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  • 1. 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)
  • 2.
    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.

  • 3. 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.

  • 4.
    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)
  • 5.
    Comba, Pietro
    Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Yrkes-miljömedicin. Linköping University, Faculty of Health Sciences.
    Epidemiologic studies of nasal cancer and occupational exposures1992Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The object of the present research has been to elucidate the associations between malignant epithelial neoplasms of the nasal cavities and paranasal sinuses and workplace exposures to ascertained as well as suspected cancer causing agents and processes.

    The research includes six independent case-control studies, located in various Italian regions. These regions are characterized by different patterns of industrialization, resulting in an involvement of various occupations of interest. Furthermore, the main findings of a national programme of surveillance of nasal cancer are presented.

    The regions selected for the studies were the district ofBiella in Piedmont (high proportion of the active population employed in textile industry), the province of Brescia in Lombardy (high proportion of the activepopulation employed in metal industry), the provinces of Verona and Vicenza in Venetia (an area characterized by textile and leather industry and by farming), the province of Siena (a mainly rural area, with a well-established wood industry) and the province of Pisa (characterized by the presence of wood and leather industry); the two latter provinces are both located in Tuscany. The national surveillance program was based on the collaborative effort of 61 ear, nose and throat departments operating all over Italy. Finally, a case-control study involving subjects from the National Cancer Institute in Milan provided information at a national level, since patients from all over the country attend this centre.

    The present research confrrmed the well established risk of nasal cancer associated with the occupations of woodworker and leatherworker. The combined estimates of the odds ratios were 6.0 (90% CI: 3.8-9.3) and 5. 7 (90 % Cl: 2.8-12), respectively, which are lower and somewhat less dramatic effects than seen in some of the earlier studies.

    A significant association between nasal cancer and some other occupations was detected, namely metal industry, the combined estimate of the odds ratio being 2.3 (90 % Cl: 1.2-4.3), textile and gannent industry (OR: 2.2; 90% Cl: 1.2-4.1), mining and construction industry (OR: 2.8; 90% Cl: 1.6·5.0), fanning (OR: 2.3; 90% Cl: 1.4-3.8) and other occupations entailing exposures to dusts and fumes (OR: 2.0; 90% Cl: 1.1-3.6).

    The etiologic fraction associated with all hazardous occupational exposures was about 60 %, indicating that a considerable preventive effect could be achievable by improving the quality of the work environment. With regard to the high fatality of this disease, and the serious impairments of quality of life among the survivors, the importance of prevention is not only obvious but also ethically imperative.

  • 6.
    Dinka, David
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Nyce, J.M.
    Department of Library and Information Management, Emporia State, Emporia, KS 66801, United States.
    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.
    The need for transparency and rationale in automated systems2006In: Interacting with computers, ISSN 0953-5438, E-ISSN 1873-7951, Vol. 18, no 5, p. 1070-1083Article in journal (Refereed)
    Abstract [en]

    As medical devices and information systems become increasingly complex, the issue of how to support users becomes more important. However, many current help systems are often ignored or found to be too complicated to use by clinicians. In this article, we suggest an approach that allows designers to think about user support and automating tasks in ways users find more acceptable. The issue we address in particular is the notion of transparency and to what extent it allows the end-user to understand and critique the advice given. We have found that one central problem with existing support systems is that often the end-user does not understand the differences between the automated parts and the parts that have to be done manually. By taking aspects of transparency and control into account when designing an automated tool it seems that some of the more refractory issues that help systems pose for professional users can be addressed. © 2006 Elsevier B.V. All rights reserved.

  • 7.
    Dinka, David
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Nyce, J.M.
    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.
    Holmberg, K.
    Adding value with 3D visualization and haptic forces to radiosurgery - A small theory-based, quasi-experimental study2006In: Journal of medical systems, ISSN 0148-5598, E-ISSN 1573-689X, Vol. 30, no 4, p. 293-301Article in journal (Refereed)
    Abstract [en]

    This study investigates the use of 3D representation and haptic technology in radiosurgery. The users, experienced users of the Leksell GammaKnife, prefer the 3D representation for constructing a first draft of their plan for neurosurgical intervention. When it comes to the final adjustments, however, they still choose the traditional 2D representation and interaction devices. The perceived control over the radiosurgical process is not considered adequate using the 3D interaction methods. Practitioners do not consider the haptic forces implemented in this test system useful. Possible explanations for these findings are discussed in the paper. © Springer Science+Business Media, Inc. 2006.

  • 8.
    Ekberg, Kerstin
    Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Yrkes-miljömedicin. Linköping University, Faculty of Health Sciences.
    An epidemiologic approach to disorders in the neck and shoulders1994Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Complaints about pain in the locomotor system represent a commonly occuning health problem among working people all over the world. In this context, a series of studies were employed to determine if work organization and psychosocial conditions at work, in addition to physical work load, contribute to the development of disorders in the neck and shoulders. The potentially health-promoting effect of early and active rehabilitation of those already suffering from disorders in the neck and shoulders was also evaluated.

    A first psychophysiological study showed that various stress conditions during monotonous work had limited effects on muscle tension. The interindividual variability in muscle reactions to stress was large, but the results indicate that some individuals may react with a sustained, low-level muscle activity that is associated with pain.

    A cross-sectional study of a sample of a normal working population and a case-control study of patients with disorders in the neck and shoulders revealed a set of work-related core determinants, which appear to be essential component causes for the development of symptoms and signs. Prevalence ratios (PR) were calculated for determinants of early symptoms in the cross-sectional study, and odds ratios (OR) were estimated in the case-control study for determinants of disorders of the neck and shoulders. Repetitive movements demanding precision (PR 1.2 and OR 7.5, respectively), high work pace (PR 1.2 and OR 3.5, respectively), low quality work content (low decision latitude and lqw skill discretion; PR 1.3 and OR 2.6, respectively), and uncertainty about how to perform and-manage the tasks (work-role ambiguity; PR 1.2 and OR 16.5, respectively) were associated with both development of early symptoms, and disorders in the neck and shoulders. The results also show that being a woman (PR 1.3 and OR 11.4, respectively) and I or an immigrant (PR 1.3 and OR 4.9, respectively) imposes a higher risk for developing signs and symptoms in the neck and shoulders, possibly due to selective job-assignment.

