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  • 1.
    Abidi, Latifa
    et al.
    Maastricht Univ, Netherlands.
    Nilsen, Per
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Karlsson, Nadine
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Skagerström, Janna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Operations management Region Östergötland, Research and Development Unit.
    ODonnell, Amy
    Newcastle Univ, England.
    Conversations about alcohol in healthcare: cross-sectional surveys in the Netherlands and Sweden2020In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, BMC PUBLIC HEALTH, Vol. 20, no 1Article in journal (Refereed)
    Abstract [en]

    Background

    This study evaluated and compared the extent, duration, contents, experiences and effects of alcohol conversations in healthcare in the Netherlands and Sweden in 2017.

    Methods

    Survey data in the Netherlands and Sweden were collected through an online web panel. Subjects were 2996 participants (response rate: 50.8%) in Sweden and 2173 (response rate: 82.2%) in the Netherlands. Data was collected on socio-demographics, alcohol consumption, healthcare visits in the past 12 months, number of alcohol conversations, and characteristics of alcohol conversations (duration, contents, experience, effects).

    Results

    Results showed that Swedish respondents were more likely to have had alcohol conversations (OR = 1.99; 95%CI = 1.64–2.41; p = < 0.001) compared to Dutch respondents. In Sweden, alcohol conversations were more often perceived as routine (p = < 0.001), were longer (p = < 0.001), and more often contained verbal information about alcohol’s health effects (p = 0.007) or written information (p = 0.001) than in the Netherlands. In Sweden, 40+ year-olds were less likely to report a positive effect compared to the youngest respondents. In the Netherlands, men, sick-listed respondents, and risky drinkers, and in Sweden those that reported “other” occupational status such as parental leave, were more likely to have had alcohol conversations.

    Conclusions

    The results suggest that alcohol conversations are more common in healthcare practice in Sweden than in the Netherlands. However, positive effects of alcohol conversations were less likely to be reported among older respondents in Sweden. Our results indicate that alcohol preventative work should be improved in both countries, with more focus on risky drinkers and the content of the conversations in Sweden, and expanding alcohol screening in the Netherlands.

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  • 2.
    Ageberg, Eva
    et al.
    Lund Univ, Sweden.
    Bunke, Sofia
    Lund Univ, Sweden.
    Nilsen, Per
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Donaldson, Alex
    La Trobe Univ, Australia.
    Planning injury prevention training for youth handball players: application of the generalisable six-step intervention development process2020In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 26, no 2, p. 164-169Article in journal (Refereed)
    Abstract [en]

    Background Youth handball players are vulnerable to injuries. Because there is no available injury prevention training specifically developed for youth handball players targeting both upper and lower limbs or incorporating psychological aspects of injury, we undertook the Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT) project. We used an ecological participatory design incorporating the perspectives of multiple stakeholders (health beneficiaries, programme deliverers and policy makers). The aim of this paper was to describe the process of developing the I-PROTECT model, featuring injury prevention training and an accompanying implementation strategy. Design We used the generalisable six-step intervention development process, outlined to guide researchers when developing implementable, evidence-based sports injury prevention interventions, to develop the I-PROTECT model. The six-step process involves establishing a research-stakeholder collaborative partnership to (1) identify and synthesise research evidence and clinical experience; (2) consult with relevant experts; (3) engage end users to ensure their needs, capacity and values are considered; (4) test the feasibility and acceptability of the intervention; (5) evaluate the intervention against theory; and (6) obtain feedback from early implementers. Two community handball clubs in southern Sweden, offering organised training for youth male and female players, and the district handball federation, participate in the intervention development. Drafts of the I-PROTECT model will be developed and revised with key stakeholder advice and input throughout all six steps. Conclusion The I-PROTECT model described will be an end user-driven intervention, including evidence-based, theory-informed and context-specific injury prevention training for youth handball, and an associated implementation strategy.

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  • 3.
    Arias Tellez, Maria Jose
    et al.
    Univ Chile, Chile; Univ Granada, Spain.
    Acosta, Francisco M.
    Univ Granada, Spain.
    Sanchez-Delgado, Guillermo
    Univ Granada, Spain; Pennington Biomed Res Ctr, LA 70808 USA.
    Martinez-Tellez, Borja
    Univ Granada, Spain; Leiden Univ, Netherlands; Leiden Univ, Netherlands.
    Munoz-Hernandez, Victoria
    Univ Granada, Spain.
    Martinez-Avila, Wendy D.
    Univ Granada, Spain.
    Henriksson, Pontus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Granada, Spain.
    Ruiz, Jonatan R.
    Univ Granada, Spain.
    Association of Neck Circumference with Anthropometric Indicators and Body Composition Measured by DXA in Young Spanish Adults2020In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, NUTRIENTS, Vol. 12, no 2, article id 514Article in journal (Refereed)
    Abstract [en]

    Background: Due to a clinical and public health interest of neck circumference (NC), a better understanding of this simple anthropometric measurement, as a valid marker of body composition is necessary. Methods: A total of 119 young healthy adults participated in this study. NC was measured over the thyroid cartilage and perpendicular to the longitudinal axis of the neck. Body weight, height, waist circumference (WC), and hip circumference were measured. A Dual X-ray absorptiometry (DXA) scan was used to determine fat mass, lean mass, and visceral adipose tissue (VAT). Additionally, body mass index (BMI) and triponderal mass index (TMI), the waist to hip and waist to height ratios, and the fat mass and lean mass indexes (FMI and LMI, respectively) were calculated. Results: NC was positively associated in women (W) and men (M), with BMI (rW = 0.70 and rM = 0.84, respectively), TMI (rW = 0.63 and rM = 0.80, respectively), WC (rW = 0.75 and rM = 0.86, respectively), VAT (rW = 0.74 and rM = 0.82, respectively), Waist/hip (rW = 0.51 and rM = 0.67, respectively), Waist/height (rW = 0.68 and rM = 0.83, respectively) and FMI (rW = 0.61 and rM = 0.81, respectively). The association between NC and indicators of body composition was however weaker than that observed by BMI, TMI, WC and Waist/height in both women and men. It is of note that in women, NC was associated with FMI, VAT and LMI independently of BMI. In men, adding NC to anthropometric variables did not improve the prediction of body composition, while slight improvements were observed in women. Conclusions: Taken together, the present study provides no indication for NC as a useful proxy of body composition parameters in young adults, yet future studies should explore its usefulness as a measure to use in combination with BMI, especially in women.

