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  • 1.
    Aasland, Olaf G.
    et al.
    University of Oslo, Norway.
    Nygaard, Peter
    Norwegian Institute for Alcohol and Drug Research, Oslo, Norway.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    The long and winding road to widespread implementation of screening and brief intervention for alcohol problems: A historical overview with special attention to the WHO initiatives2008In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 25, no 6, p. 469-476Article in journal (Refereed)
    Abstract [en]

    Before 1970, special institutions, often prison-like, were built for the severely dependent. The effect of this type of treatment, often lasting for months or even years, was hard to document scientifically. During the 1970s several steps were taken towards a more preventive strategy that involved delivery of alcohol interventions in general health care settings, particularly within primary health care. The World Health Organization's (WHO) introduction of the concepts of hazardous and harmful drinking represented a shift from the traditional dichotomous view of individuals being alcoholic-or-not to a continuum where, in line with Rose's "prevention paradox", a large number of people with low risk may give rise to more cases of disease than the small number with high risk. The need for efficient methods to detect persons with various degrees of alcohol risk was evident, and a WHO multinational project that resulted in the publication of AUDIT (Alcohol Use Disorders identification Test) was carried out in the mid 1980s. The usefulness of this principle of case finding was then investigated in a subsequent multinational WHO project of brief intervention, as well as in several other similar projects. Many of these projects have proven quite efficient, but screening and brief intervention for alcohol problems is still not standard procedure in primary health care. The paper discusses some of the reasons why.

  • 2.
    Addelyan Rasi, Hamideh
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Moula, Alireza
    Department of Sociology & Social Work, Karlstad University, Sweden.
    Puddephatt, Antony J.
    Department of sociology, Lakehead University, Canada.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Empowering newly married women in Iran: A new method of social work intervention that uses a client-directed problem-solving model in both group and individual sessions2013In: Qualitative Social Work, ISSN 1473-3250, E-ISSN 1741-3117, Vol. 12, no 6, p. 765-781Article in journal (Refereed)
    Abstract [en]

    We set out to assess the processes by which a personal empowerment-oriented intervention based on learning spaces and the Rahyab problem-solving model can help newly married women in Iran to gain more control over their life situations. Learning to use the problem-solving model independently was an important component of this seven months’ educational program. A descriptive field study design based on qualitative methods was employed for data collection and analysis. The analysis of these processes showed how, through group and individual interventions, these women could influence their intimate relationships by altering their thoughts, their management of emotions, and their overt behavior. We invite more research on how empowerment-oriented interventions can be used to support newly married women as a part of family educational programs.

  • 3.
    Addelyan Rasi, Hamideh
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Moula, Alireza
    Karlstad University, Sweden.
    Puddephatt, Antony J.
    Department of sociology, Lakehead University, Canada.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Empowering Single Mothers in Iran: Applying a Problem-Solving Model in Learning Groups to Develop Participants’ Capacity to Improve Their Lives2013In: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263X, Vol. 43, no 5, p. 833-852Article in journal (Refereed)
    Abstract [en]

    Since 2000, a problem-solving model has been taught to the Society for Protecting the Rights of the Child, and teachers and students of social work in two universities in Iran. Since 2006, with the initiation of UNICEF, social workers, psychologists and even some psychiatrists in Iran have been learning this model. In 2008, a group of researchers created an empowerment-oriented psycho-social group and private intervention project to assess whether a group of Iranian single mothers could use this model, which was traditionally used by professionals only, to effectively and independently meet challenges in their own lives. Our results show that all women used the model effectively and, consequently, made more deliberate decisions to improve their life situations. Some of the women succeeded in finding a job and many improved their family relationships. This study suggests that empowerment-oriented social work can help many clients to achieve their goals, and that this psycho-social intervention project can be a useful model for social work in Iran and many other societies.

  • 4.
    Addelyan Rasi, Hamideh
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Moula, Alireza
    Department of Sociology & Social Work, Karlstad University, Sweden.
    Puddephatt, Antony J.
    Department of sociology, Lakehead University, Canada.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Towards a Conceptual Framework for the Socio-Cognitive Empowerment of Women in the Middle East Countries: empirical and theoretical foundations2012Manuscript (preprint) (Other academic)
    Abstract [en]

    Summary: This study set out to construct a conceptual framework that can be used in social work with women in the Middle East and other settings where women are consistently limited in their access to resources and, as a result, their decision-making capacity. We employed a qualitative secondary analysis of data from two intervention projects among Iranian women (n=25). Each intervention spanned over seven months, included individual and group sessions, and involved learning an empowerment-oriented problem-solving model. A constant comparative analysis was used to build the conceptual framework.

    Findings: The practical lessons from the Iranian projects highlight a process of change with regard to thinking, feeling and acting among women during and after the intervention. As the women developed a number of mental capacities essential to coping and life management, we constructed a theoretical proposition, which offers an explanation of their socio-cognitive empowerment. We supplement the basis for these concepts that emerged in this proposition by integrating them with psychological and social work theories into a broader conceptual framework for social work practice.

    Applications: A conceptual framework has been developed to provide structural support for social work practice with women in the Middle East. This framework can help social workers to bridge the gap between theory and practice; that is, to draw from existing social work theory and, through our model, better apply this knowledge in their practical work with women in challenging social environments.

  • 5.
    Addelyan Rasi, Hamideh
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Moula, Alireza
    Department of Sociology & Social Work, Karlstad University, Sweden.
    Can a psychosocial intervention programme teaching coping strategies improve the quality of life of Iranian women? A non-randomised quasi-experimental study2013In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 3, p. 2407-Article in journal (Refereed)
    Abstract [en]

    Objectives: To assess whether a psychosocial intervention teaching coping strategies to women can improve quality of life (QOL) in groups of Iranian women exposed to social pressures.

    Design: Quasi-experimental nonrandomized group design involving two categories of Iranian women, each category represented by nonequivalent intervention and comparison groups.

    Setting: A large urban area in Iran.

    Participants: 44 women; 25 single mothers and 19 newly married women.

    Interventions: Seventh-month psychosocial intervention aimed at providing coping strategies.

    Primary outcome measures: Effect sizes in four specific health-related domains and two overall perceptions of QOL and health measured by the WHOQOL-BREF instrument.

    Results: Large effect sizes were observed among the women exposed to the intervention in the WHOQOL-BREF subdomains measuring physical health (r=0.68; p<0.001), psychological health (r=0.72; p<0.001), social relationships (r=0.52; p<0.01), environmental health (r=0.55; p<0.01), and in the overall perception of QOL (r=0.72; p<0.001); the effect size regarding overall perception of health was between small and medium (r=0.20; not significant). Small and not statistically significant effect sizes were observed in the women provided with traditional social welfare services.

    Conclusions: Teaching coping strategies can improve the QOL of women in societies where gender discrimination is prevalent. The findings require reproduction in studies with a more rigorous design before the intervention model can be recommended for widespread distribution.

  • 6.
    Ahldén, Ingegerd
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Göransson, Anne
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Alehagen, Siw
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Parenthood education in Swedish antenatal care: perceptions of midwives and obstetricians in charge.2008In: The Journal of perinatal education : an ASPO/Lamaze publication, ISSN 1058-1243, Vol. 17, no 2, p. 21-27Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe perceptions of parenthood education among midwives and obstetricians in charge of antenatal care in Sweden. Focus group interviews of 25 obstetricians and midwives were conducted. Data were analyzed with a phenomenographic approach. Five main categories emerged: aim of the parenthood education, content and expectations, implementation, support to group leaders, and strategies for the future. There is a strong belief in parenthood education, and the overall aim was considered to be support in the transition to parenthood. Contents should focus on awareness of the expected child, confidence in the biological processes, and the changes of roles. Pedagogies training, cost effectiveness, development, and the need to reach target groups were emphasized.

  • 7.
    Alexanderson, Kristina
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Borg, Karin E.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hensing, Gunnel K.E.
    Department of Social Medicine, The Sahlgrenska Academy at Göteborg University.
    Sickness absence with low-back, shoulder, or neck diagnoses: An 11-year follow-up regarding gender differences in sickness absence and disability pension2005In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 25, no 2, p. 115-124Article in journal (Refereed)
    Abstract [en]

    Background: There is very little knowledge on the long-term outcomes of sickness absence. The aim was to investigate sickness absence and disability pensions over 11 years in a cohort of young persons initially long-term sick listed with back, neck, or shoulder diagnoses.

    Method: A prospective population-based cohort study of all 213 individuals in the Municipality of Linköping, Sweden, who in 1985 were aged 25-34 and had at least one new sick-leave spell > 28 days with such diagnoses.

    Main results: More women (61%) than men fulfilled the inclusion criteria. In 1996, 22% of the cohort (14% of the men, 26% of the women) had been granted disability pension; 76% of these individuals with musculoskeletal and the rest with psychiatric diagnoses. Partial disability pension was granted to 59% of the women, 17% of the men. Women were more often granted temporary disability pension than men.

    Conclusions: This proved to be a high-risk group for disability pension. There were large and somewhat unexpected gender differences regarding incidence and type of disability pension. It has been debated how soon physicians should be concerned about the risk of long-term disability regarding these diagnoses; at four or eight weeks of sickness absence - our results support the former, at least for women.

  • 8. Andersson, A
    et al.
    Vimarlund, Vivian
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Management perspective on Information and Communication Technology - Requirement specification for process-oriented healthcare2001In: JAMIA Journal of the American Medical Informatics Association, ISSN 1067-5027, E-ISSN 1527-974X, p. 854-854Conference paper (Other academic)
  • 9.
    Andersson, Agneta
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Ölvander, Christina
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Stark Ekman, Diana
    Karolinska Institute.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
    Alcohol use among university students in Sweden measured by an electronic screening instrument2009In: BMC PUBLIC HEALTH, ISSN 1471-2458, Vol. 9, no 229Article in journal (Refereed)
    Abstract [en]

    Background: Electronic-based alcohol screening and brief interventions for university students with problem drinking behaviours forms an important means by which to identify risky drinkers. Methods: In this study an e-SBI project was implemented to assess drinking patterns, and to provide personalised feedback about alcohol consumption and related health problems, to students in a Swedish university. In this study, third semester university students (n = 2858) from all faculties (colleges) at the University were invited to participate in e-SBI screenings. This study employed a randomised controlled trial, with respondents having a equal chance of being assigned to a limited, or full-feedback response. Results: The study shows that high risk drinkers tend to underestimate their own consumption compared to others, and that these high risk drinkers experience more negative consequences after alcohol intake, than other respondents. There was a strong belief, for both high-and low-risk drinkers, that alcohol helped celebrations be more festive. This study also confirms findings from other study locations that while males drank more than females in our study population; females reached the same peak alcohol blood concentrations as males. Conclusion: Obtaining clear and current information on drinking patterns demonstrated by university students can help public health officials, university administration, and local health care providers develop appropriate prevention and treatment strategies.