    A controlled, two-year follow-up of cohorts of subjects with early and active rehabilitation versus traditional, less active treatment of neck~shoulder disorders respectively, did not support the hypothesis that active rehabilitation, as compared to traditional treatment methods, promotedbetter health, unless work conditions were changed. People who remained on the same job after rehabilitation, independent of type of treatment, had a less positive prognosis (relative risk 3.6) than those who had a changed work situation.

    Further analysis of which factors retained people in long-term sick-leave suggested that work conditions are more important than personality and other individual characteristics in determining the amount of time that will elapse before individuals will resume work after a sickleave. There was no gender-difference in this respect.

  • 9.
    Hermansson, Ann-Charlotte
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Socialmed FHVC.
    Nyce, James M
    Exploration of the life histories and future of war-wounded Salvadoran and Iranian Kurd quota refugees in Sweden: A qualitative approach2003In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 12, no 2, p. 142-153Article in journal (Refereed)
    Abstract [en]

    This study explores the life histories of ten Salvadoran and twelve Iranian Kurd refugees. Both groups came to Sweden as war-wounded quota refugees and their migration was forced. They had spent many years in guerilla movements and were experienced soldiers despite their youth. They were interviewed during hospitalisation shortly after arrival in Sweden, and followed-up after two years. The findings suggest that repatriation is a recurrent theme in the future plans of these refugees. The reconstruction of identity may take many forms due to a background as youth soldiers as well as their different experiences of the culture in the host country. Longitudinal studies of how refugees rebuild their lives are needed, and comprehensive analysis from different theoretical perspectives is a necessary complement to general adaptation models.

  • 10.
    Hermansson, Ann-Charlotte
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, PC - Psykiatricentrum, FMC - Flyktingmedicinskt centrum.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Socialmed FHVC.
    Thyberg, Mikael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    The long-term impact of torture on the mental health of war-wounded refugees: Findings and implications for nursing programmes2003In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 17, no 4, p. 317-324Article in journal (Refereed)
    Abstract [en]

    Today, nurses from many disciplines are expected to provide nursing care to refugees severely traumatized in war and conflict. The general aim of this study was to explore the long-term impact of torture on the mental health of war-wounded refugees. The study group consisted of 22 tortured and 22 nontortured male refugees who had been injured in war. Standardized interview schedules, exploring different background characteristics, and three instruments for assessment of mental health were used: the Hopkins Symptom Checklist, the Post Traumatic Symptom Scale and a well-being scale. The prevalence of psychiatric symptoms was high in both groups. However, there were no significant differences in mental health between the tortured and the nontortured refugees. The patterns of associations between background characteristics and mental health were different in the two groups. The strongest associations with lower level of mental health were higher education in the tortured group and unemployment in the nontortured group. Methodological difficulties in research on sequelae of prolonged traumatization remain. Further studies within the caring sciences can broaden the present understanding of the impact of torture and other war traumas. ⌐ 2003 Nordic College of Caring Sciences.

  • 11.
    Hermansson, Ann-Charlotte
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Socialmed FHVC.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Socialmed FHVC.
    Thyberg, Mikael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    The Mental Health of War-wounded Refugees: An 8-year Follow-up2002In: Journal of Nervous and Mental Disease, ISSN 0022-3018, E-ISSN 1539-736X, Vol. 190, p. 374-380Article in journal (Refereed)
    Abstract [en]

    The complex nature of recent wars and armed conflicts has forced many war-injured persons into exile. To investigate their long-term mental health, three instruments for assessing mental health (HSCL-25, PTSS-10, and a Well-Being scale) were presented to 44 war-wounded refugees from nine different countries 8 years after arrival in Sweden. The prevalence of psychiatric symptoms was high and corresponds to findings in previous studies of refugee patient populations. A lower level of mental health was associated with higher education, unemployment, and poor physical health. The findings suggest a high psychiatric morbidity and a need for psychiatric interventions in this refugee group. Methodological issues to be considered in research on sequels of war traumas are discussed.

  • 12.
    Irestig, Magnus
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Eriksson, Henrik
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    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.
    The Impact of Participation in Information System Design: A comparison of contextual placements2004In: Proceedings of Participatory Design Conference 2004, 2004Conference paper (Refereed)
  • 13.
    Irestig, Magnus
    et al.
    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.
    Politics and technology in health information systems development: A discourse analysis of conflicts addressed in a systems design group2008In: Journal of Biomedical Informatics, ISSN 1532-0464, E-ISSN 1532-0480, Vol. 41, no 1, p. 82-94Article in journal (Refereed)
    Abstract [en]

    Different types of disagreements must be managed during the development of health information systems. This study examines the antagonisms discussed during the design of an information system for 175,000 users in a public health context. Discourse analysis methods were used for data collection and analysis. Three hundred and twenty-six conflict events were identified from four design meetings and divided into 16 categories. There were no differences regarding the types of conflicts that the different participants brought into the design discussions. Instead, conflict occurrence was primarily affected by the agendas that set the stage for examinations and debates. The results indicate that the selection of design method and the structure used for the meetings are important factors for the manner in which conflicts are brought into consideration during health information system design. Further studies comparing participatory and non-participatory information system design practices in health service settings are warranted. © 2007 Elsevier Inc. All rights reserved.

  • 14. Kaminskas, A
    et al.
    Ziedén, Bo
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Elving, B
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Förebygg.med.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Förebygg.med.
    Abaravicius, A
    Bergdahl, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Olsson, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Kucinskiene, Z
    Adipose tissue fatty acids in men from two populations with different cardiovascular risk - the LiVicordia study.1999In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 59, p. 227-232Article in journal (Refereed)
  • 15.
    Kohli, S
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Noorling Brage, H
    Löfman, O
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Förebygg.med.
    Childhood leukaemia in areas with different radon levels: A spatial and temporal analysis using GIS2000In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 54, no 11, p. 822-826Article in journal (Refereed)
    Abstract [en]

    Objectives-To evaluate the relation between exposure to ground radon levels and leukaemia among children using existing population and disease registers. Design-Ecological correlation study. Setting-The county of Ostergotland in Sweden. Methods-Every child born in the county between 1979 and 1992 was mapped to the property centroid coordinates by linking addresses in the population and property registers. Population maps were overlaid with radon maps and exposure at birth and each subsequent year was quantified as high, normal, low or unknown. This was analysed with data from the tumour registry. Standardised mortality ratios (SMRs) were calculated using the age and sex specific rates for Sweden for the year 1995. Results-90 malignancies occurred among 53 146 children (498 887 person years) who formed the study population. SMRs for acute lymphatic leukemia (ALL) among children born in high, normal and low risk areas were 1.43, 1.17 and 0.25 respectively. The relative risk for the normal risk group and high risk group as compared with the low risk group was 4.64 (95% CI 1.29, 28.26) and 5.67 (95% CI 1.06, 42.27). The association between ALL and continued residence at normal or high risk areas showed a similar trend. No association between radon risk levels and any other malignancy was seen. Conclusion-Children born in and staying at areas where the risk from ground radon has been classified as low are less likely to develop ALL than those born in areas classified as normal and high risk.