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  • 4.
    Bahr, Roald
    et al.
    Norwegian Sch Sport Sci, Norway; Aspetar Orthopaed and Sports Med Hosp, Qatar.
    Clarsen, Ben
    Norwegian Sch Sport Sci, Norway; Norwegian Inst Publ Hlth, Norway.
    Derman, Wayne
    Stellenbosch Univ, South Africa.
    Dvorak, Jiri
    Schulthess Clin, Switzerland.
    Emery, Carolyn A.
    Univ Calgary, Canada.
    Finch, Caroline F.
    Edith Cowan Univ, Australia.
    Hägglund, Martin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Junge, Astrid
    Med Sch Hamburg, Germany; Schulthess Clin, Switzerland.
    Kemp, Simon
    Rugby Football Union, England; London Sch Hyg and Trop Med, England.
    Khan, Karim M.
    Univ British Columbia, Canada; British Journal Sports Med, England.
    Marshall, Stephen W.
    Univ N Carolina, NC USA; Univ N Carolina, NC USA.
    Meeuwisse, Willem
    Univ Calgary, Canada; Natl Hockey League, Canada.
    Mountjoy, Margo
    McMaster Univ, Canada; FINA Bur Sport Med, Switzerland.
    Orchard, John W.
    Univ Sydney, Australia.
    Pluim, Babette
    Royal Netherlands Lawn Tennis Assoc, Netherlands; AMC VUmc IOC Res Ctr Excellence, Netherlands; Univ Pretoria, South Africa.
    Quarrie, Kenneth L.
    New Zealand Rugby, New Zealand; AUT Univ, New Zealand.
    Reider, Bruce
    Univ Chicago, IL 60637 USA.
    Schwellnus, Martin
    Univ Pretoria, South Africa.
    Soligard, Torbjorn
    Int Olymp Comm, Switzerland; Fac Kinesiol, Canada.
    Stokes, Keith A.
    Univ Bath, England; Rugby Football Union, England.
    Timpka, Toomas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
    Verhagen, Evert
    Amsterdam UMC, Netherlands.
    Bindra, Abhinav
    Int Olymp Comm, Switzerland.
    Budgett, Richard
    Int Olymp Comm, Switzerland.
    Engebretsen, Lars
    Norwegian Sch Sport Sci, Norway; Int Olymp Comm, Switzerland.
    Erdener, Ugur
    Int Olymp Comm, Switzerland.
    Chamari, Karim
    Aspetar Sports Med and Orthoped Hosp, Qatar.
    International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020 (including STROBE Extension for Sport Injury and Illness Surveillance (STROBE-SIIS))2020In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 54, no 7, p. 372-389Article in journal (Refereed)
    Abstract [en]

    Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport-specific or setting-specific consensus statements on sports injury (and, eventually, illness) epidemiology to date. Our objective was to further strengthen consistency in data collection, injury definitions and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups and a 3-day consensus meeting in October 2019. This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems; severity of health problems; capturing and reporting athlete exposure; expressing risk; burden of health problems; study population characteristics and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE Extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). The IOC encourages ongoing in- and out-of-competition surveillance programmes and studies to describe injury and illness trends and patterns, understand their causes and develop measures to protect the health of the athlete. Implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.

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  • 5.
    Bahr, Roald
    et al.
    Norwegian Sch Sport Sci, Norway; Aspetar Orthopaed and Sports Med Hosp, Qatar.
    Clarsen, Ben
    Norwegian Sch Sport Sci, Norway; Norwegian Inst Publ Hlth, Norway.
    Derman, Wayne
    Stellenbosch Univ, South Africa.
    Dvorak, Jiri
    Schulthess Clin, Switzerland; Schulthess Clin, Switzerland.
    Emery, Carolyn A.
    Univ Calgary, Canada; Univ Calgary, Canada.
    Finch, Caroline F.
    Edith Cowan Univ, Australia.
    Hägglund, Martin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Junge, Astrid
    Med Sch Hamburg, Germany; Schulthess Clin, Switzerland.
    Kemp, Simon
    Rugby Football Union, England; London Sch Hyg and Trop Med, England.
    Khan, Karim M.
    Univ British Columbia, Canada; British Journal Sports Med, England.
    Marshall, Stephen W.
    Univ N Carolina, NC 27515 USA; Univ N Carolina, NC 27515 USA.
    Meeuwisse, Willem
    Univ Calgary, Canada; Natl Hockey League, Canada.
    Mountjoy, Margo
    McMaster Univ, Canada; FINA Bur Sport Med, Switzerland.
    Orchard, John W.
    Univ Sydney, Australia.
    Pluim, Babette
    Royal Netherlands Lawn Tennis Assoc, Netherlands; AMC VUmc IOC Res Ctr Excellence, Netherlands.
    Quarrie, Kenneth L.
    New Zealand Rugby, New Zealand; AUT Univ, New Zealand.
    Reider, Bruce
    Univ Chicago, IL 60637 USA.
    Schwellnus, Martin
    Univ Pretoria, South Africa.
    Soligard, Torbjorn
    Int Olymp Comm, Switzerland; Fac Kinesiol, Canada.
    Stokes, Keith A.
    Univ Bath, England; Rugby Football Union, England.
    Timpka, Toomas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
    Verhagen, Evert
    Amsterdam UMC, Netherlands.
    Bindra, Abhinav
    Int Olymp Comm, Switzerland.
    Budgett, Richard
    Int Olymp Comm, Switzerland.
    Engebretsen, Lars
    Norwegian Sch Sport Sci, Norway; Int Olymp Comm, Switzerland.
    Erdener, Ugur
    Int Olymp Comm, Switzerland.
    Chamari, Karim
    Aspetar Sports Med and Orthoped Hosp, Qatar.
    International Olympic Committee Consensus Statement: Methods for Recording and Reporting of Epidemiological Data on Injury and Illness in Sports 2020 (Including the STROBE Extension for Sports Injury and Illness Surveillance (STROBE-SIIS))2020In: ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE, ISSN 2325-9671, Vol. 8, no 2, article id 2325967120902908Article in journal (Refereed)
    Abstract [en]

    Background: Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport- or setting-specific consensus statements on sports injury (and, eventually, illnesses) epidemiology to date. Objective: To further strengthen consistency in data collection, injury definitions, and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. Study Design: Consensus statement of the International Olympic Committee (IOC). Methods: The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups, and a 3-day consensus meeting in October 2019. Results: This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems, severity of health problems, capturing and reporting athlete exposure, expressing risk, burden of health problems, study population characteristics, and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). Conclusion: The IOC encourages ongoing in- and out-of-competition surveillance programs and studies to describe injury and illness trends and patterns, understand their causes, and develop measures to protect the health of the athlete. The implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.

  • 6.
    Barra, Mathias
    et al.
    Akershus Univ Hosp, Norway.
    Broqvist, Mari
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Gustavsson, Erik
    Linköping University, Department of Culture and Society, Division of Philosophy, History, Arts and Religion. Linköping University, Faculty of Arts and Sciences.
    Henriksson, Martin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Juth, Niklas
    Karolinska Inst, Sweden.
    Sandman, Lars
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Solberg, Carl Tollef
    Akershus Univ Hosp, Norway; Univ Bergen, Norway.
    Severity as a Priority Setting Criterion: Setting a Challenging Research Agenda2020In: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 28, no 1, p. 25-44Article in journal (Refereed)
    Abstract [en]

    Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to todays severity criteria in Norway and Sweden. The Scandinavian perspective on severity might be conducive to the international discussion, given its long-standing use as a priority setting criterion, despite having reached rather different conclusions so far. We then argue that severity can be viewed as a multidimensional concept, drawing on accounts of need, urgency, fairness, duty to save lives, and human dignity. Such concerns will often be relative to local mores, and the weighting placed on the various dimensions cannot be expected to be fixed. Thirdly, we present what we think are the most pertinent questions to answer about severity in order to facilitate decision making in the coming years of increased scarcity, and to further the understanding of underlying assumptions and values that go into these decisions. We conclude that severity is poorly understood, and that the topic needs substantial further inquiry; thus we hope this article may set a challenging and important research agenda.