  • 10.
    Andrews, Johanna Y.
    et al.
    Karolinska Institute.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Umbilical cord-cutting practices and place of delivery in Bangladesh2011In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 114, no 1, p. 43-46Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate place of delivery, umbilical cord-cutting instruments used, and substances applied to the cord stump in Bangladesh. Methods: A cross-sectional data analysis was performed on a nationally representative sample of 4925 women of reproductive age (15-49 years) with at least 1 child. Results: More than 80% of women delivered at home. In 6% of cases, blades from a clean-delivery kit (CDK) were used to cut the cord; in 90% of cases, the blades used were from another source; in 4% of cases, other instruments such as bamboo strips and scissors were used to cut the cord. In 51% of cases, a substance (e.g. antibiotic powder/ointment, alcohol/spirit, mustard oil with garlic, boric powder, turmeric, and chewed rice) was applied to the stump after the cord was cut. Conclusion: The present findings underscore the need for further advocacy, availability, and use of cord-cutting instruments from CDKs, especially for deliveries that occur outside healthcare facilities.

  • 11.
    Angbratt, Marianne
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Estimated calcium intake related to lifestyle and bone mineral density in an adult Swedish population2005Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Osteoporosis is a public health problem. It is a disease that is present for a long period without signs, before resulting in the clinical sign, i.e. fracture(s). Osteoporosis can be prevented in part and there are treatments. Among other lifestyle factors, the dietary intake of calcium is important when working with preventive intervention towards individuals and groups. For dietary assessment, an instrument adjusted for Swedish circumstances is needed.

    The aims of the thesis are to design and validate an instrument estimating calcium intake (I), to estimate calcium intake from dairy products and supplements in an adult Swedish population, and to explore associations between calcium intake and some lifestyle factors and between calcium intake and bone mineral density (II).

    Two questionnaires were prepared, one short (A), containing questions about dairy products and supplements, and another more extensive (B), with questions on a wide variety of food products. The questionnaires were validated with dietary history as the gold standard. Two  age groups of women, 20-30 and 50-60 years, were included (n=467) (I). A randomised sample of 15% women and men aged 20-79 years in two communities answered a questionnaire (n= 1510). Forearm bone mineral density was measured in a subsample of this group (n=448) (II).

    We found questionnaire A to be sufficient when discriminating individuals with low calcium intake from individuals with sufficient calcium intake (I). The mean calcium intake from dairy products was well attained (878 mg/day) although the range was wide. However, 12% in the 20-30 years age group and 31% in the 70- 79 years age group did not meet the recommended daily intake. Associations were found between calcium intake and residence and also physical activity. There was a tendency towards an association between calcium intake and forearm bone mineral density. No other associations with lifestyle factors were observed (II).

    ln osteoporosis intervention work there is every reason to strive towards meeting the recommended daily intake for all individuals, and our quick and cheap food frequency questionnaire could be of value.

    List of papers
    1. Questionnaire about Calcium Intake: Can We Trust the Answers?
    Open this publication in new window or tab >>Questionnaire about Calcium Intake: Can We Trust the Answers?
    1999 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 9, no 3, p. 220-225Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to construct and evaluate reliable questions concerning calcium intake and to include them in a questionnaire to be used in a community-based intervention program for preventing osteoporosis. Estimating calcium intake is an important factor in evaluating risk profiles for community residents. A very large amount of calcium in the Swedish diet comes from dairy foods. Two questionnaires were designed. Questionnaire A contained eight questions concerning consumption of dairy foods. Questionnaire B contained 52 questions on consumption of calcium-rich food groups and dishes, and also included the eight questions mentioned above. Questionnaire A was sent to 467 randomized women aged 20–30 and 50–60 years. Women with a low calcium intake also answered questionnaire B. In order to validate the questionnaires a selected number of the women were interviewed using a dietary history. In total 363 women answered questionnaire A, 118 of whom had a calcium intake below the recommended amount. Ninety-six women completed questionnaire B. Twenty-two women were interviewed with the dietary history. Statistical analyses using t-tests of the differences between answers to the same questions in two questionnaires and the interview, gave the following results. Questionnaire A provides reliable information about those who do not reach the recommended level of calcium intake. Questionnaire B does not provide any more information than questionnaire A. It is not possible to rank calcium levels in the diet with the questionnaires. Using the estimated calcium intake from dairy foods obtained in questionnaire A, individuals at risk of consuming less than the recommended intake of calcium can be identified, as can those consuming the required amount. In conclusion, questionnaire A is useful in discriminating between subjects with low and high calcium intake.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-25767 (URN)10.1007/s001980050140 (DOI)000080177200006 ()10201 (Local ID)10201 (Archive number)10201 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13
    2. Calcium intake in a Swedish adult population: relationship to life-style factors and bone mineral density. A descriptive study
    Open this publication in new window or tab >>Calcium intake in a Swedish adult population: relationship to life-style factors and bone mineral density. A descriptive study
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background. This study is part of a community-based intervention programme dealing with the prevention of osteoporosis. The study aims were to estimate the calcium intake from dairy products and calcium supplements within a general population, and thereafter to study associations between calcium intake, relevant lifestyle factors, and forearm bone mineral density.

    Methods. A randomised sample of 15 % of the inhabitants aged 20 - 79 years ( = 1510) from two Swedish municipalities answered a questionnaire, and a selected sub-sample (n=448) had their forearm bone mineral density measured.

    Results. The mean consumption of calcium from dairy products was 878 mg/day. Men consumed more than women, and calcium intake decreased with increasing age. Twelve percent of the youngest age group in the study population and 31 % of the oldest age group did not meet the recommended daily intake. Associations were found between calcium intake and both residence and physical activity. There was a tendency towards an association between calcium intake and forearm bone mineral density. No other associations with lifestyle factors were observed.

    Conclusion. Calcium intake is in general well attained in an adult Swedish population, although the intake range is wide (55 to 3213 mg/day from dairy products). Women aged 50-59 years and older people are at increased risk of not meeting the recommended daily intake.

    Keywords
    calcium intake, osteoporosis, prevention, lifestyle factors, bone mineral density, residence
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-102727 (URN)
    Available from: 2013-12-19 Created: 2013-12-19 Last updated: 2013-12-19
  • 12.
    Angbratt, Marianne
    et al.
    Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Blomberg, Carina
    Vadstena Primary Health Care Centre, Vadstena, Sweden.
    Grahn Kronhed, Ann-Charlotte
    Vadstena Primary Health Care Centre, Vadstena, Sweden.
    Waller, John
    Vadstena Primary Health Care Centre, Vadstena, Sweden.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Wingren, Gun
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Möller, Margareta
    Research and Development Unit, Primary Health Care, Borås, Sweden.
    Calcium intake in a Swedish adult population: relationship to life-style factors and bone mineral density. A descriptive studyManuscript (preprint) (Other academic)
    Abstract [en]

    Background. This study is part of a community-based intervention programme dealing with the prevention of osteoporosis. The study aims were to estimate the calcium intake from dairy products and calcium supplements within a general population, and thereafter to study associations between calcium intake, relevant lifestyle factors, and forearm bone mineral density.

    Methods. A randomised sample of 15 % of the inhabitants aged 20 - 79 years ( = 1510) from two Swedish municipalities answered a questionnaire, and a selected sub-sample (n=448) had their forearm bone mineral density measured.

    Results. The mean consumption of calcium from dairy products was 878 mg/day. Men consumed more than women, and calcium intake decreased with increasing age. Twelve percent of the youngest age group in the study population and 31 % of the oldest age group did not meet the recommended daily intake. Associations were found between calcium intake and both residence and physical activity. There was a tendency towards an association between calcium intake and forearm bone mineral density. No other associations with lifestyle factors were observed.

    Conclusion. Calcium intake is in general well attained in an adult Swedish population, although the intake range is wide (55 to 3213 mg/day from dairy products). Women aged 50-59 years and older people are at increased risk of not meeting the recommended daily intake.

  • 13.
    Angbratt, Marianne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Ekberg, Joakim
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Walter, Lars
    Östergötlands Läns Landsting, Center for Health and Developmental Care, Center for Public Health.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Prediction of obesity from infancy to adolescence2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 9, p. 1249-1252Article in journal (Refereed)
    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.

  • 14.
    Angbratt, Marianne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Blomberg, C.
    Kronhed, A.-C.
    Waller, J.
    Vadstena Primary Care Centre, Vadstena, Sweden.
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine.
    Moller, M.
    Möller, M., Centre for Caring Sciences, ÖrebroCountyCouncil, Örebro, Sweden.
    Prevalence and correlates of insufficient calcium intake in a Swedish population: Populations at risk across the lifespan2007In: Public Health Nursing, ISSN 0737-1209, E-ISSN 1525-1446, Vol. 24, no 6, p. 511-517Article in journal (Refereed)
    Abstract [en]

    To examine associations between calcium intake in the diet, lifestyle factors, and forearm bone mineral density (BMD) in order to identify population subgroups for targeting by screening programs. A questionnaire was sent to a random sample of 15 of the inhabitants aged 20-79 years from 2 Swedish municipalities, and the subsample from one of the municipalities was invited to measurement of BMD. The survey response rate was 74 (n=1,1121,510) and participation in BMD measurements was 68 (n=448659). Only a tendency (p=.085) toward direct association between calcium intake and forearm BMD was found, and the best multiple regression model was retained to explain BMD excluded calcium intake. Low calcium intake was, instead, in complementary analyses, found to be correlated with the factors old age, female sex, and urban residence in the best multiple regression model. Population subgroups whose calcium intake is in a range that justifies preventive action could be identified. Screening programs staffed by public health nurses can thereby be informed regarding the subgroups of the population that are at the highest risk of insufficient calcium intake. © 2007, Blackwell Publishing, Inc.