  • 16.
    Krevers, Barbro
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Physiotherapy.
    Öberg, Birgitta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Development of the 'Patient perspective On Care and Rehabilitation process' instrument (POCR)2002In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 14, no 5, p. 402-411Article in journal (Refereed)
    Abstract [en]

    Background and aims: There is a lack of instruments for assessing patient-perceived quality of care developed from a process perspective and also from theoretical concepts based on a patient perspective. The objective was to develop an instrument for following-up the care and rehabilitation process of the elderly from the patients' perspective. Methods: The present instrument, the "Patient perspective On Care and Rehabilitation process" (POCR), is based on a theoretical framework for the patients' evaluation of the care process, i.e., an instrument-construction reflecting that the patients' needs differed during the care process. The POCR contains two scales, one measures the fulfilment of needs and the other the importance of the fulfilment of needs. Data collection took place via telephone interviews. Results: A factor analysis based on 306 cases resulted in seven factors reflecting the different phases in the care process and with an explained variance of 60.8. Assessed by Cronbach's alpha coefficient, the internal consistency was 0.83 for the total importance scale and between 0.55-0.71 for each factor. Conclusions: The POCR is a valid, reliable and useful multidimensional instrument for measuring patient-perceived outcome of the care and rehabilitation process in the elderly. (C) 2002, Editrice Kurtis.

  • 17.
    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.
    Rethinking health promotion: a global approach.2001In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 11, no 3, p. 354-354Article, book review (Other academic)
  • 18.
    Kristenson, Margareta
    Linköping University, Department of health and environment. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Förebygg.med. Linköping University, Faculty of Health Sciences.
    The LiVcordia Study: Possible causes for the differences in coronary heart disease mortality between Lithuania and Sweden1998Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: In recent decades coronary heart disease (CHD) mortality has declined in Western Europe and increased in Central and Eastern Europe. A large difference in CHD mortality has developed and the causes are not known. Lithuania and Sweden had similar CHD mortality rates for middle-aged men twenty years ago but in 1994 this mortality was four times higher in Lithuania than in Sweden. Also within countries CHD mortality is higher in low socioeconomic groups.

    Aim of the study: The LiVicordia (Linköping-Vilnius-coronary-artery-disease-risk-assessment) study aimed at identifying possible explanations for the different CHD mortality rates in the two countries.

    Method: This cross-sectional study concomitantly compared 150 randomly sampled 50-year-old men in each of the cities Vilnius, Lithuania and Linköping, Sweden from October 1993 nntil March 1995 using identical, standardised methodology. Investigations included a broad range of traditional and psychosocial risk factors for CHD, measures of oxidative stress, a standardised laboratory stress test and ultrasound measures of Peripheral atherosclerosis.

    Results: The differences found in traditional risk factors for CHD were small. Systolic blood pressure (SBP) was higher in Vilnius men, smoking was similar and plasma LDL cholesterol levels higher in Linköping men. Lower serum levels of the lipid soluble antioxidant vitamins carotene, lycopene and ytocopherol were found in Vilnius men, and also a higher susceptibility of LDL to oxidation in vitro. An unfavourable pattern of psychosocial risk factors for CHD: job strain, social isolation, depression and vital exhaustion characterised Vilnins men, who also showed an attenuated cortisol response to the laboratory stress test. This stress response has earlier been shown in states of chronic stress; loss of dynamic capacity to respond to new demands may be a predisposing factor for disease. Vilnius men had more peripheral atherosclerosis; thicker intima media, more and larger plaques and greater stiffness. Measures of atherosclerosis related to SBP, smoking, LDL cholesterol arrl P-carotene. The same unfavourable profile of risk factors for CHD, which characterised Vilnius men, was also found in underprivileged groups withip the cities. There were few differences in traditional risk factors.

    Conclusions: Thus, based on our survey on risk factors for CHD, it can be stated that traditional risk factors seem not to explain the different CHD mortality rates between Lithuania and Sweden. Possible alternative explanations are psychosocial strain and oxidative stress. These factors were also found among men in underprivileged groups within the cities. Therfore the influence of the risk factors studied may be relevant also for socioeconomic inequalities in CHD mortality within countries.

  • 19.
    Kristenson, Margareta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Förebygg.med.
    Jarkman, Kristina
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Göransson, Anne
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Förebygg.med.
    Wärnberg Gerdin, E
    Vang, Johannes
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Förebygg.med.
    Häggström, Anita
    Problembaserad inlärning som modell för utbildning i folkhälsovetenskap.2000In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 2, p. 154-159Article in journal (Other academic)
  • 20.
    Kristenson, Margareta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Förebygg.med.
    Kucinskiene, Z
    Bergdahl, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Tagesson, C
    Orth-Gomer, K
    Olsson, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Self-rated health and biological mechanisms: experiences from the LiVicordia study.2000In: Self-rated health in a European perspective / [ed] Peter Nilsson and Kristina Orth-Gomér, Linköping: Linköpings universitet , 2000, p. 167-175Chapter in book (Other academic)
  • 21.
    Kristenson, Margareta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Socialmed FHVC.
    Kucinskiené, Zita
    Schäfer-Elinder, Liselotte
    Leanderson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Östergötlands Läns Landsting, Pain and Occupational Centre, Occupational and Environmental Medicine Centre.
    Tagesson, Christer
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Östergötlands Läns Landsting, Pain and Occupational Centre, Occupational and Environmental Medicine Centre.
    Lower serum levels of beta-carotene in Lithuanian men are accompanied by higher urinary excretion of the oxidative DNA adduct, 8-hydroxydeoxyguanosine: The LiVicordia study.2003In: Nutrition (Burbank, Los Angeles County, Calif.), ISSN 0899-9007, E-ISSN 1873-1244, Vol. 19, no 1, p. 11-15Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: In 1995, middle-aged Lithuanian men had a four-fold higher risk than Swedish men of dying from coronary heart disease. The cross-sectional LiVicordia study had reported significantly lower levels of the lipid-soluble antioxidants lycopene, ▀-carotene, and ?-tocopherol among Lithuanian men than among Swedish men. We examined whether there were differences in urinary 8-hydroxydeoxyguanosine (8OHdG), a marker of oxidative stress, between these groups of men. METHODS: Using automated coupled column high-performance liquid chromatography with electrochemical detection, we examined 50-y-old men randomly sampled from Link÷ping, Sweden (n = 99) and Vilnius, Lithuania (n = 109) with regard to urinary concentrations of 8-OHdG. RESULTS: Levels of 8-OHdG were higher in the Lithuanian men than in the Swedish men (20.9 ▒ 0.91 versus 14.9 ▒ 0.75 nM/L, P < 0.001), and this difference was evident in smokers (P < 0.01) and non-smokers (P < 0.001). Serum levels of a- and ▀-carotene were inversely correlated to urinary 8-OHdG levels (P < 0.05 in both cases). Habitual smoking and low levels of ▀-carotene contributed significantly to higher oxidative DNA damage expressed as urinary 8-OHdG. CONCLUSIONS: These findings indicate that increased urinary 8-OHdG levels accompany lower serum levels of antioxidants in Lithuanian men. They supported previous suggestions that increased oxidative stress may be one factor behind the higher mortality in Lithuanian men. ⌐ Elsevier Science Inc. 2003.