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  • 7.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Science & Engineering.
    Heterogeneous treatment effects of a text messaging smoking cessation intervention among university students2020In: PLoS ONE, E-ISSN 1932-6203, Vol. 15, no 3, article id e0229637Article in journal (Refereed)
    Abstract [en]

    Introduction

    Despite tobacco being an important preventable factor with respect to ill health and death, it is a legal substance that harms and kills many of those who use it. Text messaging smoking cessation interventions have been evaluated in a variety of contexts, and are generally considered to have a positive effect on smoking cessation success. In order for text messaging interventions to continue to be useful as prevalence of smoking decreases, it may be necessary to tailor the interventions to specific individuals. However, little is known with regard to who benefits the most and least from existing interventions.

    Methods

    In order to identify heterogenous treatment effects, we analyzed data from a randomized controlled trial of a text messaging smoking cessation intervention targeting university students in Sweden. We used a Bayesian hierarchical model where the outcome was modelled using logistic regression, and so-called horseshoe priors were used for coefficients. Predictive performance of the model, and heterogeneous treatment effects, were calculated using cross-validation over the trial data.

    Results

    Findings from the study of heterogenous treatment effects identified less effect of the intervention among university students with stronger dependence of nicotine and students who smoke a greater quantity of cigarettes per week. No heterogeneity was found with respect to sex, number of years smoking, or the use of snuff.

    Discussion

    Results emphasize that individuals with a more developed dependence of nicotine may have a harder time quitting smoking even with support. This questions the dissemination and development of text messaging interventions to university students in the future, as they may not be the optimal choice of intervention for those with a more developed dependence. On the other hand, text messaging interventions may be useful to disseminate among university students that are at risk of developing a strong dependence.

    Trial registration

    International Standard Randomized Controlled Trial Number (ISRCTN): 75766527; http://www.controlled-trials.com/ISRCTN75766527.

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  • 8.
    Bendtsen, Marcus
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    Müssener, Ulrika
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    Linderoth, Catharina
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    Thomas, Kristin
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    A Mobile Health Intervention for Mental Health Promotion Among University Students: Randomized Controlled Trial2020In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 8, no 3, article id e17208Article in journal (Refereed)
    Abstract [en]

    Background: High positive mental health, including the ability to cope with the normal stresses of life, work productively, and be able to contribute to one’s community, has been associated with various health outcomes. The role of positive mental health is therefore increasingly recognized in national mental health promotion programs and policies. Mobile health (mHealth) interventions could be a cost-effective way to disseminate positive psychological interventions to the general population.

    Objective: The aim of this study was to estimate the effect of a fully automated mHealth intervention on positive mental health, and anxiety and depression symptomology among Swedish university students using a randomized controlled trial design.

    Methods: A 2-arm, single-blind (researchers), parallel-groups randomized controlled trial with an mHealth positive psychology program intervention group and a relevant online mental health information control group was employed to estimate the effect of the novel intervention. Participants were recruited using digital advertising through student health care centers in Sweden. Inclusion criteria were (1) university students, (2) able to read and understand Swedish, (3) and have access to a mobile phone. Exclusion criteria were high positive mental health, as assessed by the Mental Health Continuum Short Form (MHC-SF), or high depression and anxiety symptomology, as assessed by the Hospital Anxiety Depression Scale (HADS). The primary outcome was positive mental health (MHC-SF), and the secondary outcomes were depression and anxiety symptomatology (HADS). The subscales of MHC-SF were also analyzed as exploratory outcomes. Outcomes were measured 3 months after randomization through questionnaires completed on the participants’ mobile phones.

    Results: A total of 654 participants (median age 25 years), including 510 (78.0%) identifying as female, were randomized to either the intervention (n=348) or control group (n=306). At follow-up, positive mental health was significantly higher in the intervention group compared with the control group (incidence rate ratio [IRR]=1.067, 95% CI 1.024-1.112, P=.002). For both depression and anxiety symptomatology, the intervention group showed significantly lower scores at follow-up compared with the control group (depression: IRR=0.820, 95% CI 0.714-0.942, P=.005; anxiety: IRR=0.899, 95% CI 0.840-0.962, P=.002). Follow-up rates were lower than expected (58.3% for primary outcomes and 52.3% for secondary outcomes); however, attrition analyses did not identify any systematic attrition with respect to baseline variables.

    Conclusions: The mHealth intervention was estimated to be superior to usual care in increasing positive mental health among university students. A protective effect of the intervention was also found on depressive and anxiety symptoms. These findings demonstrate the feasibility of using an automated mobile phone format to enhance positive mental health, which offers promise for the use of mHealth solutions in public mental health promotion.

    Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN54748632; http://www.isrctn.com/ISRCTN54748632

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  • 9.
    Broqvist, Mari
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    von Goes, Lovisa
    Hjälpmedelscentralen, Region Jönköpings län.
    Svensson, Carina
    Hjälpmedelscentralen, Region Jönköpings län.
    Volmevik Lundberg, Pernilla
    Hjälpmedelscentralen, Region Jönköpings län.
    Winberg, Anette
    Tidigare anställd vid Hälsa och habilitering, Region Uppsala.
    Beslutsstöd för prioriteringar på individnivå: Exempel från hjälpmedelsverksamhet2019Report (Other academic)
    Abstract [en]

    Since 1997, when the ethical platform for resource allocation was introduced in the Swedish health care system, methods have been in development with the aim of supporting the healthcare providers in the difficult decisions of assigning priorities. The methodological focus has been on the major issues, on the allocation of resources at regional level and policy decisions in various activities, but the large number of priorities are made on a daily basis in interactions between health care staff and patients.

    This report is addressed to those who strive to prioritize at individual level on more equal and explicit grounds, in line with the guidelines on priorities that the Riksdag has decided on. The tool presented here is called Decision support for priorities at the individual level. It aims to guide the analysis of the persons´ health care needs so that the need-solidarity and the cost-effectiveness principle are taken into account in the assessment. It is the result of many years of development work and tested in practice in Center for assistive technology in different regions for several years. In addition to being used in prescribing such technology, decision support is also possible to test for other types of health care interventions.

    The decision support consists of an assessment form and a manual. Severity, patient benefit and patient benefit in relation to costs are the variables that should be assessed and direct the health care staff in assigning a priority.

    One aim of using the decision support is to facilitate priorities on more equal grounds. Introduced in a well-organized manner, it can contribute to, but not alone, create such priorities. In order to create mutual understanding and acceptance for grounds and transparency in priorities, a thought-out implementation process is also required. In this report, such an example is given from Region Jönköpings län and prescribers of assistive devices. The main ingredients for succeeding in such work seem to be support from the management and political level, methodological support and constant perseverance.

