomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Spreco, Armin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Dahlström, Örjan
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV).
    Eriksson, Olle
    Linköpings universitet, Institutionen för datavetenskap, Statistik. Linköpings universitet, Filosofiska fakulteten.
    Gursky, Elin
    National Strategies Support Directorate, ANSER/Analytic Services Inc., Arlington, VA, USA.
    Ekberg, Joakim
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Blomqvist, Eva
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Tekniska högskolan.
    Strömgren, Magnus
    Department of Geography and Economic History, Umeå University, Sweden.
    Karlsson, David
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Tekniska högskolan.
    Eriksson, Henrik
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Tekniska högskolan.
    Nyce, James
    Department of Anthropology, Ball State University, Muncie, IN, USA.
    Hinkula, Jorma
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Hälsouniversitetet.
    Holm, Einar
    Department of Geography and Economic History, Umeå University, Sweden.
    Performance of eHealth data sources in local influenza surveillance: a 5-year open cohort study2014Ingår i: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 16, nr 4, s. e116-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There is abundant global interest in using syndromic data from population-wide health information systems--referred to as eHealth resources--to improve infectious disease surveillance. Recently, the necessity for these systems to achieve two potentially conflicting requirements has been emphasized. First, they must be evidence-based; second, they must be adjusted for the diversity of populations, lifestyles, and environments.

    OBJECTIVE: The primary objective was to examine correlations between data from Google Flu Trends (GFT), computer-supported telenursing centers, health service websites, and influenza case rates during seasonal and pandemic influenza outbreaks. The secondary objective was to investigate associations between eHealth data, media coverage, and the interaction between circulating influenza strain(s) and the age-related population immunity.

    METHODS: An open cohort design was used for a five-year study in a Swedish county (population 427,000). Syndromic eHealth data were collected from GFT, telenursing call centers, and local health service website visits at page level. Data on mass media coverage of influenza was collected from the major regional newspaper. The performance of eHealth data in surveillance was measured by correlation effect size and time lag to clinically diagnosed influenza cases.

    RESULTS: Local media coverage data and influenza case rates showed correlations with large effect sizes only for the influenza A (A) pH1N1 outbreak in 2009 (r=.74, 95% CI .42-.90; P<.001) and the severe seasonal A H3N2 outbreak in 2011-2012 (r=.79, 95% CI .42-.93; P=.001), with media coverage preceding case rates with one week. Correlations between GFT and influenza case data showed large effect sizes for all outbreaks, the largest being the seasonal A H3N2 outbreak in 2008-2009 (r=.96, 95% CI .88-.99; P<.001). The preceding time lag decreased from two weeks during the first outbreaks to one week from the 2009 A pH1N1 pandemic. Telenursing data and influenza case data showed correlations with large effect sizes for all outbreaks after the seasonal B and A H1 outbreak in 2007-2008, with a time lag decreasing from two weeks for the seasonal A H3N2 outbreak in 2008-2009 (r=.95, 95% CI .82-.98; P<.001) to none for the A p H1N1 outbreak in 2009 (r=.84, 95% CI .62-.94; P<.001). Large effect sizes were also observed between website visits and influenza case data.

    CONCLUSIONS: Correlations between the eHealth data and influenza case rates in a Swedish county showed large effect sizes throughout a five-year period, while the time lag between signals in eHealth data and influenza rates changed. Further research is needed on analytic methods for adjusting eHealth surveillance systems to shifts in media coverage and to variations in age-group related immunity between virus strains. The results can be used to inform the development of alert-generating eHealth surveillance systems that can be subject for prospective evaluations in routine public health practice.

  • 20.
    Timpka, Toomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Spreco, Armin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Dahlström, Örjan
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Eriksson, Olle
    Linköpings universitet, Institutionen för datavetenskap, Statistik. Linköpings universitet, Filosofiska fakulteten.
    Gursky, Elin
    ANSER/Analytic Services Inc, Arlington, Virginia, USA.
    Ekberg, Joakim
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Blomqvist, Eva
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Filosofiska fakulteten.
    Strömgren, Magnus
    Umeå University, Sweden.
    Karlsson, David
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Tekniska högskolan.
    Eriksson, Henrik
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Tekniska högskolan.
    Nyce, Jim
    Ball State University, Muncie, IN, USA.
    Hinkula, Jorma
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Hälsouniversitetet.
    Holm, Einar
    Umeå University, Sweden.
    Predictive value of telenursing complaints in influenza surveillance: a prospective cohort study in Sweden2013Konferensbidrag (Övrigt vetenskapligt)
  • 21.
    Timpka, Toomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Spreco, Armin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Dahlström, Örjan
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Eriksson, Olle
    Linköpings universitet, Institutionen för datavetenskap, Statistik. Linköpings universitet, Filosofiska fakulteten.
    Gursky, Elin
    ANSER/Analytic Services Inc, Arlington, Virginia, USA.
    Ekberg, Joakim
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Strömgren, Magnus
    Umeå University, Sweden.
    Karlsson, David
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Tekniska högskolan.
    Hinkula, Jorma
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Hälsouniversitetet.
    Holm, Einar
    Umeå University, Sweden.
    Intentions to perform non-pharmaceutical protective behaviors during influenza outbreaks: a cross-sectional study of a representative sample of the Swedish adult population2013Konferensbidrag (Övrigt vetenskapligt)
  • 22.
    Timpka, Toomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Spreco, Armin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Eriksson, Olle
    Linköpings universitet, Institutionen för datavetenskap, Statistik. Linköpings universitet, Filosofiska fakulteten.
    Dahlström, Örjan
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV).
    Gursky, E. A.
    Analytic Serv Inc, VA USA.
    Stromgren, M.
    Umeå University, Sweden.
    Holm, E.
    Umeå University, Sweden.
    Ekberg, Joakim
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Hinkula, Jorma
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Hälsouniversitetet.
    Nyce, J. M.
    Ball State University, IN 47306 USA.
    Eriksson, Henrik
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Tekniska högskolan.
    Predictive performance of telenursing complaints in influenza surveillance: a prospective cohort study in Sweden2014Ingår i: Eurosurveillance, ISSN 1025-496X, E-ISSN 1560-7917, Vol. 19, nr 46, s. 24-32Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Syndromic data sources have been sought to improve the timely detection of increased influenza transmission. This study set out to examine the prospective performance of telenursing chief complaints in predicting influenza activity. Data from two influenza seasons (2007/08 and 2008/09) were collected in a Swedish county (population 427,000) to retrospectively determine which grouping of telenursing chief complaints had the largest correlation with influenza case rates. This grouping was prospectively evaluated in the three subsequent seasons. The best performing telenursing complaint grouping in the retrospective algorithm calibration was fever (child, adult) and syncope (r=0.66; pless than0.001). In the prospective evaluation, the performance of 14-day predictions was acceptable for the part of the evaluation period including the 2009 influenza pandemic (area under the curve (AUC)=0.84; positive predictive value (PPV)=0.58), while it was strong (AUC=0.89; PPV=0.93) for the remaining evaluation period including only influenza winter seasons. We recommend the use of telenursing complaints for predicting winter influenza seasons. The method requires adjustments when used during pandemics.