  • 22.
    Kristenson, Margareta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Förebygg.med.
    Lassvik, Claes
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Bergdahl, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Kucinskiene, Z
    Aizieniene, L
    Ziedén, Bo
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Schäfer Elinder, Liselott
    Olsson, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Ultrasound determined carotid and femoral atherosclerosis in Lithuanian and Swedish men: The LiVicordia study2000In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 151, no 2, p. 501-508Article in journal (Refereed)
    Abstract [en]

    Coronary heart disease mortality is four times higher in Lithuanian compared to Swedish middle-aged men. Using the same equipment (Acuson XP10 with 5 MHz linear transducer) and staff, we compared the amount of atherosclerosis in carotid and femoral arteries in 100 randomly sampled 50-year-old men in each of the cities Vilnius, Lithuania and Linköping, Sweden. Atherosclerotic plaques were more abundant in Vilnius men compared to Linköping men (53 versus 28% in the common carotid artery, 73 versus 37% in the common femoral artery, P<0.001 for both). Plaques were thicker and more extended in arteries of Vilnius men, and an ultrasound atherosclerosis score was higher in both carotid and femoral arteries (P<0.001 for all). More Vilnius men had a maximal intima-media thickness of the common femoral artery above 1 mm (P<0.005). Stiffness in the common carotid artery was higher in Vilnius men (P<0.001). In a linear regression model of the pooled material, after adjustment for city was made, smoking, systolic blood pressure, low density lipoprotein cholesterol and β-carotene (inversely) significantly contributed to a high total ultrasound score (r2=0.32). These findings show that the higher coronary mortality noted in Lithuanian men goes together with a higher prevalence of early peripheral atherosclerosis.

  • 23.
    Kristjansson, I
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Faresjö, Tomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Lionis, C
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Nosratabadi, Ali Reza
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine.
    Gudmundsson, K
    Halling, A
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Förebygg.med.
    Tagesson, Christer
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Östergötlands Läns Landsting, Pain and Occupational Centre, Occupational and Environmental Medicine Centre.
    Assessment of aluminium in human deciduous teeth2000In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 16, no 3, p. 231-233Article in journal (Refereed)
    Abstract [en]

    The possible role of environmental aluminium exposure in the pathogenesis of various diseases has highlighted the need for methods by which the long-term exposure to aluminium can be assessed. Therefore, we have further developed a method to determine aluminium in human deciduous teeth and applied this method for studying populations in Sweden, Crete and Iceland.

  • 24.
    Leandersson, Per
    Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Yrkes-miljömedicin. Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Mineral fibers, cigarette smoke, and oxidative DNA damage: An experimental study1992Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This study concerns the ability of mineral fibers and cigarette smoke to generate reactive oxygen metabolites and to cause damage to DNA. The generation of hydroxyl radicals (OH") was demonstrated by using the DNA base, deoxyguanosine (dG) as a trapping agent for OH" and determining its hydroxylation to 8-hydroxydeoxyguanosine (80HdG), and oxidative DNA damage was assessed as formation of 80HdG in isolated DNA or in DNA of human lung cells in culture. Both asbestos (chrysotile) and manmade mineral fibers (~)were found to generate OH" and damage DNA in aqueous buffer solutions, andmore OH· was generated by the iron-containing rock and slag wools than by glass wool and ceramic fibers. The OH• generation by rock wool was decreased by treatment with heat, oxygen or desferrioxamine, indicating that chemical characteristics including iron on the fiber surface were important determinants of the OH" formation. A variety of natural mineral fibers (asbestos, erionite, and wollastonite) and MMMF (rock wool, glass wool, and ceramic fibers) were found to stimulate polymorphonuclear leukocytes (PMNL) togenerate OH" in the presence of exogenously added iron, and amosite, crocidolite, antophyllite, erionite, and wollastonite caused OH" formation also in the absence of exogenously added iron. Cigarette smoke potentiated the damaging action of rock wool onisolated DNA, suggesting that iron-containing fibers might catalyze O:H" formation from hydrogen peroxide generated in the smoke. Cigarette smoke-induced damage to isolated DNA was inhibited by tyrosinase and catalase, indicating that polyphenols in the smoke,e.g. hydroquinone and catechol, were important for the hydrogen peroxide generation. Cigarette smoke was also found to cause oxidative DNA damage and DNA strand break formation in cultured human lung cells by mechanisms involving OH" attack on the DNAmolecule and endonuclease activation. Moreover, cigarette tar was demonstrated to promote P:MNL-mediated DNA strand-break formation in human lung cells, and tar loaded with iron was more damaging than regular tar.

    These fmdings indicate that mineral fibers, by producing OH· themselves and by stimulating PMNL to generate OH· in the presence of iron, may cause oxidative DNA damage under experimental conditions. They also indicate that cigarette smoke may cause DNA base hydroxylation and DNA strand-break formation in human lung cells via mechanisms involving OH", and that iron is important for the OH•-formation. Altogether, the findings point to the possibility that mineral fibers may promote OH" generation by cigarette smoke and inflammatory cells and so increase the risk of DNA damage in human lung cells.