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  • 10.
    Burstrom, Kristina
    et al.
    Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Teni, Fitsum Sebsibe
    Karolinska Inst, Sweden.
    Gerdtham, Ulf-G.
    Lund Univ, Sweden.
    Leidl, Reiner
    German Res Ctr Environm Hlth, Germany; Ludwig Maximilians Univ Munchen, Germany.
    Helgesson, Gert
    Karolinska Inst, Sweden.
    Rolfson, Ola
    Karolinska Inst, Sweden; Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden; Ctr Registers Vastra Gotaland, Sweden.
    Henriksson, Martin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Experience-Based Swedish TTO and VAS Value Sets for EQ-5D-5L Health States2020In: PharmacoEconomics (Auckland), ISSN 1170-7690, E-ISSN 1179-2027Article in journal (Refereed)
    Abstract [en]

    Background and Objective Although value sets for the five-level version of the generic health-related quality-of-life instrument EQ-5D are emerging, there is still no value set available in the literature based on time trade-off valuations made by individuals experiencing the valued health states. The aim of this study was to estimate experience-based value sets for the EQ-5D-5L for Sweden using time trade-off and visual analogue scale valuation methods. Methods In a large, cross-sectional, population-based, self-administered postal health survey, the EQ-5D-5L descriptive system, EQ visual analogue scale and a time trade-off question were included. Time trade-off and visual analogue scale valuations of the respondents current health status were used in statistical modelling to estimate a single-index value of health for each of the 3125 health states. Ordinary least-squares and generalised linear models were estimated with the main effect within each of the five dimensions represented by 20 dummy variables reflecting the additional decrement in value for levels 2-5 when the severity increases by one level sequentially beginning from having no problem. Interaction variables representing the occurrence of severity levels in at least one of the dimensions were tested: severity level 2 or worse (N2); severity level 3 or worse (N3); severity level 4 or worse (N4); severity level 5 (N5). Results A total of 896 health states (28.7% of the 3125 possible EQ-5D-5L health states) were reported by the 25,867 respondents. Visual analogue scale (n = 23,899) and time trade-off (n = 13,381) responders reported valuations of their currently experienced health state. The preferred regression models used ordinary least-squares estimation for both time trade-off and visual analogue scale values and showed consistency in all coefficients after combining certain levels. Levels 4 and 5 for the dimensions of mobility, self-care and usual activities were combined in the time trade-off model. Including the interaction variable N5, indicating severity level 5 in at least one of the five dimensions, made it possible to distinguish between the two worst severity levels where no other dimension is at level 5 as this coefficient is applied only once. In the visual analogue scale regression model, levels 4 and 5 of the mobility dimension were combined. The interaction variables N2-N4 were included, indicating that each of these terms reflect a statistically significant decrement in visual analogue scale value if any of the dimensions is at severity level 2, 3 or 4, respectively. Conclusions Time trade-off and visual analogue scale value sets for the EQ-5D-5L are now available for Sweden. The time trade-off value set is the first such value set based on experience-based time trade-off valuation. For decision makers with a preference for experience-based valuations of health states from a representative population-based sample, the reported value sets may be considered fit for purpose to support resource allocation decision as well as evaluating population health and healthcare performance.

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  • 11.
    Cadenas-Sanchez, Cristina
    et al.
    Univ Granada, Spain; Univ Cadiz, Spain; Univ Publ Navarra, Spain.
    Esteban-Cornejo, Irene
    Univ Granada, Spain; Northeastern Univ, MA 02115 USA.
    Migueles, Jairo H.
    Univ Granada, Spain.
    Labayen, Idoia
    Univ Publ Navarra, Spain.
    Verdejo-Roman, Juan
    Univ Granada, Spain; Ctr Biomed Technol CTB, Spain.
    Mora-Gonzalez, Jose
    Univ Granada, Spain; Univ North Carolina Charlotte, NC 28233 USA.
    Henriksson, Pontus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Maldonado, Jose
    Univ Granada, Spain; Inst Invest Biosanit IBS, Spain.
    Gomez-Vida, Jose
    San Cecilio Hosp, Spain.
    Hillman, Charles H.
    Northeastern Univ, MA 02115 USA.
    Erickson, Kirk I
    Univ Pittsburgh, PA 15260 USA.
    Kramer, Arthur F.
    Northeastern Univ, MA 02115 USA; Univ Illinois, IL 61801 USA.
    Catena, Andres
    Univ Granada, Spain.
    Ortega, Francisco B.
    Univ Granada, Spain; Karolinska Inst, Sweden.
    Differences in Brain Volume between Metabolically Healthy and Unhealthy Overweight and Obese Children: The Role of Fitness2020In: JOURNAL OF CLINICAL MEDICINE, Vol. 9, no 4, article id 1059Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to examine whether metabolically healthy overweight/obese children have greater global and regional gray matter volumes than their metabolically unhealthy peers. We further examined the association between gray matter volume and academic achievement, along with the role of cardiorespiratory fitness in these associations. A total of 97 overweight/obese children (10.0 +/- 1.2 years) participated. We classified children as metabolically healthy/unhealthy based on metabolic syndrome cut-offs. Global and regional brain volumes were assessed by magnetic resonance imaging. Academic achievement was assessed using the Woodcock-Munoz standardized test. Cardiorespiratory fitness was assessed by the 20 m shuttle run test. Metabolically healthy overweight/obese (MHO) children had greater regional gray matter volume compared to those who were metabolically unhealthy (MUO) (all p &lt;= 0.001). A similar trend was observed for global gray matter volume (p = 0.06). Global gray matter volume was positively related to academic achievement (beta = 0.237, p = 0.036). However, all the associations were attenuated or disappeared after adjusting for cardiorespiratory fitness (p &gt; 0.05). The findings of the present study support that metabolically healthy overweight/obese children have greater gray matter volume compared to those that are metabolically unhealthy, which is in turn related to better academic achievement. However, cardiorespiratory fitness seems to explain, at least partially, these findings.

  • 12.
    Cadenas-Sanchez, Cristina
    et al.
    Univ Granada, Spain.
    Migueles, Jairo H.
    Univ Granada, Spain.
    Esteban-Cornejo, Irene
    Univ Granada, Spain; Northeastern Univ, MA 02115 USA.
    Mora-Gonzalez, Jose
    Univ Granada, Spain.
    Henriksson, Pontus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Rodriguez-Ayllon, Maria
    Univ Granada, Spain.
    Molina-Garcia, Pablo
    Univ Granada, Spain.
    Löf, Marie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Labayen, Idoia
    Univ Publ Navarra, Spain.
    Hillman, Charles H.
    Northeastern Univ, MA 02115 USA; Northeastern Univ, MA 02115 USA.
    Catena, Andres
    Univ Granada, Spain.
    Ortega, Francisco B.
    Univ Granada, Spain; Karolinska Inst, Sweden.
    Fitness, physical activity and academic achievement in overweight/obese children2020In: Journal of Sports Sciences, ISSN 0264-0414, E-ISSN 1466-447XArticle in journal (Refereed)
    Abstract [en]

    The aim of this study was to examine the associations of fitness and physical activity with academic achievement in children with overweight/obesity. A total of 106 (10.0 +/- 1.1y, 61 boys) children participated. The fitness components were assessed by field and laboratory-based tests. Physical activity was measured via accelerometry. The academic achievement was assessed by a standardised test and school-grades. Field-based cardiorespiratory fitness was associated with language skills (ss-standardised- ranging from 0.281 to 0.365, p amp;lt; 0.01). The field-based muscular strength was associated with grade point average, natural and social sciences, and foreign language (ss = 0.280-0.326, all p amp;lt;= 0.01). Speed-agility was associated with some language-related skills (ss = 0.325-0.393, all p amp;lt;= 0.01). The laboratory-based muscular strength also showed an association with mathematics skills (ss = 0.251-0.306, all p amp;lt;= 0.01). Physical activity did not show significant association with academic achievement (p amp;gt; 0.01). Overall, the significant associations observed for muscular strength and speed/agility were attenuated and disappeared in many cases after additional adjustments for body mass index and cardiorespiratory fitness, indicating that these associations are inter-dependent. Our study contributes by indicating that other fitness components apart from cardiorespiratory fitness, such as muscular strength and speed-agility, are positively associated with academic achievement. However, these associations appear to be dependent on body mass index and cardiorespiratory fitness.