  • 23.
    Timpka, Toomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Spreco, Armin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Gursky, Elin
    National Strategies Support Directorate, ANSER/Analytic Services Inc, Arlington, Virginia, USA.
    Eriksson, Olle
    Linköpings universitet, Institutionen för datavetenskap, Statistik. Linköpings universitet, Filosofiska fakulteten.
    Dahlström, Örjan
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Strömgren, Magnus
    Umeå University, Sweden.
    Ekberg, Joakim
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Pilemalm, Sofie
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Informatik. Linköpings universitet, Filosofiska fakulteten.
    Karlsson, David
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Tekniska högskolan.
    Hinkula, Jorma
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin.
    Holm, Einar
    Umeå University, Sweden.
    Intentions to perform non-pharmaceutical protective behaviors during influenza outbreaks in Sweden: a cross-sectional study following a mass vaccination campaign2014Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, nr 3, s. e91060-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Failure to incorporate the beliefs and attitudes of the public into theoretical models of preparedness has been identified as a weakness in strategies to mitigate infectious disease outbreaks. We administered a cross-sectional telephone survey to a representative sample (n = 443) of the Swedish adult population to examine whether self-reported intentions to improve personal hygiene and increase social distancing during influenza outbreaks could be explained by trust in official information, self-reported health (SF-8), sociodemographic factors, and determinants postulated in protection motivation theory, namely threat appraisal and coping appraisal. The interviewees were asked to make their appraisals for two scenarios: a) an influenza with low case fatality and mild lifestyle impact; b) severe influenza with high case fatality and serious disturbances of societal functions. Every second respondent (50.0%) reported high trust in official information about influenza. The proportion that reported intentions to take deliberate actions to improve personal hygiene during outbreaks ranged between 45–85%, while less than 25% said that they intended to increase social distancing. Multiple logistic regression models with coping appraisal as the explanatory factor most frequently contributing to the explanation of the variance in intentions showed strong discriminatory performance for staying home while not ill (mild outbreaks: Area under the curve [AUC] 0.85 (95% confidence interval 0.82;0.89), severe outbreaks AUC 0.82 (95% CI 0.77;0.85)) and acceptable performance with regard to avoiding public transportation (AUC 0.78 (0.74;0.82), AUC 0.77 (0.72;0.82)), using handwash products (AUC 0.70 (0.65;0.75), AUC 0.76 (0.71;0.80)), and frequently washing hands (AUC 0.71 (0.66;0.76), AUC 0.75 (0.71;0.80)). We conclude that coping appraisal was the explanatory factor most frequently included in statistical models explaining self-reported intentions to carry out non-pharmaceutical health actions in the Swedish outlined context, and that variations in threat appraisal played a smaller role in these models despite scientific uncertainties surrounding a recent mass vaccination campaign.

  • 24.
    Wenemark, Marika
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Persson, Andreas
    Statistics Sweden, Örebro, Sweden.
    Noorlind Brage, Helle
    Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Svensson, Tommy
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för sociologi (SOC). Linköpings universitet, Filosofiska fakulteten.
    Kristenson, Margareta
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Applying Motivation Theory to Achieve Increased Respondent Satisfaction, Response Rate and Data Quality in a Self-administered Survey2011Ingår i: Journal of Official Statistics, ISSN 0282-423X, E-ISSN 2001-7367, Vol. 27, nr 2, s. 393-414Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Response rates to surveys are declining in most countries. Attempts to persuade or pressure respondents to increase response might be counterproductive in the long-term because they can negatively affect attitudes towards future surveys. Targeting respondents’ own motivation to participate in surveys is an alternative approach to achieve higher response rates. Self-determination theory provides a theoretical framework for how intrinsic motivation can be stimulated. We used self-determination theory as inspiration to re-design a self-administered health-related survey. Two versions of the questionnaire and two data collection methods were used in an experimental design. Effects were measured in terms of respondent satisfaction, response rate, and data quality. The results suggest that it is possible to improve response rates in a way that also promotes data quality and positive experiences for the respondents.

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