  • 25.
    Lindqvist, Kent
    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.
    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.
    Karlsson, Nadine
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Impact of social standing on injury prevention in a World Health Organization Safe Community - Intervention outcome by household employment contract2004In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 33, no 3, p. 605-611Article in journal (Refereed)
    Abstract [en]

    Background. Although social inequality in health has been an argument for community-based injury prevention programmes, intervention outcomes with regard to differences in social standing have not been analysed. The objective of this study was to investigate rates of injuries treated in health-care among members of households at different levels of labour market integration before and after the implementation of a WHO Safe Community programme. Methods. A quasi-experimental design was used with pre- and post-implementation data collection covering the total populations <65 years of age during one year in the programme implementation municipality (population 41 000) and in a control municipality (population 26 000). Changes in injury rates were studied using prospective registration of all acute care episodes with regard to social standing in both areas during the study periods. Results. Male members of households categorized as not vocationally active displayed the highest pre-intervention injury rates. Also after the intervention, males in households classified as not vocationally active displayed notably elevated injury rates in both the control and study areas. Households in the study area in which the significant member was employed showed a post-intervention decrease in injury rate among both men (P < 0.001) and women (P < 0.01). No statistically significant change was observed in households in which the significant member was self-employed or not vocationally active. In the control area, only an aggregate-level decrease (P < 0.05) among members of households in which the significant member was employed was observed. Conclusions. The study displayed areas for improvement in the civic network-based WHO Safe Community model. Even though members of non-vocationally active households, in particular men, were at higher pre-intervention injury risk, they were not affected by the interventions. This fact has to be addressed when planning future community-based injury prevention programmes. © International Epidemiological Association 2004, all rights reserved.

  • 26.
    Ljungman, Anders
    Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Yrkes-miljömedicin. Linköping University, Faculty of Health Sciences.
    Mechanisms of inflammatory lung injury: Studies in isolated perfused rat lungs1995Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Isolated perfused rat lungs (IPRLs) were used to study mechanisms andmediators of lung injury due to (i) ischemia-reperfusion (IR) and (ii) endotoxin. To investigate the role of polymorphonuclear neutrophils (PMNs) in IR injury, PMNs were added to the perfusate of IPRLs subjected to IR. PMNs did not contribute to the injury as assessed by albumin leak indices. Addition of erythrocytes or catalase attenuated the injury, indicating that IR injury is dependent on a non-PMN source of toxic 02 metabolites. Moreover, increased levels of 6-keto-PGE1o: and tromboxane B2 were found in the perfusate and cyclooxygenase and thromboxane synthase inhibitors (indomethacin and U 63557A) reduced the injury, suggesting that cyclooxygenase metabolites of arachidonic acid are involved in IR lung injury.

    To study PMN-dependent injury in IPRLs, phorbol ester-activated PMNs were added to the perfusate in the presence of Iloprost, a long-acting prostacyclin analog. Iloprost attenuated the lung injury and decreased PMN adherence to endothelial monolayers in vitro, indicating that prostacyclin is an important regulator of PMN-dependent injury in the lung. PMN-dependent lung injury was further explored by adding calcium ionophore-activatcd PMNs prestimulated with endotoxin to the perfusate and studying the increases in pulmonary arterial pressure and capillary permeability. Both these effects were attenuated by the Ginkgo biloba-derived platelet-activating factor (PAF) antagonist, BN 52021, suggesting that endotoxin-stimulated, calcium ionophore (A 23187)activated PMNs exert important parts of their pro-inflammatory action via generation of PAF. Furthermore, addition of endotoxin to the perfusate of IPRLs caused elevated levels of group-11 phospholipase A2 (PLAz), tumor necrosis factor alpha (TNF-o:) and interleukin-1 beta (Il-1~) mRNA in the lung tissue and release of PLA2 and TNF-o: activity into the perfusate. Increased TNF-a m RNA levels and increased TNF-o: activity release were also found in alveolar macrophages exposed in vitro to asbestos as well as man made mineral fibers. In conclusion, these observations illustrate the importance of PLA2 - related mediators in inflammatory lung injury and demonstrate that neutrophils are involved in some but not necessary for all types of lung injury to occur.

  • 27.
    Nilsen, Per
    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.
    Hudson, D.S.
    Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, Stockholm, Sweden.
    Kullberg, Agneta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    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.
    Ekman, R.
    Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, Stockholm, Sweden, Swedish Rescue Services Agency, Natl. Ctr. for Lrng. from Accidents, Skövde, Sweden.
    Lindqvist, Kent
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Making sense of safety2004In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 10, no 2, p. 71-73Other (Other academic)
    Abstract [en]

    [No abstract available]

  • 28.
    Ockander, Marlene
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society.
    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.
    Long-term sickness absence: Women's opinions about health and rehabilitation2005In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 50, no 5, p. 508-517Article in journal (Refereed)
    Abstract [en]

    Aims. This paper reports a study to identify associations between ideas of health and rehabilitation in groups of women having first-hand experience of long-term sickness absence. Background. As a central part of their work, nurses have to be able to understand people in distress. When someone is unable to work because of illness, nurses are one of the central professional categories involved in their rehabilitation. Methods. Data were collected by Q-sort grid and biographical interviews from 82 women aged 30-49 years who had either been absent from work because of sickness for 60 days or more, or were receiving a disability pension. The data were first analysed by patterns and structures obtained from a modified factor analysis. The second phase of the analysis dealt with relocating the results from the statistical analyses to their social context. Results. Six opinions representing different conceptions of health, illness, and rehabilitation were identified. These ranged from reflecting high levels of trust in the health care system to reliance on 'nature's course' and emphasizing the meaning of 'feeling all right'. Conclusions. For women on long-term sick leave, it is reasonable to expect that their communication with rehabilitation professionals will be founded in a mutual understanding of basic concepts. However, the disparate opinions about health and rehabilitation identified in this study show that future studies need to investigate the prospective value of this categorization to see whether and how these conceptions affect rehabilitation practices. © 2005 Blackwell Publishing Ltd.