  • 15.
    Aremu, Olatunde
    et al.
    Karolinska Institutet.
    Lawoko, Stephen
    Karolinska Institutet.
    Dalal, Koustuv
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Childhood vitamin A capsule supplementation coverage in Nigeria: a multilevel analysis of geographic and socioeconomic inequities.2010In: TheScientificWorldJournal, ISSN 1537-744X, Vol. 10, p. 1901-1914Article in journal (Refereed)
    Abstract [en]

    Vitamin A deficiency (VAD) is a huge public health burden among preschool-aged children in sub-Saharan Africa, and is associated with a high level of susceptibility to infectious diseases and pediatric blindness. We examined the Nigerian national vitamin A capsule (VAC) supplementation program, a short-term cost-effective intervention for prevention of VAD-associated morbidity for equity in terms of socioeconomic and geographic coverage. Using the most current, nationally representative data from the 2008 Nigerian Demographic and Health Survey, we applied multilevel regression analysis on 19,555 children nested within 888 communities across the six regions of Nigeria. The results indicate that there was variability in uptake of VAC supplement among the children, which could be attributed to several characteristics at individual, household, and community levels. Individual-level characteristics, such as maternal occupation, were shown to be associated with receipt of VAC supplement. The results also reveal that household wealth status is the only household-level characteristic that is significantly associated with receipt of VAC, while neighborhood socioeconomic disadvantage and geographic location were the community-level characteristics that determined receipt of VAC. The findings from this study have shown that both individual and contextual socioeconomic status, together with geographic location, is important for uptake of VAC. These findings underscore the need to accord the VAC supplementation program the much needed priority with focus on characteristics of neighborhoods (communities), in addition to individual-level characteristics.

  • 16.
    Aremu, Olatunde
    et al.
    Karolinska Institutet.
    Lawoko, Stephen
    Karolinska Institutet.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Neighborhood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: a multilevel discrete choice analysis2011In: International Journal of Women's Health, ISSN 1179-1411, Vol. 3, p. 167-174Article in journal (Refereed)
    Abstract [en]

    Background: High maternal mortality continues to be a major public health problem in most part of the developing world, including Nigeria. Understanding the utilization pattern of maternal healthcare services has been accepted as an important factor for reducing maternal deaths. This study investigates the effect of neighborhood and individual socieconomic position on the utilization of different forms of place of delivery among women of reproductive age in Nigeria.

    Methods: A population-based multilevel discrete choice analysis was performed using the most recent populationbased 2008 Nigerian Demographic and Health Surveys data of women aged between 15 and 49 years. The analysis was restriced to 15,162 ever-married women from 888 communities across the 36 states of the federation including the Federal Capital Territory of Abuja.

    Results: The choice of place to deliver varies across the socioeconomic strata. The results of the multilevel discrete choice models indicate that with every other factor controlled for, the household wealth status, women's occupation, women's and partner's high level of education attainment, and possession of health insurance were associated with use of private and government health facilities for child birth relative to home delivery. The results also show that higher birth order and young material age were associated with use of home delivery. Living in a highly socioeconomic disadvantaged neighborhood is associated with home birth compared with the patronage of government health facilities. More specifically, the result revealed that choice of facility-based delivery is clustered around the neighborhoods.

    Conclusion: Home delivery, which cuts across all socioeconomic strata, is a common practice among women in Nigeria. Initatives that would encourage the appropriate use of healthcare facilities at little or no cost to the most disadvantaged should be accorded the utmost priority.

     

  • 17.
    Backe, S
    et al.
    Karlstad University.
    Ericson, L
    Karlstad University.
    Janson, S
    Karlstad University.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Rock climbing injury rates and associated risk factors in a general climbing population2009In: SCANDINAVIAN JOURNAL OF MEDICINE and SCIENCE IN SPORTS, ISSN 0905-7188, Vol. 19, no 6, p. 850-856Article in journal (Refereed)
    Abstract [en]

    The objective was to examine injury rates and associated risk factors in a representative sample of climbers. A random sample (n=606) of the Swedish Climbing Association members was sent a postal survey, with an effective response rate of 63%. Self-reported data regarding climbing history, safety practices and retrospective accounts of injury events (recall period 1.5 years) were obtained. Descriptive statistical methods were used to calculate injury incidences, and a two-step method including zero-inflated Poissons regression analysis of re-injuries was used to determine the combination of risk factors that best explained individual injury rates. Overall, 4.2 injuries per 1000 climbing hours were reported, overuse injuries accounting for 93% of all injuries. Inflammatory tissue damages to fingers and wrists were the most common injury types. The multivariate analysis showed that overweight and practicing bouldering generally implied an increased primary injury risk, while there was a higher re-injury risk among male climbers and a lower risk among the older climbers. The high percentage of overuse injuries implies that climbing hours and loads should be gradually and systematically increased, and climbers regularly controlled for signs and symptoms of overuse. Further study of the association between body mass index and climbing injury is warranted.

  • 18.
    Backe, S.
    et al.
    Karlstad University.
    Janson, S.
    Karlstad University.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Governance and implementation of sports safety practices by municipal offices in Swedish communities2012In: International Journal of Injury Control and Safety Promotion, ISSN 1745-7300, E-ISSN 1745-7319, Vol. 19, no 2, p. 163-169Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to explore whether all-purpose health or safety promotion programmes and sports safety policies affect sports safety practices in local communities. Case study research methods were used to compare sports safety activities among offices in 73 Swedish municipalities; 28 with ongoing health or safety promotion programmes and 45 controls. The offices in municipalities with the WHO Healthy Cities (HC) or Safe Communities programmes were more likely to perform frequent inspections of sports facilities, and offices in the WHO HC programme were more likely to involve sports clubs in inspections. More than every second, property management office and environmental protection office conducted sports safety inspections compared with less than one in four planning offices and social welfare offices. It is concluded that all-purpose health and safety promotion programmes can reach out to have an effect on sports safety practices in local communities. These safety practices also reflect administrative work routines and managerial traditions.

  • 19. Baird, J.
    et al.
    Nilsen, Per
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Longabaugh, R.
    Mello, M.
    Nirenberg, T.
    Lee, C.
    Woolard, R.
    A REVIEW OF BRIEF INTERVENTION STUDIES CONDUCTED IN EMERGENCY DEPARTMENTS: A FOCUS ON MODERATORS OF TREATMENT OUTCOMES in ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH, vol 33, issue 6, pp 269A-269A2009In: ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH, 2009, Vol. 33, no 6, p. 269A-269AConference paper (Refereed)
    Abstract [en]

    n/a

  • 20.
    Bak, K
    et al.
    Linkoping Univ Hosp, Dept Orthopaed Surg, Div Sports Traumatol, S-58185 Linkoping, Sweden Gentofte Hosp, Dept Orthopaed Surg, Div Sports Traumatol, Copenhagen, Denmark.
    Jorgensen, U
    Linkoping Univ Hosp, Dept Orthopaed Surg, Div Sports Traumatol, S-58185 Linkoping, Sweden Gentofte Hosp, Dept Orthopaed Surg, Div Sports Traumatol, Copenhagen, Denmark.
    Ekstrand, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Scavenius, M
    Linkoping Univ Hosp, Dept Orthopaed Surg, Div Sports Traumatol, S-58185 Linkoping, Sweden Gentofte Hosp, Dept Orthopaed Surg, Div Sports Traumatol, Copenhagen, Denmark.
    Reconstruction of anterior cruciate ligament deficient knees in soccer players with an iliotibial band autograft - A prospective study of 132 reconstructed knees followed for 4 (2-7) years2001In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 11, no 1, p. 16-22Article in journal (Refereed)
    Abstract [en]

    One hundred and thirty-two consecutive soccer players (117 males and 15 females, median age 23, range 16-39 years) underwent primary reconstruction of the anterior cruciate ligament (ACL) with an iliotibial band (ITB) autograft. AU patients were followed prospectively for a minimum of 2 years. One hundred and eighteen patients (89%) attended an independent observer follow-up after a median of 47 (24-92) months. The time before participating in soccer was a median of 7 (5-24) months. At a median of 4 years, 80 (68%) mere still active soccer players, while 38 had changed activity to a lower level. Twenty-five gave up soccer playing for reasons unrelated to the knee, and 13 (11%) gave up due to problems from the reconstructed knee. The Lysholm score improved from a median of 82 (range 42-99, mean [SD] 80.5 [+/-11.9]) points prior to the operation to a median of 99 (range 57-100, mean [SD] 94.6 [+/-8.5]) at followup. The Tegner score improved from a median of 3.5 (0-7) preoperatively to 9 (1-10), Four patients (3%) sustained a rupture of the graft: three ruptures occurred among the 15 females (20%), and one was seen among the 117 males (0.8%) (P=0.01). Eight per cent had predominantly minor cosmetic complaints from the donor-site hernia, while 51% had temporary discomfort from the staples used for graft fixation. Using the ITB autograft for ACL reconstruction, we found excellent and good results in soccer players with ACL deficiency and high demands for optimal knee function. The failure rate in general was comparable with other methods, and the majority was still active in soccer sports at a median of 4 years after surgery, An unacceptably high rerupture rate was registered in female players.

  • 21.
    Bendtsen, Preben
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Holmqvist, Marika
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Johansson, K.
    Implementation of computerized alcohol screening and advice in an emergency department - a nursing staff perspective2007In: Accident and Emergency Nursing, ISSN 0965-2302, E-ISSN 1532-9267, Vol. 15, no 1Article in journal (Refereed)
    Abstract [en]

    Changes in attitudes towards alcohol prevention among nursing staff are evaluated after implementing an opportunistic computerized alcohol screening and intervention (e-SBI) at an emergency department. After having assessed the patients in the triage room the nurses asked patients to perform the e-SBI on a touch screen computer. Before the start of the project more than 60% of the nurses expected the patients to react negatively when asked about their alcohol habits. After one year of screening only 10% reported experience of negative reactions from the patients. More than 50% of the nurses found it easy or very easy to ask the patients to perform the e-SBI and more than 75% of the nurses agreed that the e-SBI did not affect their workload. The proportion of nurses who considered alcohol prevention to be part of their duties at the emergency department did not change (40%) after implementing the e-SBI. During the two-year study period, 1982 patients completed the e-SBI which constituted 10-20% of all patients between 16 and 70 years of age attending the department for a sub critical condition. The e-SBI seems to have better potential than ordinary alcohol screening and intervention for implementation into routine emergency departments due to its simplicity and low time consumption. © 2006 Elsevier Ltd. All rights reserved.