  • 13.
    Clark, Andrew
    et al.
    School of Health and Society, University of Salford, Salford, Greater Manchester, UK.
    Campbell, Sarah
    School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
    Keady, John
    School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
    Kullberg, Agneta
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    Manji, Kainde
    University of Salford, Salford, Greater Manchester, UK.
    Rummery, Kirstein
    Faculty of Social Science, University of Stirling, Colin Bell Building, Stirling, UK.
    Ward, Richard
    Faculty of Social Science, University of Stirling, Colin Bell Building, Stirling, UK.
    Neighbourhoods as relational places for people living with dementia2020In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 252Article in journal (Refereed)
    Abstract [en]

    An increase in the number of people living independently with dementia across the developed world has focused attention on the relevance of neighbourhood spaces for enabling or facilitating good social health and wellbeing. Taking the lived experiences and daily realities of people living with dementia as a starting point, this paper contributes new understanding about the relevance of local places for supporting those living with the condition. The paper outlines findings from a study of the neighbourhood experiences, drawing on new data collected from a creative blend of qualitatively-driven mixed methods with people living in a diverse array of settings across three international settings. The paper details some of the implications of neighbourhoods as sites of social connection based on material from 67 people living with dementia and 62 nominated care-partners. It demonstrates how neighbourhoods are experienced as relational places and considers how people living with dementia contribute to the production of such places through engagement and interaction, and in ways that may be beneficial to social health. We contend that research has rarely focused on the subjective, experiential and ‘everyday’ social practices that contextualise neighbourhood life for people living with dementia. In doing so, the paper extends empirical and conceptual understanding of the relevance of neighbourhoods as relational sites of connection, interaction, and social engagement for people living with dementia.

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  • 14.
    Dong, Huan-Ji
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Linköping University, Faculty of Medicine and Health Sciences.
    Larsson, Britt
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Bernfort, Lars
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Factors Associated with Life Satisfaction in Older Adults with Chronic Pain (PainS65+)2020In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 13, p. 475-489Article in journal (Refereed)
    Abstract [en]

    Background: Chronic pain in later life is a worldwide problem. In younger patients, chronic pain affects life satisfaction negatively; however, it is unknown whether this outcome will extend into old age.

    Objective: This study examines which factors determine life satisfaction in older adults who suffer from chronic pain with respect to socio-demographics, lifestyle behaviors, pain, and comorbidities.

    Methods: This cross-sectional study recruited a random sample of people ≥ 65 years old living in south-eastern Sweden (N= 6611). A postal survey addressed pain aspects and health experiences. Three domains from the Life Satisfaction Questionnaire (LiSat-11) were used to capture the individual’s estimations of overall satisfaction (LiSat-life), somatic health (LiSat-somhealth), and psychological health (LiSat-psychhealth).

    Results: Respondents with chronic pain (2790, 76.2± 7.4 years old) rated lower on life satisfaction than those without chronic pain, with medium effect size (ES) on LiSat-somhealth (r = 0.38, P < 0.001) and small ES on the other two domains (r < 0.3). Among the respondents with chronic pain, severe pain (OR 0.29– 0.59) and pain spreading (OR 0.87– 0.95) were inversely associated with all three domains of the LiSat-11. Current smoking, alcohol overconsumption, and obesity negatively affected one or more domains of the LiSat-11. Most comorbidities were negatively related to LiSat-somhealth, and some comorbidities affected the other two domains. For example, having tumour or cancer negatively affected both LiSat-life (OR 0.62, 95% CI 0.44– 0.88) and LiSat-somhealth (OR 0.42, 95% CI 0.24– 0.74). Anxiety or depression disorders had a negative relationship both for LiSat-life (OR 0.54, 95% CI 0.38– 0.78) and LiSat-psychhealth (OR 0.10, 95% CI 0.06– 0.14).Conclusion: Older adults with chronic pain reported lower life satisfaction but the difference from their peers without chronic pain was trivial, except for satisfaction with somatic health. Pain management in old age needs to consider comorbidities and severe pain to improve patients’ life satisfaction.

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  • 15.
    Edelbring, Samuel
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Orebro Univ, Sweden.
    Alehagen, Siw
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Mörelius, Evalotte
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus Linköping/Motala. Edith Cowan Univ, Australia.
    Johansson, AnnaKarin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Rytterström, Patrik
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Should the PBL tutor be present?: A cross-sectional study of group effectiveness in synchronous and asynchronous settings2020In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, BMC MEDICAL EDUCATION, Vol. 20, no 1Article in journal (Refereed)
    Abstract [en]

    Background

    The tutorial group and its dynamics are a cornerstone of problem-based learning (PBL). The tutor’s support varies according to the setting, and it is pertinent to explore group effectiveness in relation to different settings, for example online or campus-based. The PBL groups’ effectiveness can partly be assessed in terms of cognitive and motivational aspects, using a self-report tool to measure PBL group effectiveness, the Tutorial Group Effectiveness Instrument (TGEI).

    This study’s aim was to explore tutor participation in variations of online and campus-based tutorial groups in relation to group effectiveness. A secondary aim was to validate a tool for assessing tutorial group effectiveness in a Swedish context.

    Methods

    A cross-sectional study was conducted with advanced-level nursing students studying to become specialised nurses or midwives at a Swedish university. The TGEI was used to measure motivational and cognitive aspects in addition to overall group effectiveness. The instrument’s items were translated into Swedish and refined with an expert group and students. The responses were calculated descriptively and compared between groups using the Mann–Whitney U and Kruskal–Wallis tests. A psychometric evaluation was performed using the Mokken scale analysis. The subscale scores were compared between three different tutor settings: the tutor present face-to-face in the room, the tutor present online and the consultant tutor not present in the room and giving support asynchronously.

    Results

    All the invited students (n = 221) participated in the study. There were no differences in motivational or cognitive aspects between students with or without prior PBL experience, nor between men and women. Higher scores were identified on cognitive aspects (22.6, 24.6 and 21.3; p < 0.001), motivational aspects (26.3, 27 and 24.5; p = 002) and group effectiveness (4.1, 4.3, 3.8, p = 0.02) for the two synchronously tutored groups compared to the asynchronously tutored group. The TGEI subscales showed adequate homogeneity.