  • 29.
    Ockander, Marlene
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society.
    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.
    Nyce, J.M.
    School of Library and Information Management, Emporia, KS 66801, United States, Department of Radiology, Indiana University School of Medicine, Indianapolis, IN 46202, United States.
    How to avoid long-term sickness absence: The advice from women with personal experience2005In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 22, no 4, p. 394-398Article in journal (Refereed)
    Abstract [en]

    Objective. The aim of this study was to describe women's perceptions of what can be done to avoid extended sickness absence with following suffering and passivity. Methods. Qualitative interviews were conducted with 82 women who had been on sickness absence (60 days or more) or were receiving disability pensions. The data were analysed using phenomenological methods. Results. To be able to get back to work was found to be equivalent to breaking away from the prospect of isolation and loneliness. To support this, four parties were identified along with suggestions for their actions: the healthcare professionals, the woman who is on sick leave herself, the employer, and the social insurance official. Most interestingly, the family and close relatives were almost not mentioned at all. The results are connected to a theoretical model of distress in terms of enduring and suffering. Conclusions. It is necessary to look more carefully at how women on sickness absence use the resources in the world (like their families) to get well. More generally, the task is to understand why society deals insufficiently with women who need time off and cannot keep up with their duties because of illness. © The Author (2005). Published by Oxford University Press. All rights reserved.

  • 30.
    Parenmark, Gunder
    Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Yrkes-miljömedicin. Linköping University, Faculty of Health Sciences.
    On prevention and rehabilitation of work related musculoskeletal disorders from upper extremitis1993Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Neck pain and shoulder impairment are the most common causes of disability pension among workers in Sweden. Women are affected to a greater extent than men. Such complaints are also costly in terms of national economy by affecting health care and social insurance. The situation is much the same in all industrialized countries. Efforts aiming at prevention and rehabilitation seem so far to have had relatively smalleffects. The number of people affected has increased over the last few years.

    A series of studies have been countered in a manufacturing industry with high degree of assembly work. Jobs with large contents of repetitive, monotonous arm movements in fixed postures were highly overrepresented in workers with complaints. Exposure to such tasks plays an important role for the emergance of symptoms.

    Those studies also showed that shoulder-neck complaints are still the overriding cause of long term sickleave in the manufacturing industry. They accounted for 45 days on an annual basis; 60 percent of long term sickleave and 30 percent of short term absence were caused by shoulder and neck disorders.

    On-the-job training, aiming at an ergonomically adequate working technique, decreases musculoskeletal complaints among newly employed assembly workers.

    Carpal tunnel syndrome can be treated surgically with success. However, if workers return to monotonous and repetitive work tasks after surgery the long run rehabilitation outcome will be poor.

    An outpatient rehabilitation programme performed in team work including work pace efforts can reduce the number of relapses due to shoulder-neck symptoms.

    Ergonomic implementations in a wider sense including organizational factors may reduce sickleave and labour turnover among assembly workers. Sickleave decreased by 5 percentage points and personnel turnover dropped by 25 per cent in the factory at study. Production costs were reduced by 10 per cent. Thus, ergonomical changes are no contradiction to productivity.

  • 31.
    Persson, Bodil
    Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Yrkes-miljömedicin. Linköping University, Faculty of Health Sciences.
    Occupational exposures and malignant lymphoma1995Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The incidence of malignant lymphoma, especially non-Hodgkin's lymphoma (NHL) has increased over the last few decades. This statement is true despite the fact that methods for diagnosing malignant lymphoma has changed and misclassification has been a problem. In the present series of investigations, various occupational and non-occupational exposures were studied as possible determinants of malignant lymphomas, i.e. both Hodgkin's disease (HD) and NHL.

    Two questionnaireMbased case-referent studies were performed in the central part of Sweden. It was noted that exposure to solvents and to phenoxy herbicides involved increased risks for HD and NHL, whereas farming was not associated with an increased risk for NHL. Exposure to wood might also appem·ed as a determinant of risk.

    A pooled analysis of the two case-referent studies was performed to focus on biological interactions and rare exposmes. The analyses included three steps: ascertaining Mantel-Haenszel odds ratios (MHOR) stratified on age and gender, calculating logistic odds ratios (LOR) and determining biological interactions. Occupational exposure to various solvents, e.g. white spirit (MHOR 2.6), thinner (MHOR 1. 9), gasoline (MHOR 1.9) and aviation gasoline (.MHOR 3.5), was found to be connected with increased risks. Moreover, paper pulp workers and painters appeared with increased risks (MHOR 2.4 and 2.5, respectively). When confounding also from other exposures not only age and gender was considered, occupational exposure to plastic and rubber chemicals (LOR 2.2), phenoxy herbicides (LOR 2.6) and wood preservatives (LOR 2.6) showed increased risks. Lrunberjacking was also associated with an increased risk (LOR 1. 7), whereas no clearly increased risk was connected with exposure to dry wood among carpenters and cabinet-makers (LOR 1.1 ). A synergistic effect was found for combined exposures to solvents and phenoxy herbicides and to solvents and rubber and plastic chemicals.

    Pulp and paper mill workers were investigated by using the registers of deaths and burials. Several causes of death were considered, and malignant lymphoma mortality was found to be doubled.

    As most of the studies had included only living subjects, a study was performed in order to evaluate the potential bias of incomplete ascertainment of cases. No bias could be verified in this respect.

  • 32.
    Pilemalm, Sofie
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    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.
    Third Generation Participatory Design - making particiption applicable to large-scale information system projects2004In: Proceedings of Participatory Design Conference 2004, 2004Conference paper (Refereed)
  • 33.
    Ståhlbom, Bengt
    Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Yrkes-miljömedicin. Linköping University, Faculty of Health Sciences.
    Dimethylethylamine and dimethylbenzylamine in foundries and the epoxy industry: Analysis, metabolism, biological monitoring, toxicological effects and occupational exposure1998Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Dimethylethylamine (DMEA) and dimethylbenzylamine (DMBA) are tertiary aliphatic amines, used as catalysts e.g., in mould core manufacturing and heat cured epoxy systems. Health effects such as visual disturbances and respiratory irritation occur among workers handling DMEA and airway symptoms are recorded by many workers exposed to DMBA. In this thesis, gas chromatographic methods for the determination of DMEA and DMBA in air and DMEA, dimethylethylamine- N-oxide (DMEAO), DMBA and dimethylbenzylaminc-N-oxide (DMBAO) in urine have been developed in order to monitor the air concentration of the amines, to investigate the metabolism and to establish methods useful for biological monitoring. Studies have been performed on volunteers in experimental exposures and on workers in the industrial setting. Dose-effect and dose-response relations were investigated for both DMEA and DMBA. An exposurechamber was developed, using a permeation technique, for the generation of low air levels of DMBA.