  • 22.
    Bendtsen, Preben
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
    Karlsson, Nadine
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hazardous Drinking Concepts, Limits and Methods: Low Levels of Awareness, Knowledge and Use in the Swedish Population.2011In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 46, no 5, p. 638-645Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate the awareness and knowledge of hazardous drinking limits among the general population in Sweden and the extent to which people estimate their alcohol consumption in standard drinks to assess their level of drinking.

    Methods: A population-based study involving 6000 individuals selected from the total Swedish population was performed. Data were collected by means of a postal questionnaire. The mail survey response rate was 54.3% (n = 3200) of the net sample of 5891 persons.

    Results: With regard to drinking patterns, 10% of the respondents were abstainers, 59% were sensible drinkers and 31% were classified as hazardous drinkers. Most of the abstainers (80%), sensible drinkers (64%) and hazardous drinkers (56%) stated that they had never heard about the standard drink method. Familiarity with the hazardous drinking concept also differed between the three categories although ∼61% of sensible and hazardous drinkers expressed awareness of the concept (46% of the abstainers). Knowledge about the limits for sensible drinking was very poor. Between 94 and 97% in the three categories did not know the limit. There was a statistically significant association between having visited health care within the last 12 months and being aware of the standard drink method and the hazardous drinking concept, but not with knowing the hazardous drinking limits. Similarly, there was a significant association between having had at least one alcohol conversation in health care within the last 12 months and being aware of the standard drink method and the hazardous drinking concept, but not with knowing the hazardous drinking limits.

    Conclusion: The results can be seen as a major challenge for the health-care system and public health authorities because they imply that a large proportion of the Swedish population does not know when alcohol consumption becomes a threat to their health. The current strategy to disseminate knowledge about sensible drinking limits to the population through the health-care system seems to have failed and new means of informing the population are warranted.

  • 23.
    Bendtsen, Preben
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    McCambridge, Jim
    London School of Hygiene and Tropical Medicine, United Kingdom.
    Bendtsen, Marcus
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, The Institute of Technology.
    Karlsson, Nadine
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Effectiveness of a proactive mail-based alcohol Internet intervention for university students: dismantling the assessment and feedback components in a randomized controlled trial2012In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 14, no 5Article in journal (Refereed)
    Abstract [en]

    Background: University students in Sweden routinely receive proactive mail-based alcohol Internet interventions sent from student health services. This intervention provides personalized normative feedback on alcohol consumption with suggestions on how to decrease drinking. Earlier feasibility trials by our group and others have examined effectiveness in simple parallel-groups designs.Objective: To evaluate the effectiveness of electronic screening and brief intervention, using a randomized controlled trial design that takes account of baseline assessment reactivity (and other possible effects of the research process) due to the similarity between the intervention and assessment content. The design of the study allowed for exploration of the magnitude of the assessment effects per se.Methods: This trial used a dismantling design and randomly assigned 5227 students to 3 groups: (1) routine practice assessment and feedback, (2) assessment-only without feedback, and (3) neither assessment nor feedback. At baseline all participants were blinded to study participation, with no contact being made with group 3. We approached students 2 months later to participate in a cross-sectional alcohol survey. All interventions were fully automated and did not have any human involvement. All data used in the analysis were based on self-assessment using questionnaires. The participants were unaware that they were participating in a trial and thus were also blinded to which group they were randomly assigned.Results: Overall, 44.69% (n = 2336) of those targeted for study completed follow-up. Attrition was similar in groups 1 (697/1742, 40.01%) and 2 (737/1742, 42.31% retained) and lower in group 3 (902/1743, 51.75% retained). Intention-to-treat analyses among all participants regardless of their baseline drinking status revealed no differences between groups in all alcohol parameters at the 2-month follow-up. Per-protocol analyses of groups 1 and 2 among those who accepted the email intervention (36.2% of the students who were offered the intervention in group 1 and 37.3% of the students in group2 ) and who were risky drinkers at baseline (60.7% follow-up rate in group 1 and 63.5% in group 2) suggested possible small beneficial effects on weekly consumption attributable to feedback.Conclusions: This approach to outcome evaluation is highly conservative, and small benefits may follow the actual uptake of feedback intervention in students who are risky drinkers, the precise target group.Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 24735383; http://www.controlled-trials.com/ISRCTN24735383 (Archived by WebCite at http://www.webcitation.org/6Awq7gjXG)

  • 24.
    Bendtsen, Preben
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Stark Ekman, Diana
    Karlstad University.
    Johansson, Anne Lie
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Leijon, Matti
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Johansson, Kjell
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Referral to an electronic screening and brief alcohol intervention in primary health care in Sweden: impact of staff referral to the computer2011In: International Journal of Telemedicine and Applications, ISSN 1687-6415, E-ISSN 1687-6423, Vol. 2011, p. 1-11, article id 918763Article in journal (Refereed)
    Abstract [en]

    The aim of this paper was to evaluate whether primary health care staff's referral of patients to perform an electronic screening and brief intervention (e-SBI) for alcohol use had a greater impact on change in alcohol consumption after 3 month, compared to patients who performed the test on their own initiative. Staff-referred responders reported reduced weekly alcohol consumption with an average decrease of 8.4 grams. In contrast, self-referred responders reported an average increase in weekly alcohol consumption of 2.4 grams. Staff-referred responders reported a 49% reduction of average number of heavy episodic drinking (HED) occasions per month. The corresponding reduction for self-referred responders was 62%. The differences between staff- and self-referred patient groups in the number who moved from risky drinking to nonrisky drinking at the followup were not statistically significant. Our results indicate that standalone computers with touchscreens that provide e-SBIs for risky drinking have the same effect on drinking behaviour in both staff-referred patients and self-referred patients.

  • 25.
    Bengtsson, Hakan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Match Injury Rates in Professional Soccer Vary With Match Result, Match Venue, and Type of Competition2013In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 41, no 7, p. 1505-1510Article in journal (Refereed)
    Abstract [en]

    Background: Player activities in soccer matches are influenced by the match result and match venue. It is not known whether injury rates are influenced by these factors. Purpose: To investigate whether there are associations between injury rates and the match result, venue, and type of competition in male soccer. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-six professional clubs from 10 countries were followed prospectively during 9 seasons (2001-2002 to 2009-2010). All matches, and injuries occurring in these matches, were registered by the teams medical staff. An injury was registered if it resulted in player absence from training or matches. Information about match result, venue, and type of competition for all reported matches was gathered by the authors from online databases. Injury rates in matches with varying match characteristics were compared by use of generalized estimating equations. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: A total of 2738 injuries during 6010 matches were registered. There were no associations between odds of 1 injury occurrence and match result or type of competition, whereas the odds were decreased in matches played away compared with home matches (OR, 0.89; 95% CI, 0.80-0.99). The odds of 2 or more injury occurrences in a match were increased in matches resulting in a draw (OR, 1.39; 95% CI, 1.15-1.69) or loss (OR, 1.66; 95% CI, 1.38-1.98) compared with matches won and were decreased in other cup matches compared with league matches (OR, 0.57; 95% CI, 0.39-0.84) and in matches played away compared with home matches (OR, 0.70; 95% CI, 0.60-0.82). Finally, injuries with more than 1 weeks absence occurred more frequently in Champions League matches compared with league matches both for matches with 1 injury (OR, 1.26; 95% CI, 1.09-1.45) and matches with 2 or more injuries (OR, 1.57; 95% CI, 1.13-2.20). Conclusion: The odds of 2 or more injury occurrences in professional soccer were higher in matches resulting in a loss or a draw compared with a win, whereas the odds of injury occurrences were lower in matches played away compared with home matches. The rate of moderate and severe injuries increased with the importance of the match.

  • 26.
    Berg, Hans-Yngve
    et al.
    Swedish National Road and Transport Research Institute (VTI), Linköping, Sweden.
    Eliasson, Kristian
    Swedish National Road and Transport Research Institute (VTI), Linköping, Sweden.
    Palmkvist, Jan
    Swedish National Road and Transport Research Institute (VTI), Linköping, Sweden.
    Gregersen, Nils-Petter
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Learner drivers and lay instruction: how socio-economic standing and lifestyle are reflected in driving practice from the age of 161999In: Transportation Research Part F: Traffic Psychology and Behaviour, ISSN 1369-8478, Vol. 2, no 3, p. 167-179Article in journal (Refereed)
    Abstract [en]

    On September 1st 1993, a new law came into effect in Sweden, permitting instructor-supported driving practice from the age of 16 instead of 17 years and 6 months. The intention was to enable young people to gain more experience of driving a car before they acquire a driver's permit and thereby to reduce their accident risk.

    The study was conducted by means of a questionnaire posted to 601 17-year-olds throughout Sweden. The participants were analysed concerning gender, socio-economic standing (blue-collar and white-collar), and lifestyle (friend-oriented, externally-oriented and parent-oriented). The results show that men obtain a learner's permit more often than women (67.4% vs 57.2%) and that youngsters in white-collar families acquire a learner's permit in more cases than those in blue-collar families (67.4% vs 52.4%). One of the reasons for the latter group not acquiring a permit is that they cannot afford it, while children in white-collar families state that they have neither the time nor the desire. No significant difference was found between the three lifestyle groups.

    When it comes to the amount of practice, the men have been out on the road on average 39.9 h during their first 13 months, compared to 19.9 h for the women. In the lifestyle groups, those who belong to the so-called externally-oriented lifestyle have practised most. They have reported 39.2 h compared to the parent-oriented group with the least amount of training, 27.9 h on average. The friend-oriented group has 22.2 h of practice.

    When both lifestyle and socio-economic standing were considered, even greater differences were found. The white-collar group of the externally-oriented lifestyle reported as much as 51.5 h, compared to the blue-collar group of the parent-oriented lifestyle with only 18.4 h of practising.

    The above result is important because it is not in accordance with the intentions of the new driving practice system. The idea behind the new system was that all young people should have the opportunity for a longer period of driving practice in order to reduce the high accident risk during the first year with a driver’s license. If it is impossible for certain groups of youngsters to start their driving practice at the age of 16, the situation will become socially unjust and measures must be taken to remedy this situation.