    Conclusions

    The tutor’s presence is productive for PBL group effectiveness. However, the tutor need not be in the actual room but can provide support in online settings as long as the tutoring is synchronous.

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  • 16.
    Edouard, Pascal
    et al.
    Univ Jean Monnet, France; Univ Hosp St Etienne, France; French Athlet Federat FFA, France; EAA, Switzerland; CHU Vaudois, Switzerland.
    Glover, Danny
    Hlth Educ Yorkshire and Humber, England; Univ Edinburgh, Scotland.
    Murray, Andrew
    Univ Edinburgh, Scotland.
    Timpka, Toomas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
    Sorg, Marine
    Univ Hosp St Etienne, France.
    Depiesse, Frederic
    French Athlet Federat FFA, France; EAA, Switzerland; Univ Hosp Martin, France; IAAF, Monaco.
    Branco, Pedro
    EAA, Switzerland; IAAF, Monaco.
    Junge, Astrid
    MSH Med Sch Hamburg, Germany; Swiss Concuss Ctr, Switzerland; Schulthess Clin, Switzerland.
    Infographic. Useful steps in the prevention of illnesses during international athletics championships2020In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 54, no 4, p. 251-252Article in journal (Other academic)
    Abstract [en]

    n/a

  • 17.
    Edouard, Pascal
    et al.
    Univ Jean Monnet, France; Univ Hosp St Etienne, France; CHU Vaudois, Switzerland; EAA, Switzerland; FFA, France.
    Navarro, Laurent
    Univ Jean Monnet, France.
    Branco, Pedro
    EAA, Switzerland; IAAF, Monaco.
    Gremeaux, Vincent
    CHU Vaudois, Switzerland; Univ Lausanne, Switzerland.
    Timpka, Toomas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
    Junge, Astrid
    MSH Med Sch Hamburg, Germany; Schulthess Klin, Switzerland.
    Injury frequency and characteristics (location, type, cause and severity) differed significantly among athletics (track and field) disciplines during 14 international championships (2007-2018): implications for medical service planning2020In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 54, no 3, p. 159-167Article in journal (Refereed)
    Abstract [en]

    Objective To analyse differences between athletic disciplines in the frequency and characteristics of injuries during international athletics championships. Methods Study design, injury definition and data collection procedures were similar during the 14 international championships (2007-2018). National medical teams and local organising committee physicians reported all newly incurred injuries daily on a standardised injury report form. Results were presented as number of injuries and number of injuries per 1000 registered athletes, separately for male and female athletes, and for each discipline. Results From a total of 8925 male and 7614 female registered athletes, 928 injuries were reported in male and 597 in female athletes. The discipline accounting for the highest proportion of injuries was sprints, for both men (24%) and women (26%). The number of injuries per 1000 registered athletes varied between disciplines for men and women: highest in combined events for male athletes (235 (95% CI 189 to 281)) and female athletes (212 (95% CI 166 to 257)), and lowest for male throwers (47 (95% CI 35 to 59)) and female throwers (32 (95% CI 21 to 43)) and for female race walkers (42 (95% CI 19 to 66)). Injury characteristics varied significantly between disciplines for location, type, cause and severity in male and female athletes. Thigh muscle injuries were the main diagnoses in the disciplines sprints, hurdles, jumps, combined events and race walking, lower leg muscle injuries in marathon running, lower leg skin injury in middle and long distance running, and trunk muscle and lower leg muscle injuries in throws. Conclusions Injury characteristics differed substantially between disciplines during international athletics championships. Strategies for medical service provision (eg, staff, facilities) during athletics championships should be discipline specific and be prepared for targeting the main injuries in each discipline.

  • 18.
    Ekstrand, Jan
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Aspetar Orthopaed and Sports Med Hosp, Qatar.
    Spreco, Armin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Windt, Johann
    Linköping University, Faculty of Medicine and Health Sciences. US Olymp Comm, CO USA; US Coalit Prevent Illness and Injury Sport, CO USA.
    Khan, Karim M.
    Linköping University, Faculty of Medicine and Health Sciences. Univ British Columbia, Canada.
    Are Elite Soccer Teams Preseason Training Sessions Associated With Fewer In-Season Injuries? A 15-Year Analysis From the Union of European Football Associations (UEFA) Elite Club Injury Study2020In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, article id 0363546519899359Article in journal (Refereed)
    Abstract [en]

    Background: Preseason training develops players physical capacities and prepares them for the demands of the competitive season. In rugby, Australian football, and American football, preseason training may protect elite players against in-season injury. However, no study has evaluated this relationship at the team level in elite soccer. Purpose/Hypothesis: The aim of this study was to investigate whether the number of preseason training sessions completed by elite soccer teams was associated with team injury rates and player availability during the competitive season. It was hypothesized that elite soccer teams who participate in more preseason training will sustain fewer injuries during the competitive season. Study Design: Descriptive epidemiology study. Methods: We used the Union of European Football Associations (UEFA) injury dataset to analyze 44 teams for up to 15 seasons (total, 244 team-seasons). Separate linear regression models examined the association between the number of team preseason training sessions and 5 in-season injury measures. Injury-related problems per team were quantified by totals of the following: (1) injury burden, (2) severe injury incidence, (3) training attendance, (4) match availability, and (5) injury incidence. Results: Teams averaged 30 preseason training sessions (range, 10-51). A greater number of preseason training sessions was associated with less injury load during the competitive season in 4 out of 5 injury-related measures. Our linear regression models revealed that for every 10 additional preseason training sessions that the team performed, the in-season injury burden was 22 layoff days lower per 1000 hours (P = .002), the severe injury incidence was 0.18 severe injuries lower per 1000 hours (P = .015), the training attendance was 1.4 percentage points greater (P = .014), and the match availability was 1.0 percentage points greater (P = .042). As model fits were relatively low (adjusted R-2 = 1.3%-3.2%), several factors that contribute to in-season injury outcomes were unaccounted for. Conclusion: Teams that performed a greater number of preseason training sessions had "healthier" in-season periods. Many other factors also contribute to in-season injury rates. Understanding the benefit of preseason training on in-season injury patterns may inform sport teams planning and preparation.