    DMEA and DMBA were rapidly absorbed through the respiratory tract and quickly distributed in the body. DMEA was to a large extent (90 %) metabolised into DMEAO and DMEA and DMEAO (SumDMEA) were excreted into the urine following a biphasic pattern. DMBA was metabolised to nearly 100 % and eliminated into the urine with a half-life of 4.3 h. More than 50 % was eliminated within 2 hours after the exposure. There was a significant correlation between the time-weighted average exposure level (TWA) of the two amines and the concentration of the amines and their metabolites (SumDMEA, SumDMBA) in the post-shift urine, in both the experimental and industrial study. Thus, both U-SumDMEA and U-SumDMBA may become important biomarkers in order to monitor industrial exposures of the corresponding amine.

    DMEA exposure to a constant air level of 40-50 mg/m3 during eight hours caused epithelial corneal oedema with visual disturbances and respiratory irritalion. A 15 min exposure at 80 mg/m 3 caused eye irritation but no visual disturbances and 8 h exposure at 20 mg/m3 did not cause visual disturbances or eye irritation.

    Low air concentrations (20-120 )Jg/m3 ) of DMBA increased the number of metachromatic cells and eosinophils in a dose-response related manner in the nasal mucosa in healthy vountecrs, without causing significant clinical symptoms.

    Industrial exposure levels of DMEA in mould core manufacturing workers were determined. The mean TWA of DMEA was 3.7 mg/m3 (range 0.5-14). The determination of DMBA in epoxy workers showed a mean TW A air concentration of 18 pg/m3 (range 3-48), with a 2 h peak exposure of 91 µ/m3.

    This thesis will facilitate the evaluation and assessment of risk and threshold limit values of DMEA, DMBA, and other related compounds.

  • 34.
    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.
    Proactive health computing2001In: Artificial Intelligence in Medicine, ISSN 0933-3657, E-ISSN 1873-2860, Vol. 23, no 1, p. 13-24Article in journal (Refereed)
    Abstract [en]

    In an analysis departing from the global health situation, the foundation for a change of paradigm in health informatics based on socially embedded information infrastructures and technologies is identified and discussed. It is shown how an increasing computing and data transmitting capacity can be employed for proactive health computing. As a foundation for ubiquituos health promotion and prevention of disease and injury, proactive health systems use data from multiple sources to supply individuals and communities evidence-based information on means to improve their state of health and avoid health risks. The systems are characterised by:being profusely connected to the world around them, using perceptual interfaces, sensors and actuators,responding to external stimuli at faster than human speeds,networked feed-back loops, andhumans remaining in control, while being left outside the primary computing loop.The extended scientific mission of this new partnership between computer science, electrical engineering and social medicine is suggested to be the investigation of how the dissemination of information and communication technology on democratic grounds can be made even more important for global health than sanitation and urban planning became a century ago. Copyright © 2001 Elsevier Science B.V.

  • 35.
    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.
    The patient and the primary care team: a small-scale critical theory2000In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 31, no 3, p. 558-564Article in journal (Refereed)
    Abstract [en]

    For increasing the understanding of team-based delivery of primary care, ratings of care satisfaction and stimulated-recall interviews were used to compose a small-scale critical theory. Three teams and 24 patients at a community health care centre participated in the study. It was found that the multiprofessional team was vulnerable to discrepancies between the health service policy and the available care resources. If pre-paid patients arrive with too high expectations and demands on the service, a significant part of the team's attention is used for economizing with care procedures. When health and economics are entangled for the team, the patients are not invited to share decisions about their health. The patients' concerns are instead turned to the social arena, which is separated by language and context from the health analysis. Simultaneously, when the teams are led to solve the health problems without involving the patients in the process, the team members convert these to their own personal distress when they fail. The conclusion is that the discrepancy between care policy and factual resources is an important cause of imbalance in patient-primary care team interaction. If service strategy and team organization and resources are not continuously adjusted to each other, the effects will continue to obstruct communication during consultations.

  • 36.
    Timpka, Toomas
    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, FHVC - Folkhälsovetenskapligt centrum.
    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.
    Svanstrom, L.
    Svanström, L., Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    From sports injury prevention to safety promotion in sports2006In: Sports Medicine, ISSN 0112-1642, E-ISSN 1179-2035, Vol. 36, no 9, p. 733-745Article, review/survey (Refereed)
    Abstract [en]

    Every fifth unintentional injury treated at a healthcare facility in the industrialised part of the world is associated with sports or physical exercise. This article reviews the literature regarding the theoretical and practical underpinnings for community-based sports safety promotion, including both professional and recreational sports. While injury prevention entails the implementation of specific interventions in terms of structural or educational measures, sports safety promotion includes also the antecedent and wider campaigns that are required to succeed with these measures. Comprehensive sports safety promotion programmes thus require that the perspective on the sports injury problem is made broader than consideration of the individual athlete. The results display that involvement in sports safety issues from the sports federations that formulate policies and allocate resources is necessary for coordinated implementation of programme actions. The authorities responsible for sports facilities and legislations in the civil society also need to be included, because of the fact that they control many of the central safety determinants in the sporting environment. It is concluded that the sports injury problem needs to be addressed in liaison with the leaders of socially defined sports communities and the governments representing geographically defined civic communities, and that the safety-supporting environment in professional sports is underdeveloped compared with other areas of working life. © 2006 Adis Data Information BV. All rights reserved.

  • 37.
    Valdimarsson, T
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Gastroenterology and Hepatology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, GE: gastromed.
    Toss, Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Löfman, O
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Förebygg.med.
    Ström, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Gastroenterology and Hepatology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, GE: gastromed.
    Three years' follow-up of bone density in adult coeliac disease: Significance of secondary hyperparathyroidism2000In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 35, no 3, p. 274-280Article in journal (Refereed)
    Abstract [en]

    Background: The mechanisms of disturbances in bone mineral density (BMD) in coeliac disease are not completely understood. The aim of this prospective study was to investigate the possible significance of secondary hyperparathyroidism (SHPT) with regard to BMD in patients with untreated coeliac disease. Methods: One hundred and five adult patients with untreated coeliac disease were examined for BMD and serum parathyroid hormone (PTH) concentration. BMD in the hip, lumbar spine, and forearm were examined up to 3 years after the introduction of a gluten-free diet. Results: SHPT was found in 27% (28 of 105) of the patients. In patients with SHPT serum levels of 25- hydroxy-vitamin D were lower and those of alkaline phosphatase higher than in patients with normal PTH, but ionized serum calcium did not differ between the two groups. BMD was more severely reduced in patients with SHPT. Although the BMD increment was more rapid in patients with than in those without SPTH, only in the latter group did mean BMD became normal after 1-3 years on a gluten-free diet (GFD). After 3 years on a GFD more than half of the patients with initial SHPT still had low BMD in both the hip and the forearm. Furthermore, in patients with SHPT the intestinal mucosa more often remained atrophic at the 1-year follow-up, despite good compliance with the diet. Conclusions: Low BMD in patients with untreated coeliac disease is often associated with SHPT. After 3 years on a GFD the BMD remains low only in patients with initial SHPT. We therefore suggest that PTH should be measured when the diagnosis of coeliac disease is made, as an indicator of more serious intestinal disorder and complicating bone disease.