  • 27.
    Berg, Hans-Yngve
    et al.
    Swedish National Road Administration, Borlänge, Sweden.
    Gregersen, Nils-Petter
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Laflamme, Lucie
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Typical patterns in road-traffic accidents during driver training: An explorative Swedish national study2004In: Accident Analysis & Prevention, ISSN 0001-4575, Vol. 36, no 4, p. 603-608Article in journal (Refereed)
    Abstract [en]

    A new law came into force in Sweden on 1 September 1993, which makes instructor-assisted driving practice possible at the age of 16 years instead of the previous 17 years and 6 months. When the age limit was reduced, the possibility that this would lead to more road-traffic accidents (RTA) during driving practice was discussed. The aim of this study was to highlight typical road-traffic accident patterns and to discuss their potential for improved training and targeted prevention. A total of 11 variables (41 categories) descriptive of the 1081 RTA involving novice drivers and police registered during the period 1994–1999 were analysed simultaneously using in turn, two multivariate analysis techniques: the Factorial Analysis of Correspondence (FAC) and the Hierarchical Ascendant Classification (HAC). Four accident classes were identified and quantified, of which the first two were more typical of rural areas: (1) accidents in rural areas on straight stretches and related to speed limit 70 km/h (n=306); (2) accidents in rural areas on straight stretches and high-speed related (n=97); (3) accidents in built-up areas, low-speed related and of the type rear-end (n=298); and (4) accidents in built-up areas, at road junctions and low-speed related (n=380). Together, these classes point to a variety of opportunities to develop ways of working with targeted prevention. Instead of adopting a general attempt to counteract the relationship between individual variables and accidents, it is possible instead to focus on a whole context and its relationship with its typical accidents and any resulting injuries. This, in its turn, allows greater specificity in the build up of the Swedish licence and training regulations and its corresponding course curriculum.

  • 28.
    Bergström, Ingrid
    et al.
    Karolinska University Hospital.
    Bergström, Karin
    Stockholm shool of economics.
    Grahn Kronhed, Ann-Charlotte
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Rehabilitation in West County.
    Karlsson, Susanne
    Karolinska University Hospital.
    Brinck, Jonas
    Karolinska University Hospital.
    Back extensor training increases muscle strength in postmenopausal women with osteoporosis, kyphosis and vertebral fractures2011In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 13, no 3, p. 110-117Article in journal (Refereed)
    Abstract [en]

    We determined the efficacy of a back muscle extensor strengthening program on the back muscle extensor strength, kyphosis, height and thoracic expansion in women with at least one vertebral fracture, kyphosis and osteoporosis. Thirty-six patients were included and randomized to a control or a training group. The training focused on back muscle extensor strengthening program for 1 h, twice a week for 4 months and was performed by a physiotherapist. The main outcome measure was the back muscle extensor strength. In an intention-to-treat analysis no significant effects on back muscle strength in the training group vs. controls could be seen (p = 0.74). In a per-protocol analysis (n = 28), the training group increased back muscle strength from 290 ± 87 to 331 ± 89 N while the control group showed no improvement. After adjusting for the strength at baseline, a significant effect of training could be demonstrated (p = 0.029). When comparing the heights between the groups a significant group × time interaction was observed (p = 0.012) where the training women increased their mean height with 0.3 cm (p = 0.101) and controls decreased 0.44 cm (p = 0.045). The training group improved their thoracic expansion compared with baseline (p = 0.03). No effect of training on kyphosis was seen. In conclusion, a 4-months back extensor training program can improve back strength and seems to maintain height and thoracic expansion.

  • 29.
    Biswas, Animesh
    et al.
    Centre for Injury prevetion Research, Dhaka Bangladesh.
    Rahman, Aminur
    Centre for Injury prevetion Research, Dhaka Bangladesh.
    Mashreky, Saidur
    Centre for Injury prevetion Research, Dhaka Bangladesh.
    Rahman, Fazlur
    Centre for Injury prevetion Research, Dhaka Bangladesh.
    Dalal, Koustuv
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Unintentional injuries and parental violence against children during flood: a study in rural Bangladesh2010In: Rural and remote health, ISSN 1445-6354, Vol. 10, no 1, p. 1199-Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Violence and injuries are under-reported in developing countries, especially during natural disasters such as floods. Compounding this, affected areas are isolated from the rest of the country. During 2007 Bangladesh experienced two consecutive floods which affected almost one-third of the country. The objective of this study was to examine unintentional injuries to children in rural Bangladesh and parental violence against them during floods, and also to explore the association of socioeconomic characteristics. METHODS: A cross-sectional rural household survey was conducted in the worst flood-affected areas. A group of 638 randomly selected married women of reproductive age with at least one child at home were interviewed face-to-face using pre-tested structured questionnaires. The chi2 test and logistic regression were used for data analysis. RESULTS: The majority of families (90%) were affected by the flood and were struggling to find food and shelter, resulting in the parents becoming violent towards their children and other family members in the home. Cuts (38%), falls (22%) and near drowning (21%) comprised the majority of unintentional injuries affecting children during the floods. A large number of children were abused by their parents during the floods (70% by mothers and 40% by fathers). The incidence of child injuries and parental violence against children was higher among families living in poor socio-economic conditions, whose parents were of low occupational status and had micro-credit loans during the floods. CONCLUSIONS: Floods can have significant effects on childhood injury and parental violence against children. The improvement of socio-economic conditions would assist in preventing child injuries and parental violence.

  • 30. Bobak, M
    et al.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Pikhart, H
    Marmot, M
    Life span and disability: a cross sectional comparison of Russian and Swedish community based data2004In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 329, no 7469, p. 767-770Article in journal (Refereed)
    Abstract [en]

    Objectives To compare levels of disability (in terms of physical function and self rated health) among middle aged and elderly people in Russia and Sweden, a country with high life expectancy. Design Cross sectional study. Setting General population of the Russian Federation and of two counties in southern Sweden. Participants Randomly selected men and women in Sweden (n = 9489) and Russia (n = 1599). Main outcome measures Official life table data, self rated health and physical functioning (subscale of the SF-36). Results The official life table data showed large differences in mortality-for example, 36% of Russian men aged 45-49 years would survive the next 25 years compared with 75% of Swedish men. The survey data showed, for both sexes, similar levels of self rated health and physical functioning in the two countries up to the age of about 45 years, but after that, the age related decline in both outcomes was much faster in Russia than in Sweden. By combining the national life tables with survey data on physical functioning we estimated that in the age group 45-49 years, 99% of Russian and 97% of Swedish men would be free of disability, of these, if these data were for a cohort, only 17% of Russians would be alive and free of disability 25 years later compared with 65% of Swedes. The difference in survival was similar in women. Conclusions Large differences exist in survival without disability between elderly Russians and Swedes. The short life span in Russia reflects high levels of ill health and disability and is associated with a rapid age related decline in physical functioning.

  • 31.
    Boman, John
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Richt, Bengt
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Nordqvist, Cecilia
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ett bättre liv: Ett bidrag till utvärderingen av dagverksamheten vid Cedersborgs Resurscentrum i Norrköping1997Report (Other academic)
  • 32.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Fridlund, B
    Jonköping University, Sweden .
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
    Sunnergren, O
    County Hospital Ryhov, Sweden .
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Effects of a group-based educational programme on adherence to CPAP treatment in obstructive sleep apnoea in JOURNAL OF SLEEP RESEARCH, vol 21, issue SI, pp 348-3482012In: JOURNAL OF SLEEP RESEARCH, Wiley-Blackwell , 2012, Vol. 21, no SI, p. 348-348Conference paper (Refereed)
    Abstract [en]

    n/a

  • 33.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Sunnergren, Ola
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    A mixed method evaluation of a group-based educational programme for CPAP use in patients with obstructive sleep apnea2013In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 19, no 1, p. 173-184Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectives  Continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) has a low long-term adherence. Educational interventions are few and sparsely described regarding content, pedagogical approach and participants' perceptions. The aim was to describe adherence to CPAP treatment, knowledge about OSA/CPAP, as well as OSA patients' perceptions of participating in a group-based programme using problem-based learning (PBL) for CPAP initiation. Educational programme  The PBL programme incorporated elements from theories and models concerning motivation and habits. Tutorial groups consisting of four to eight patients met at six sessions during 6 months. Methods  A sequential explanatory mixed method design was used on 25 strategically selected patients. Quantitative data regarding, clinical variables, OSA severity, CPAP use, and knowledge were collected at baseline, after 2 weeks and 6 months. Qualitative data regarding patients' perceptions of participation were collected after 6 months by semi-structured interviews using a phenomenographic approach. Results  72% of the patients were adherent to CPAP treatment after 2 weeks and 6 months. All patients improved their baseline knowledge about OSA and CPAP after 2 weeks and sustained it after 6 months. Anxiety and fear, as well as difficulties and needs were motivational factors for participation. Patients described the difficulties of behavioural change, an awareness that improvements do not occur immediately, a realization of the importance of both technical and emotional support and the need for a healthier lifestyle. Conclusion and practice implications  A group-based programme using PBL seems to facilitate adaptive and developmental learning and result in acceptable CPAP adherence levels.

  • 34.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Johansson, P
    Östergötlands Läns Landsting.
    Riegel, B
    University of Penn, USA .
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Fridlund, B
    Jonköping University, Sweden .
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Do cardiovascular signs and risk factors differ between hypertensive men and women with high versus low risk on the Berlin sleep apnoea questionnaire in a primary care setting? in JOURNAL OF SLEEP RESEARCH, vol 21, issue SI, pp 230-2312012In: JOURNAL OF SLEEP RESEARCH, Wiley-Blackwell , 2012, Vol. 21, no SI, p. 230-231Conference paper (Refereed)
    Abstract [en]

    n/a

  • 35.
    Broström, Anders
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Johansson, Peter
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology . Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
    Fridlund, Bengt
    Jonköping University.
    Putative facilitators and barriers for adherence to CPAP treatment in patients with obstructive sleep apnea syndrome: A qualitative content analysis2010In: SLEEP MEDICINE, ISSN 1389-9457, Vol. 11, no 2, p. 126-130Article in journal (Refereed)
    Abstract [en]

    Introduction: Effective treatment of obstructive sleep apnea syndrome (OSAS) with continuous positive airway pressure (CPAP) can reduce morbidity and mortality, but adherence rates are low without a clear consensus Of causes. Objective: To explore the experiences of adherence to CPAP treatment in patients with OSAS. Methods: A qualitative content analysis was employed. Data were collected by in-depth interviews with 23 purposively selected patients. Results: Adherence to CPAP treatment was summarized according to "facilitators" and "barriers" to CPAP treatment. Facilitators for adherence, as described by the patients were a desire to avoid symptoms, knowledge about the risk for medical consequences, fear of negative social consequences and disturbing the sleep of significant others. Other facilitators were a positive attitude to CPAP treatment, trust in healthcare personnel, a sense of engagement from the spouse and a feeling of physical improvement. Barriers included experiencing practical problems, negative psychological effects of the equipment, and negative attitudes to the treatment. Other barriers were side-effects as well as insufficient support from healthcare personnel and the spouse. Conclusion: Adherence to CPAP treatment is a multifaceted problem including patient, treatment, condition, social and healthcare related factors. Knowledge about facilitators and barriers for adherence to CPAP treatment can be used in interventional Strategies.