  • 19.
    Fagher, Kristina
    et al.
    Lund Univ, Sweden.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Jacobsson, Jenny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
    Lexell, Jan
    Lund Univ, Sweden; Uppsala Univ, Sweden.
    Prevalence of Sports-Related Injuries and Illnesses in Paralympic Athletes2020In: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 12, no 3, p. 271-280Article in journal (Refereed)
    Abstract [en]

    BackgroundWith increased participation in Paralympic sports, the burden of sports-related injuries and illnesses may increase. However, there is limited knowledge about the epidemiology of sports-related injuries and illnesses in Paralympic sports (SRIIPS). ObjectiveTo describe among Swedish Paralympic athletes the 1-year retrospective period prevalence of severe SRIIPS and the point prevalence of all SRIIPS and to examine differences in prevalence proportions between athletes with different impairments, behaviors, and sport characteristics. DesignCross-sectional study. SettingSwedish Paralympic Programme. ParticipantsOne hundred and four Paralympic athletes with visual, physical, and intellectual impairment. MethodsAn eHealth application adapted to Paralympic athletes was used to collect self-report data on existing and previous SRIIPS, as well as impairment, behavior, and sport characteristics. Main Outcome MeasurementsOne-year retrospective period prevalence and point prevalence. ResultsThe period prevalence of severe injuries was 31% (95% CI 23-40) and the point prevalence 32% (95% CI 24-41). The period prevalence of severe illnesses was 14% (95% CI 9-23), and 13% of the athletes (95% CI 8-22) reported a current illness. More severe injuries (Pamp;lt;.05) were reported by athletes aged 18 to 25years, not using assistive device, having pain during sport, using analgesics, continuing training injured, and feeling guilt when missing exercise. Athletes who reported a previous severe injury, having pain in daily life and during sport, using analgesics, and being upset when unable to exercise had a higher prevalence of current injuries (Pamp;lt;.05). Being female, reporting previous severe illness, using prescribed medication, and feeling anxious/depressed were features associated with ongoing illnesses (Pamp;lt;.05). ConclusionParalympic athletes report a high prevalence of SRIIPS. Behavioral and psychological aspects as well as pain and use of medication appear to be associated with the occurrence of SRIIPS. The results imply that factors leading to SRIIPS are complex and call for a broad biopsychosocial approach when developing preventive measures. Level of EvidenceIII.

  • 20.
    Henriksson, Hanna
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Granada, Spain.
    Henriksson, Pontus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Granada, Spain; Karolinska Inst, Sweden.
    Tynelius, Per
    Karolinska Inst, Sweden; Stockholm Cty Council, Sweden.
    Ekstedt, Mattias
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Gastroentorology.
    Berglind, Daniel
    Karolinska Inst, Sweden; Stockholm Cty Council, Sweden.
    Labayen, Idoia
    Univ Publ Navarra, Spain.
    Ruiz, Jonatan R.
    Univ Granada, Spain; Karolinska Inst, Sweden.
    Lavie, Carl J.
    Univ Queensland, LA 70121 USA.
    Ortega, Francisco B.
    Univ Granada, Spain; Karolinska Inst, Sweden.
    Cardiorespiratory fitness, muscular strength, and obesity in adolescence and later chronic disability due to cardiovascular disease: a cohort study of 1 million men2020In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 41, no 15, p. 1503-+Article in journal (Refereed)
    Abstract [en]

    Aims Cardiorespiratory fitness, muscular strength, and obesity in adulthood are risk factors for cardiovascular disease (CVD). However, Little is known regarding the associations of these risk factors, already in adolescence, with later disability due to chronic CVD. Hence, we investigated associations of cardiorespiratory fitness, muscular strength, and body mass index (BMI) in adolescence with Later chronic disability due to specific causes of CVD disability (i.e. cerebrovascutar disease, ischaemic heart disease and heart failure). Methods and results This population-based cohort study included 1 078 685 male adolescents (16-19 years) from the Swedish military conscription register from 1972 to 1994. Cardiorespiratory fitness (bicycle ergometer test), muscular strength (knee extension strength), and BMI were measured during the conscription examination. Information about disability pension due to CVD was retrieved from the Social Insurance Agency during a mean follow-up of 28.4 years. Cardiorespiratory fitness was strongly and inversely associated with later risk of chronic CVD disability for all investigated causes. The association was particularly strong for ischaemic heart diseases (hazard ratio 0.11, 95% confidence interval 0.05-0.29 for highest vs. lowest fitness-quintiles). Furthermore, overweight/obesity were associated with CVD disability for all investigated causes. Conversely, associations of muscular strength with CVD disability were generally weak. Conclusions This study provides evidence for associations between low levels of cardiorespiratory fitness and obesity with later risk of chronic disability due to CVD. Preventive actions may begin at young ages and include promotion of cardiorespiratory fitness and healthy body weight.

  • 21.
    Henriksson, Martin
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Björnsson, Bergthor
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Eilard, M. Sternby
    Univ Gothenburg, Sweden.
    Lindell, G.
    Lund Univ, Sweden.
    Strömberg, C.
    Karolinska Univ Hosp, Sweden.
    Hemmingsson, O.
    Umea Univ, Sweden.
    Isaksson, B.
    Uppsala Univ, Sweden.
    Rizell, M.
    Univ Gothenburg, Sweden.
    Sandström, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Treatment patterns and survival in patients with hepatocellular carcinoma in the Swedish national registry SweLiv2020In: BJS OPEN, ISSN 2474-9842, Vol. 4, no 1, p. 109-117Article in journal (Refereed)
    Abstract [en]

    Background Consistent data on clinical features, treatment modalities and long-term survival in patients with hepatocellular carcinoma (HCC) using nationwide quality registers are lacking. This study aimed to describe treatment patterns and survival outcomes in patients diagnosed with HCC using a national maintained database. Methods Characteristics and treatment patterns in patients diagnosed with HCC and registered in the national register of liver and bile duct tumours (SweLiv) between 2009 and 2016 were reviewed. Overall survival (OS) was estimated using Kaplan-Meier analysis and the log rank test to compare subgroups for clinical features, treatment modalities and outcomes according to the year of treatment. Results A total of 3376 patients with HCC were registered over 8 years, 246 (7 center dot 3 per cent) of whom underwent transplantation. Some 501 (14 center dot 8 per cent) and 390 patients (11 center dot 6 per cent) had resection and ablation as primary treatment. Transarterial chemoembolization and systemic sorafenib treatment were intended in 476 (14 center dot 1 per cent) and 426 patients (12 center dot 6 per cent) respectively; the remaining 1337 (39 center dot 6 per cent) were registered but referred for best supportive care (BSC). The 5-year survival rate was approximately 75 per cent in the transplantation group. Median OS was 4 center dot 6 (i.q.r. 2 center dot 0 to not reached) years after resection and 3 center dot 1 (2 center dot 3-6 center dot 7) years following ablation. In patients referred for palliative treatment, median survival was 1 center dot 4 (0 center dot 8-2 center dot 9), 0 center dot 5 (0 center dot 3-1 center dot 2) and 0 center dot 3 (0 center dot 1-1 center dot 0) years for the TACE, sorafenib and BSC groups respectively (P amp;lt; 0 center dot 001). Median survival was 0 center dot 9 years for the total HCC cohort in 2009-2012, before publication of the Swedish national treatment programme, increasing to 1 center dot 4 years in 2013-2016 (P amp;lt; 0 center dot 001). Conclusion The survival outcomes reported were in line with previous results from smaller cohorts. The introduction of national guidelines may have contributed to improved survival among patients with HCC in Sweden.