  • 38.
    Vimarlund, Vivian
    et al.
    Linköping University, Department of Computer and Information Science, EISLAB - Economic Information Systems. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Socialmed FHVC.
    Design participation as an insurance: Risk-management and end-user participation in the development of information systems in healthcare organizations2002In: Methods of Information in Medicine, ISSN 0026-1270, Vol. 41, no 1, p. 76-80Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this paper is to build a theoretical framework for analysis of when decision-makers should use end-user participation as a form of insurance for unforeseen consequences of implementing information systems in healthcare organizations. Method: Data were collected in a case study of an information system development project in a small clinical setting. During the initial phase, the future end-users of the system were allowed to actively influence the system design and test every new tool that was considered for implementation. Results: The results of the case study suggest that when time and effort are invested in allowing healthcare staff to participate in information system development processes, the benefits can well exceed the costs throughout the life cycle of the project. Risk-averse decision-makers fearing negative secondary consequences of a HIS, with regard to clinical work flow, will always adopt measures to prevent future failures, if they can find a possibility of shifting these risks. Therefore, they calculate the present discounted value of the effects accrued over time to the unit and predict the amount of resources they are willing to pay to acquire an insurance (such as design participation) that will protect the organization from future losses. Conclusions: End-user participation in the design process can be the key positive influence on the quality of the service and, thereby, organizational effectiveness. Investments in broad design participation can, consequently, be a productive activity that transforms potential current income into future benefits.

  • 39.
    Vimarlund, Vivian
    et al.
    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.
    To choose to be poor today but have good future prospects: Consumer participation in the development of information systems in healthcare organizations.2000In: JAMIA Journal of the American Medical Informatics Association, ISSN 1067-5027, E-ISSN 1527-974X, p. 1150-1150Conference paper (Other academic)
  • 40.
    Vimarlund, Vivian
    et al.
    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.
    Patel, VL
    Linkoping Univ, Dept Social Med, Linkoping, Sweden McGill Univ, Montreal, PQ, Canada Linkoping Univ, Dept Comp Sci, MDA, Linkoping, Sweden.
    Information technology and knowledge exchange in health-care organizations1999In: JAMIA Journal of the American Medical Informatics Association, ISSN 1067-5027, E-ISSN 1527-974X, p. 632-636Article in journal (Refereed)
    Abstract [en]

    Despite the increasing global interest in information technology among health care institutions, little has been discussed about its importance for the effectiveness of knowledge management. In this study, economic theories are used to analyze and describe a theoretical framework for the use of information technology in the exchange of knowledge. The analyses show that health care institutions would benefit from developing global problem-solving collaboration, which allows practitioners to exchange knowledge unrestricted by time and geographical barriers. The use of information technology for vertical integration of health-care institutions would reduce knowledge transaction costs, Le. decrease costs for negotiating and creating communication channels, and facilitating the determination of what, when, and how to produce knowledge. A global network would allow organizations to increase existing knowledge, and thus total productivity, while also supporting an environment where the generation of new ideas is unrestricted Using all the intellectual potential of market actors and thereby releasing economic resources can reduce today's global budget conflicts in the public sector, Le. the necessity to choose between health care services and for instance, schools and support for the elderly. In conclusion, global collaboration and coordination would reduce the transaction costs inherent in knowledge administration and allow a more effective total use of scarce health-care resources.

  • 41.
    Zidén, Bo
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Kaminkas, A
    Kristensson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum, Förebygg.med.
    Kucinskiene, Z
    Vessby, B
    Olsson, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Diczfaluzy, U
    Increased plasma 7B-hydroxycholesterol concentrations in a population with high risk for cardiovascular disease.1999In: Arteriosclerosis, Thrombosis and Vascular Biology, ISSN 1079-5642, E-ISSN 1524-4636, Vol. 19, p. 967-971Article in journal (Refereed)
  • 42.
    Öberg, Birgitta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Meeting the other: A way of fighting age discrimination? A discussion circle with young and old participants in Sweden2007In: Journal of Intergenerational Relationships, ISSN 1535-0770, E-ISSN 1535-0932, Vol. 5, no 2, p. 27-44Article in journal (Refereed)
    Abstract [en]

    The idea that we are living in a society which is more and more segregated according to age is often voiced today. A feeling of facing a widening generation gap is mirrored in writings from governmental offices and non-governmental organizations in Sweden and in other parts of the world. The UNESCO Institute of Education's (UIE) conference in 1999 about Intergenerational Practice and Programmes (IP) is one example of the efforts made to analyse the gap between generations. In the declaration from the conference a definition of intergenerational programmes: "Intergenerational programmes are vehicles for purposeful and ongoing exchange of resources and learning among older and younger generations for individual and social benefits and is given as well as guiding principles for future intergenerational projects."1 An account of ongoing intergenerational projects in different countries is also included (Hutton-Yeo & Ohsako, 2000:3). The authors point out that there is a need to move from the traditional one-way IP (the young learning from the old) to IP based upon reciprocal relationships between different generations. They also underline the need to further develop non-familial IPs where biologically unrelated members of different ages interact (Hutton-Yeo & Ohsako, 2000:4-6). The Swedish drafting committee about issues of ageing and life in later years, "Senior 2005," points out that research and exchange of the experience regarding the potentialities of intergenerational encounters should be encouraged and reinforced. Only few such projects in Sweden have been accounted for. Boström states in her dissertation that in spite of the fact that many minor projects are carried out by voluntary organisations, interest groups, and enthusiastic individuals, most of these are not analysed and remain undocumented (Boström, 2003). The present article reports about a Swedish project aiming at a rapprochement between the generations. After a short presentation of the organisation in charge of the project, the different parts of the project are described. A discussion of the observations made in the course of the project is followed by an introduction of some theoretical concepts and ideas and the observations that are analysed and explained. © 2007 by The Haworth Press, Inc. All rights reserved.

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