  • 36.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Sunnergren, O
    County Hospital Ryhov, Sweden .
    Johansson, P
    Östergötlands Läns Landsting.
    Svensson, E
    Swedish Defence Research Agency, Sweden .
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Symptoms among hypertensive patients with undiagnosed obstructive sleep apnoea in primary care - a structural equation model analysis in JOURNAL OF SLEEP RESEARCH, vol 21, issue SI, pp 230-2302012In: JOURNAL OF SLEEP RESEARCH, Wiley-Blackwell , 2012, Vol. 21, no SI, p. 230-230Conference paper (Refereed)
    Abstract [en]

    n/a

  • 37.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Sunnergren, Ola
    Länssjukhuset Ryhov, Jönköping.
    Johansson, Peter
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Svensson, Erland
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Symptom profile of undiagnosed obstructive sleep apnoea in hypertensive outpatients in primary care: a structural equation model analysis2012In: Quality in Primary Care, ISSN 1479-1072, E-ISSN 1479-1064, Vol. 20, no 4, p. 287-298Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Obstructive sleep apnoea (OSA) has been linked to hypertension in sleep clinic populations, but little is known about the symptom profile of undiagnosed OSA in hypertensive outpatients in primary care.

    AIM:

    To explore characteristics associated with undiagnosed  OSA in hypertensive primary care patients.

    METHODS:

    Cross-sectional design, including 411 consecutive patients (52% women), mean age 57.9 years (standard deviation [SD] 5.9 years), with diagnosed hypertension (blood pressure >140/90 mmHg) from four primary care centres. All subjects  underwent a full-night, home-based, respiratory recording to establish the presence and severity of OSA. Clinical variables, medication and comorbidities, as well as data from self-rating scales regarding symptoms/characteristics, insomnia, excessive daytime sleepiness, depressive symptoms  and health were collected during a clinical examination. Factor analyses and structural equation modelling (SEM) were used to explore the relationships between self-rated symptoms, clinical characteristics and objectively verified diagnosis of OSA. Main outcome: Measures symptom  profile of undiagnosed OSA (as measured by the Apnoea/Hypopnoea Index [AHI]) in hypertensive outpatients in primary care.

    RESULTS:

    Fifty-nine percent of the patients had an AHI ≥ 5/hour indicating OSA. An exploratory factor analysis based on 19 variables yielded a six-factor model  (anthropometrics, blood pressure, OSA-related symptoms, comorbidity, health complaints and physical activity) explaining 58% of the variance. SEM analyses showed strong significant associations between anthropometrics (body mass index, neck circumference, waist circumference) (0.45), OSA-related  symptoms (snoring, witnessed apnoeas, dry mouth) (0.47) and AHI. No direct effects of OSA on comorbidities, blood pressure, dyssomnia or self-rated health were observed.

    CONCLUSION:

    OSA was highly prevalent and was directly associated with anthropometrics and OSA-related symptoms  (snoring, witnessed apnoeas and dry mouth in the morning). When meeting patients with hypertension, these characteristics could be used by general practitioners to identify patients who are in need of referral to a sleep clinic for OSA evaluation.

  • 38.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Sunnergren, Ola
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Fridlund, Bengt
    Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Gender differences in respiratory disturbance, sleep and daytime sleepiness in hypertensive patients with different degrees of obesity2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 2, p. 140-149Article in journal (Refereed)
    Abstract [en]

    Background: Hypertension (HT) and obesity have both been linked to obstructive sleep apnoea (OSA). Difficulties have been described in identifying patients with OSA in primary care, causing low referral rates to sleep clinics. Increased knowledge about gender-specific characteristics and symptoms may help to identify patients. Aim: The aim was to describe gender differences regarding undiagnosed OSA, self-rated sleep, insomnia and daytime sleepiness in middle-aged primary care patients with HT and different degrees of obesity. Methods: A cross-sectional design was used and 394 patients (52.5% women), mean age 57.8 years (SD 6.7 years), with HT (BP >140/90 mmHg) were included. Clinical examinations, respiratory recordings and self-rated scales regarding OSA symptoms, sleep, insomnia and daytime sleepiness were used. Body mass index (BMI) was classified according to the criteria from the National Institutes of Health. Results: Pre-obesity and obesity classes I and II were seen among 53%, 26% and 8% of the men and 37%, 19% and 14% of the women, respectively. Occurrence of mild, moderate and severe OSA increased significantly across the BMI classes for both genders (p<0.01). Ninety percent of the men and 80% of the women in obesity class II had OSA. Insomnia was prevalent in obese patients. Other clinical variables did not differ between BMI classes or genders. Conclusion: The occurrence of overweight/obesity and OSA was high among both genders. A high BMI might be a convenient clinical marker for healthcare personnel to identify hypertensive patients with possible OSA in need of further evaluation and treatment.

  • 39.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Franzén Årestedt, Kristofer
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Nursing Science.
    The attitudes to CPAP treatment inventory: development and initial validation of a new tool for measuring attitudes to CPAP treatment2011In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 20, no 3, p. 460-471Article in journal (Refereed)
    Abstract [en]

    ontinuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but low adherence rates are common. The aim was to develop the attitudes to CPAP treatment inventory (ACTI), and to investigate the validity and reliability of the instrument among patients with OSAS. ACTI was developed on the basis of: (i) in-depth interviews with 23 patients; (ii) examination of the scientific literature; and (iii) consensus agreement of a multi-professional expert panel. This yielded five different types of attitudes to CPAP treatment. A prospective longitudinal design was used. Two-hundred and eighty-nine patients with OSAS were recruited at three different CPAP centres. Data were collected with ACTI and obtained from medical records. The homogeneity and internal consistency reliability were satisfactorily reflected by the item-total correlations (0.59-0.81) and Cronbachs alpha (0.89), respectively. Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation; PCF). The PCF based on baseline data resulted in a one single-factor solution explaining 69% of the total variance. A confirmatory factor analysis was performed 2 weeks after CPAP initiation, resulting in the same factor solution. No indication of uniform differential item functioning was found. The predictive validity was tested with receiver operating characteristic analyses, and a cut-off of 10 on the ACTI gave a sensitivity of 93% and a specificity of 44% for CPAP termination within 6 months. The satisfactory measurement properties of this new pragmatic instrument are promising and indicate that ACTI can be useful in clinical practice to reliably measure attitudes to CPAP treatment.

  • 40.
    Bång, Magnus
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Eriksson, Henrik
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Lindqvist, K
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    An approach to context-sensitive medical applications1999In: JAMIA Journal of the American Medical Informatics Association, ISSN 1067-5027, E-ISSN 1527-974X, p. 1017-1017Conference paper (Other academic)
  • 41.
    Bång, Magnus
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Ubiquitous computing to support co-located clinical teams: Using the semiotics of physical objects in system design2007In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 76, no SUPPL. 1, p. 58-64Article in journal (Refereed)
    Abstract [en]

    Objectives: Co-located teams often use material objects to communicate messages in collaboration. Modern desktop computing systems with abstract graphical user interface (GUIs) fail to support this material dimension of inter-personal communication. The aim of this study is to investigate how tangible user interfaces can be used in computer systems to better support collaborative routines among co-located clinical teams. Methods: The semiotics of physical objects used in team collaboration was analyzed from data collected during 1 month of observations at an emergency room. The resulting set of communication patterns was used as a framework when designing an experimental system. Following the principles of augmented reality, physical objects were mapped into a physical user interface with the goal of maintaining the symbolic value of those objects. Results: NOSTOS is an experimental ubiquitous computing environment that takes advantage of interaction devices integrated into the traditional clinical environment, including digital pens, walk-up displays, and a digital desk. The design uses familiar workplace tools to function as user interfaces to the computer in order to exploit established cognitive and collaborative routines. Conclusion: Paper-based tangible user interfaces and digital desks are promising technologies for co-located clinical teams. A key issue that needs to be solved before employing such solutions in practice is associated with limited feedback from the passive paper interfaces. © 2006 Elsevier Ireland Ltd. All rights reserved.

  • 42.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care Centres.
    The Challenge of Changing Practice: Applying Theory in the Implementation of an Innovation in Swedish Primary Health Care2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: The translation of new knowledge, such as research findings, new tools or methods into health care practice has gained increased  interest in recent years. Important factors that determine implementation outcome have been identified, and models and checklists to be followed in planning as well as in carrying out an implementation process have been produced. However, there are still knowledge gaps regarding what approach should be used in which setting and for which problems. Primary health care (PHC) in Sweden is an area where there is a paucity of research regarding implementation of new methods into practice. The aim of the thesis was to apply theory in the study of the implementation of an innovation in Swedish PHC, and identify factors that influenced outcome.

    Methods: The study was performed using a quasi-experimental design, and included six PHC units, two from each one of three county councils in the southeast part of Sweden. A computer-based lifestyle intervention tool (CLT) developed to facilitate addressing lifestyle issues, was introduced at the units. Two different strategies were used for the introduction, both aiming to facilitate the process: a theory-based explicit strategy and an implicit strategy requiring a minimum of effort. Data collection was performed at baseline, and after six, nine and 24 months. Questionnaires were distributed to staff and managers, and data was also collected from the CLT database and county council registers. Implementation outcome was defined as the proportion of eligible patients being referred to the CLT, and was also measured in terms of Reach, Effectiveness, Adoption, Implementation and Maintenance according to the RE-AIM framework. Interviews were performed in order to explore experiences of the implementation process as perceived by staff and managers.

    Results: A positive organizational climate seemed to promote implementation. Organizational changes or staff shortages coinciding with the implementation process had a negative influence on outcome. The explicit implementation strategy seemed to be more effective than the implicit strategy in the short term, but the differences levelled out over time. The adopters’ perceptions of the implementation seemed to be influenced by the existing professional sub-cultures. Successful implementation was associated with positive expectations, perceptions of the innovation being compatible with existing routines and perceptions of relative advantage.

    Conclusions: The general conclusion is that when theory was applied in the implementation of a lifestyle intervention tool in Swedish PHC, factors related to the adopters and to the innovation seemed to be more important over time than the strategy used. Staff expectations, perceptions of the innovation’s relative advantage and potential compatibility with existing routines were found to be positively associated with implementation outcome, and other major organizational changes concurrent with implementation seemed to affect the outcome in a negative way. Values, beliefs and behaviour associated with the existing sub-cultures in PHC appeared to influence how the implementation of an innovation was perceived by managers and the different professionals.

    List of papers
    1. The importance of organizational climate and implementation strategy at the introduction of a new working tool in primary health care
    Open this publication in new window or tab >>The importance of organizational climate and implementation strategy at the introduction of a new working tool in primary health care
    2010 (English)In: Journal of Evaluation in Clinical Practice, ISSN 1356-1294, Vol. 16, no 6, p. 1326-1332Article in journal (Refereed) Published
    Abstract [en]

    Rationale, aims and objectives The transmission of research findings into routine care is a slow and unpredictable process. Important factors predicting receptivity for innovations within organizations have been identified, but there is a need for further research in this area. The aim of this study was to describe contextual factors and evaluate if organizational climate and implementation strategy influenced outcome, when a computer-based concept for lifestyle intervention was introduced in primary health care (PHC). Method The study was conducted using a prospective intervention design. The computer-based concept was implemented at six PHC units. Contextual factors in terms of size, leadership, organizational climate and political environment at the units included in the study were assessed before implementation. Organizational climate was measured using the Creative Climate Questionnaire (CCQ). Two different implementation strategies were used: one explicit strategy, based on Rogers theories about the innovation-decision process, and one implicit strategy. After 6 months, implementation outcome in terms of the proportion of patients who had been referred to the test, was measured. Results The CCQ questionnaire response rates among staff ranged from 67% to 91% at the six units. Organizational climate differed substantially between the units. Managers scored higher on CCQ than staff at the same unit. A combination of high CCQ scores and explicit implementation strategy was associated with a positive implementation outcome. Conclusions Organizational climate varies substantially between different PHC units. High CCQ scores in combination with an explicit implementation strategy predict a positive implementation outcome when a new working tool is introduced in PHC.

    Place, publisher, year, edition, pages
    Blackwell Publishing Ltd, 2010
    Keywords
    implementation, life style, organizational climate, primary health care
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-65943 (URN)10.1111/j.1365-2753.2009.01336.x (DOI)000285763900048 ()
    Note
    This is the authors’ version of the following article: Siw Carlfjord, A Andersson and Per Nilsen, The importance of organizational climate and implementation strategy at the introduction of a new working tool in primary health care, 2010, JOURNAL OF EVALUATION IN CLINICAL PRACTICE, (16), 6, 1326-1332. which has been published in final form at: http://dx.doi.org/10.1111/j.1365-2753.2009.01336.x Copyright: Blackwell Publishing Ltd http://eu.wiley.com/WileyCDA/Brand/id-35.htmlAvailable from: 2011-02-28 Created: 2011-02-28 Last updated: 2013-09-30
    2. Applying the RE-AIM framework to evaluate two implementation strategies used to introduce a tool for lifestyle intervention in Swedish primary health care
    Open this publication in new window or tab >>Applying the RE-AIM framework to evaluate two implementation strategies used to introduce a tool for lifestyle intervention in Swedish primary health care
    Show others...
    2012 (English)In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 27, no 2, p. 167-176Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to evaluate two implementation strategies for the introduction of a lifestyle intervention tool in primary health care (PHC), applying the RE-AIM framework to assess outcome. A computer-based tool for lifestyle intervention was introduced in PHC. A theory-based, explicit, implementation strategy was used at three centers, and an implicit strategy with a minimum of implementation efforts at three others. After 9 months a questionnaire was sent to staff members (n= 159) and data from a test database and county council registers were collected. The RE-AIM framework was applied to evaluate outcome in terms of reach, effectiveness, adoption and implementation. The response rate for the questionnaire was 73%. Significant differences in outcome were found between the strategies regarding reach, effectiveness and adoption, in favor of the explicit implementation strategy. Regarding the dimension implementation, no differences were found according to the implementation strategy. A theory-based implementation strategy including a testing period before using a new tool in daily practice seemed to be more successful than a strategy in which the tool was introduced and immediately used for patients.                 

    Place, publisher, year, edition, pages
    Oxford University Press, 2012
    Keywords
    Implementation; Primary health care; RE-AIM
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-73379 (URN)10.1093/heapro/dar016 (DOI)000304016100004 ()
    Available from: 2012-01-13 Created: 2012-01-02 Last updated: 2017-12-08Bibliographically approved
    3. Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory
    Open this publication in new window or tab >>Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory
    Show others...
    2010 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 11, no 60Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Bridging the knowledge-to-practice gap in health care is an important issue that has gained interest in recent years. Implementing new methods, guidelines or tools into routine care, however, is a slow and unpredictable process, and the factors that play a role in the change process are not yet fully understood. There is a number of theories concerned with factors predicting successful implementation in various settings, however, this issue is insufficiently studied in primary health care (PHC). The objective of this article was to apply implementation theory to identify key factors influencing the adoption of an innovation being introduced in PHC in Sweden.

    METHODS: A qualitative study was carried out with staff at six PHC units in Sweden where a computer-based test for lifestyle intervention had been implemented. Two different implementation strategies, implicit or explicit, were used. Sixteen focus group interviews and two individual interviews were performed. In the analysis a theoretical framework based on studies of implementation in health service organizations, was applied to identify key factors influencing adoption.

    RESULTS: The theoretical framework proved to be relevant for studies in PHC. Adoption was positively influenced by positive expectations at the unit, perceptions of the innovation being compatible with existing routines and perceived advantages. An explicit implementation strategy and positive opinions on change and innovation were also associated with adoption. Organizational changes and staff shortages coinciding with implementation seemed to be obstacles for the adoption process.

    CONCLUSION: When implementation theory obtained from studies in other areas was applied in PHC it proved to be relevant for this particular setting. Based on our results, factors to be taken into account in the planning of the implementation of a new tool in PHC should include assessment of staff expectations, assessment of the perceived need for the innovation to be implemented, and of its potential compatibility with existing routines. Regarding context, we suggest that implementation concurrent with other major organizational changes should be avoided. The choice of implementation strategy should be given thorough consideration.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-59064 (URN)10.1186/1471-2296-11-60 (DOI)
    Available from: 2010-09-08 Created: 2010-09-08 Last updated: 2017-12-12Bibliographically approved
    4. Experiences of the implementation of a tool for lifestyle intervention in primary health care: a qualitative study among managers and professional groups
    Open this publication in new window or tab >>Experiences of the implementation of a tool for lifestyle intervention in primary health care: a qualitative study among managers and professional groups
    2011 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 11, no 195Article in journal (Refereed) Published
    Abstract [en]

    Background:In recent years there has been increasing interest in transferring new knowledge into health care practices, a process often referred to as implementation. The various subcultures that exist among health care workers may be an obstacle in this process. The aim of this study was to explore how professional groups and managers experienced the implementation of a new tool for lifestyle intervention in primary health care (PHC). The computer-based tool was introduced with the intention of facilitating the delivery of preventive services.

    Methods:Focus group interviews with staff and individual interviews with managers at six PHC units in the southeast of Sweden were performed 9 months after the introduction of the new working tool. Staff interviews were conducted in groups according to profession, and were analysed using manifest content analysis. Experiences and opinions from the different staff groups and from managers were analysed.

    Results: Implementation preconditions, opinions about the lifestyle test, and opinions about usage were the main areas identified. In each of the groups, managers and professionals, factors related to the existing subcultures seemed to influence their experiences of the implementation. Managers were visionary, GPs were reluctant, nurses were open, and nurse assistants were indifferent.

    Conclusion: This study indicates that the existing subcultures in PHC influence how the implementation of an innovation is perceived by managers and the different professionals. In PHC, an organization with several subcultures and an established hierarchical structure, an implementation strategy aimed at all groups did not seem to result in a successful uptake of the new method.

    Place, publisher, year, edition, pages
    BioMed Central, 2011
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-71112 (URN)10.1186/1472-6963-11-195 (DOI)000294735700002 ()
    Available from: 2011-09-30 Created: 2011-09-30 Last updated: 2017-12-08
    5. Sustained use of a tool for lifestyle intervention implemented in primary health care: a 2-year follow-up
    Open this publication in new window or tab >>Sustained use of a tool for lifestyle intervention implemented in primary health care: a 2-year follow-up
    2013 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 19, no 2, p. 327-334Article in journal (Refereed) Published
    Abstract [en]

    Rational, aims and objectives: Sustainability of new methods implemented in health care is one of the most central issues in addressing the gap between research and practice, but is seldom assessed in implementation studies. The aim of this study was to evaluate the implementation of a new tool for lifestyle intervention in primary health care (PHC) 2 years after the introduction, and assess if the implementation strategy used influenced sustainability.

    Method: A computer-based lifestyle intervention tool (CLT) was introduced at six PHC units in Sweden in 2008, using two implementation strategies: explicit and implicit. The main difference between the strategies was a 4-week test period followed by a decision session, included in the explicit strategy. Evaluations were performed after 6, 9 and 24 months. After 24 months, the RE-AIM framework was applied to assess and compare outcome according to strategy.

    Results: A more positive outcome regarding Reach, Effectiveness, Adoption and Implementation in the explicit group could be almost completely attributed to one of the units. Maintenance was low and after 24 months, differences according to strategy were negligible.

    Conclusion: After 24 months the most positive outcomes regarding all RE-AIM dimensions were found in one of the units where the explicit strategy was used. The explicit strategy per se had some effect on the dimension Effectiveness, but was not associated with sustainability overall. Staff at the most successful unit earlier had positive expectations regarding the CLT and found it compatible with existing routines.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2013
    Keywords
    implementation, lifestyle, primary health care, sustainability
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-74877 (URN)10.1111/j.1365-2753.2012.01827.x (DOI)000315964800017 ()
    Note

    Funding Agencies|Medical Research Council of Southeast Sweden (FORSS)||Swedish Council for Working Life and Social Research (FAS)||

    Available from: 2012-02-10 Created: 2012-02-10 Last updated: 2017-12-07Bibliographically approved
  • 43.
    Carlfjord, Siw
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care Centres.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Lindberg, Malou
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Applying the RE-AIM framework to evaluate two implementation strategies used to introduce a tool for lifestyle intervention in Swedish primary health care2012In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 27, no 2, p. 167-176Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate two implementation strategies for the introduction of a lifestyle intervention tool in primary health care (PHC), applying the RE-AIM framework to assess outcome. A computer-based tool for lifestyle intervention was introduced in PHC. A theory-based, explicit, implementation strategy was used at three centers, and an implicit strategy with a minimum of implementation efforts at three others. After 9 months a questionnaire was sent to staff members (n= 159) and data from a test database and county council registers were collected. The RE-AIM framework was applied to evaluate outcome in terms of reach, effectiveness, adoption and implementation. The response rate for the questionnaire was 73%. Significant differences in outcome were found between the strategies regarding reach, effectiveness and adoption, in favor of the explicit implementation strategy. Regarding the dimension implementation, no differences were found according to the implementation strategy. A theory-based implementation strategy including a testing period before using a new tool in daily practice seemed to be more successful than a strategy in which the tool was introduced and immediately used for patients.                 

  • 44.
    Carlfjord, Siw
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.
    Andersson, Agneta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindberg, Malou
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    IMPLEMENTING A LIFESTYLE INTERVENTION TOOL INTO PRIMARY HEALTH CARE: IDENTIFICATION OF KEY FACTORS THAT INFLUENCE ADOPTION in INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE, vol 17, issue , pp 92-922010In: INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE, Springer Science Business Media , 2010, Vol. 17, p. 92-92Conference paper (Refereed)
    Abstract [en]

    n/a

  • 45.
    Carlfjord, Siw
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Primary Health Care Centres.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindberg, Malou
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Experiences of the implementation of a tool for lifestyle intervention in primary health care: a qualitative study among managers and professional groups2011In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 11, no 195Article in journal (Refereed)
    Abstract [en]

    Background:In recent years there has been increasing interest in transferring new knowledge into health care practices, a process often referred to as implementation. The various subcultures that exist among health care workers may be an obstacle in this process. The aim of this study was to explore how professional groups and managers experienced the implementation of a new tool for lifestyle intervention in primary health care (PHC). The computer-based tool was introduced with the intention of facilitating the delivery of preventive services.

    Methods:Focus group interviews with staff and individual interviews with managers at six PHC units in the southeast of Sweden were performed 9 months after the introduction of the new working tool. Staff interviews were conducted in groups according to profession, and were analysed using manifest content analysis. Experiences and opinions from the different staff groups and from managers were analysed.

    Results: Implementation preconditions, opinions about the lifestyle test, and opinions about usage were the main areas identified. In each of the groups, managers and professionals, factors related to the existing subcultures seemed to influence their experiences of the implementation. Managers were visionary, GPs were reluctant, nurses were open, and nurse assistants were indifferent.

    Conclusion: This study indicates that the existing subcultures in PHC influence how the implementation of an innovation is perceived by managers and the different professionals. In PHC, an organization with several subcultures and an established hierarchical structure, an implementation strategy aimed at all groups did not seem to result in a successful uptake of the new method.

  • 46.
    Carlfjord, Siw
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.
    Andersson, Agneta
    Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    The importance of organizational climate and implementation strategy at the introduction of a new working tool in primary health care2010In: Journal of Evaluation in Clinical Practice, ISSN 1356-1294, Vol. 16, no 6, p. 1326-1332Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectives The transmission of research findings into routine care is a slow and unpredictable process. Important factors predicting receptivity for innovations within organizations have been identified, but there is a need for further research in this area. The aim of this study was to describe contextual factors and evaluate if organizational climate and implementation strategy influenced outcome, when a computer-based concept for lifestyle intervention was introduced in primary health care (PHC). Method The study was conducted using a prospective intervention design. The computer-based concept was implemented at six PHC units. Contextual factors in terms of size, leadership, organizational climate and political environment at the units included in the study were assessed before implementation. Organizational climate was measured using the Creative Climate Questionnaire (CCQ). Two different implementation strategies were used: one explicit strategy, based on Rogers theories about the innovation-decision process, and one implicit strategy. After 6 months, implementation outcome in terms of the proportion of patients who had been referred to the test, was measured. Results The CCQ questionnaire response rates among staff ranged from 67% to 91% at the six units. Organizational climate differed substantially between the units. Managers scored higher on CCQ than staff at the same unit. A combination of high CCQ scores and explicit implementation strategy was associated with a positive implementation outcome. Conclusions Organizational climate varies substantially between different PHC units. High CCQ scores in combination with an explicit implementation strategy predict a positive implementation outcome when a new working tool is introduced in PHC.

  • 47.
    Carlfjord, Siw
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care Centres.
    Berglund, Ebba
    Östergötlands Läns Landsting.
    Dahlberg, Johanna
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Health care student teams participating in Quality Improvement - A large scale implementation in collaboration between University and County council2013Conference paper (Other academic)
    Abstract [en]

    Introduction

    In Health care we always need to improve patient quality and safety. Therefore from an employer’s perspective, it is very important that future employees have knowledge about Quality Improvement (QI) work. Together the Faculty of Health Sciences of Linköping University and the County Council of Östergötland have designed a learning experience where undergraduate students participate and learn about QI work in clinical practice.

     

    Methods

    Our two organizations started this project together in 2006 with an investigation. Then we begun the work with each semester as a testcycle which were evaluated. After decisions and planning we started in full scale in January 2011. Each semester, about 300 undergraduate students, in interprofessional teams, learn about Quality Improvement in 45 clinical settings, supervised by a tutor and a member of the clinical team.

     

    Results

    Since we started the outcome of the project is measured as improvement in

    student, staff and patient value. The results have been used to continuously improve the project itself. The satisfaction in the different groups has improved over time. We will show data of this at the presentation.

     

    Discussion

    This is an example of large scale implementation in two different organizations. There are also a lot of interests involved, students, tutors, staff, patients and leaders in our two companies.

    In the workshop experiences from this large scale implementation performed in cooperation between the university and the health care providers will be described. One of the student projects will also be presented. After that we invite to a discussion with the audience regarding the project and to problematize around large scale implementation. Our suggested time table is 45 min for presentation and 45 minutes for questions and discussion.

    We also plan for more presentations of student projects in poster format to be shown in the lecture hall.

  • 48.
    Carlfjord, Siw
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care Centres.
    Johansson, Kjell
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Association Between Frequency of Heavy Episodic Drinking and Self-reported Consequences: A Cross-sectional Study in a Swedish Population2012In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 47, no 6, p. 719-724Article in journal (Refereed)
    Abstract [en]

    Aims: To describe perceived negative consequences (PNCs) of alcohol consumption related to the frequency of heavy episodic drinking (HED) in a Swedish population attending primary health care (PHC). Methods: Data from a computer-based assessment, including questions about alcohol consumption and PNC, were collected from 28 PHC centres in Sweden. The analysis included 4559 responders. Risk ratios concerning PNC for different frequencies of HED were calculated. Results: Engaging in HED once a month for women and two to three times a month for men significantly raised the proportion of individuals reporting PNC, compared with engaging in HED less than once a month. The men reported PNC of alcohol consumption to a higher degree than the women, and in general, the proportion of individuals reporting PNC was associated with the frequency of HED. Conclusion: Engaging in HED once a month for women and two to three times a month for men are critical levels regarding PNC of alcohol consumption. To identify a cut-off value for categorizing individuals as hazardous alcohol consumers due to the frequency of HED, further studies are needed.

  • 49.
    Carlfjord, Siw
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.
    Johansson, Kjell
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Staff perspectives on the use of a computer-based concept for lifestyle intervention implemented in primary health care2010In: HEALTH EDUCATION JOURNAL, ISSN 0017-8969, Vol. 69, no 3, p. 246-256Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to evaluate staff experiences of the use of a computer-based concept for lifestyle testing and tailored advice implemented in routine primary health care (PHC). Design: The design of the study was a cross-sectional, retrospective survey. Setting: The study population consisted of staff at nine PHC units in the county of Ostergotland, Sweden. Method: After a computer-based concept for lifestyle intervention had been in operation for 1 year, a questionnaire was distributed to all staff members. The questions concerned experiences of and attitudes to the concept, and comments on addressing lifestyle issues in PHC. Results: Of the 291 potential respondents, 59 per cent returned the questionnaire. Eighty-five per cent found it positive to refer to the computer-based test, and 93 per cent of those who had read the written advice generated by the computer agreed with the advice provided. Seventy-five per cent thought that the concept could have an effect on a patients lifestyle, and 78 per cent had confidence in the computer-based test. Staff at smaller PHC units had more positive attitudes (p = 0.003) and referred a higher proportion of their patients to the computer-based test than staff at larger units (p = 0.000). Follow-up rates showed no significant differences between the categories. Staff believed that inclusion of more lifestyle areas, e. g. smoking and dietary habits, would make the test more useful. More time, education and the establishment of lifestyle practices were issues suggested in order to enhance the focus on lifestyle factors. Conclusion: Staff members have confidence in the computerized test and consider it a valuable tool. A development towards more lifestyle areas will make it even more useful.

  • 50.
    Carlfjord, Siw
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Lindberg, Malou
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Experiences of Working with the Tobacco Issue in the Context of Health Promoting Hospitals and Health Services: A Qualitative Study2011In: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, ISSN 1660-4601, Vol. 8, no 2, p. 498-513Article in journal (Refereed)
    Abstract [en]

    The worldwide Health Promoting Hospital and Health Services (HPH) network was initiated by the World Health Organizations in the late 1980s. The goal of the network is to change the focus of health services from curing patients to also embrace disease prevention and health promotion. In Sweden the network started in 1996, and involves mainly hospitals and primary care. The network members collaborate in task forces, one of which is working on the tobacco issue. There is limited evidence on the value of working within an HPH organization. The aim of this study was to investigate the experiences of members of the Swedish HPH network tobacco task force. Focus group interviews with task force members were analyzed using implementation theory. Three themes, overall experiences of working with tobacco issues, experiences of working with. free from tobacco in connection with surgery., and experiences of work in the HPH tobacco task force, emerged from the interviews. The results show that working with the tobacco issue in the context of health-promoting hospitals and health services met with difficulties involving the following important factors: evidence, context, facilitation and adopter characteristics. Leadership, one contextual factor, at national and local level, seems to be crucial if the work is going to succeed. The tobacco task force of the HPH network is an important facilitator supporting the task.

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