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  • 22.
    Isaksson, K.
    et al.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden; Kristianstad Cent Hosp, Sweden.
    Mikiver, R.
    Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Business support and Development, Regional Cancer Center.
    Eriksson, H.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Lapins, J.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Nielsen, K.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden; Helsingborg Hosp, Sweden.
    Ingvar, C.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Lyth, Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Operations management Region Östergötland, Research and Development Unit.
    Survival in 31 670 patients with thin melanomas: a Swedish population-based study2020In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133Article in journal (Refereed)
    Abstract [en]

    Background The incidence of cutaneous malignant melanoma (CMM) continues to increase in most countries worldwide and the majority are diagnosed with thin tumours (&lt;= 1 mm). Objectives The aim of the present study was to investigate the melanoma-specific survival (MSS) as well as conditional MSS (CMSS) in patients with thin CMM in Sweden. Patients and methods Clinical and histological parameters were obtained from the Swedish Melanoma Registry for patients diagnosed with thin CMM between 1990 and 2017. Patients were followed until the end of 2017. MSS as well as CMSS for different thickness groups were calculated using the Kaplan-Meier method and Cox regression analyses were used to calculate for survival differences between thickness groups. Results There were 31 670 patients included for final analyses. The overall 10- and 20-year MSS for thin CMMs was 97% [95% confidence interval (CI) 97-97] and 95% (95% CI 95-96), respectively. From 0 center dot 7 mm and above, MSS decreased significantly with increasing thickness level. All thickness groups had an increased survival over time. The lowest CMSS was confirmed for men with 1 center dot 0 mm in thickness but their 10-year CMSS increased steadily over time. Women had overall better MSS as well as CMSS than men. However, the relation between MSS and CMSS was similar for both sexes. Conclusions MSS was confirmed as excellent for patients with thin CMMs in Sweden. Although we could show a decreased MSS for patients with 0 center dot 7 mm thickness and above, the long-term survival and, in addition, a very favourable CMSS for those patients do not support more extended follow-up programmes than the current recommendations in Sweden. What is already known about this topic? The majority of patients with cutaneous malignant melanoma are diagnosed with thin melanomas (&lt;= 1 mm) and the survival is generally reported as favourable. What does this study add? Our national population-based designed study, including 31 670 patients with thin melanomas, is exclusive when it comes to melanoma survival data, as many former studies are based on selected and smaller cohorts of patients (e.g. referral centres/hospital-based registries). In addition to an excellent overall melanoma-specific survival (MSS), we could also report an increasing conditional MSS with time from diagnosis for patients with thin melanomas in Sweden.

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  • 23.
    Jacobsson, Jenny
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Swedish Athlet Assoc, Sweden.
    Ekberg, Joakim
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
    Rasberg, Lena
    Swedish Athlet Assoc, Sweden.
    Sjoberg, Marina
    Swedish Athlet Assoc, Sweden.
    Mirkovic, Dejan
    Swedish Athlet Assoc, Sweden.
    Nilsson, Sverker
    Swedish Athlet Assoc, Sweden.
    Developing web-based health guidance for coaches and parents in child athletics (track and field)2020In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to develop athletics health guidance (AHG) aimed at supporting coaches and parents involved in organized child athletics by providing practical advice and tools for the management of the most common health problems experienced in athletics by the 12- to 15-year olds. The study used participatory action research (PAR) and an established health service guideline development procedure modified to fit AHG development in child athletics. A sequential process consisting of four steps with associated subgoals was employed. The collected data were structured according to the AHG development steps and analyzed using qualitative methods. The most common health concern identified was injuries related to growth and overuse. No randomized controlled studies investigating injury prevention programs or any existing concepts/guidelines in child athletics were found that could be used in the development of the AHG. A requirements document was instead defined in a nominal group process and used for the AHG development. The areas included in the final AHG were as follows: training youth athletes, growth and puberty, recovery, injury prevention, injuries and illnesses, mental illness, safe sport, and anti-doping. The evidence regarding health issues in child athletics is limited, indicating that actions to support good health in the sport are currently based essentially on best practice. The long-term aim of the AHG and associated website is to systematically create and introduce conditions that can bridge the "know-do gap" and provide coaches and parents with easy-to-access and up-to-date knowledge in the field of child athlete health in athletics.

  • 24.
    Johannesen, Kasper
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Janzon, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jernberg, Tomas
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Henriksson, Martin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Subcategorizing the Expected Value of Perfect Implementation to Identify When and Where to Invest in Implementation Initiatives2020In: Medical decision making, ISSN 0272-989X, E-ISSN 1552-681X, article id 0272989X20907353Article in journal (Refereed)
    Abstract [en]

    Purpose. Clinical practice variations and low implementation of effective and cost-effective health care technologies are a key challenge for health care systems and may lead to suboptimal treatment and health loss for patients. The purpose of this work was to subcategorize the expected value of perfect implementation (EVPIM) to enable estimation of the absolute and relative value of eliminating slow, low, and delayed implementation. Methods. Building on the EVPIM framework, this work defines EVPIM subcategories to estimate the expected value of eliminating slow, low, or delayed implementation. The work also shows how information on regional implementation patterns can be used to estimate the value of eliminating regional implementation variation. The application of this subcategorization is illustrated by a case study of the implementation of an antiplatelet therapy for the secondary prevention after myocardial infarction in Sweden. Incremental net benefit (INB) estimates are based on published cost-effectiveness assessments and a threshold of SEK 250,000 (22,300) pound per quality-adjusted life year (QALY). Results. In the case study, slow, low, and delayed implementation was estimated to represent 22%, 34%, and 44% of the total population EVPIM (2941 QALYs or SEK 735 million), respectively. The value of eliminating implementation variation across health care regions was estimated to 39% of total EVPIM (1138 QALYs). Conclusion. Subcategorizing EVPIM estimates the absolute and relative value of eliminating different parts of suboptimal implementation. By doing so, this approach could help decision makers to identify which parts of suboptimal implementation are contributing most to total EVPIM and provide the basis for assessing the cost and benefit of implementation activities that may address these in future implementation of health care interventions.

  • 25.
    Kypri, Kypros
    et al.
    Univ Newcastle, Australia.
    Bowe, Steven J.
    Deakin Univ, Australia.
    Karlsson, Nadine
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    McCambridge, Jim
    Univ York, England.
    Enrolment-latency in randomized behavior change trials: individual participant data meta-analysis showed association with attrition but not effect-size2020In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 118, p. 55-59Article in journal (Refereed)
    Abstract [en]

    Objectives: Nonresponse can bias prevalence estimates in population surveys. Effects of selective participation in behavior change intervention trials have been little studied. We tested hypotheses that trial participants who are hard to recruit are (1) more likely to be lost-to-follow-up and (2) less responsive to intervention. Study Design and Setting: We undertook a two-stage individual participant data meta-analysis of four alcohol intervention trials involving 9,251 university students in Australia, New Zealand, and Sweden, comparing participants who enrolled "late" (after the final invitation to participate) vs. "early" (before that). Outcomes were whether participants completed assessments at each trials primary endpoint (late/early) and number of drinks consumed per week (intervention/control) among late enrolees vs. early enrolees. Results: Late enrolees were more likely to be lost-to-follow-up than early enrolees (OR 2.3, 95% CI: 1.7, 2.9). Intervention effect estimates were smaller for late vs. early enrolees, but not significantly so (RR = 0.93; 95% CI: 0.79, 1.08). Conclusion: Greater effort to recruit trial participants was associated with higher attrition, but there was no clear evidence of bias in effect estimation. The possibility that intervention effect estimates do not generalize beyond a relatively compliant minority of trial participants may warrant further study. (C) 2019 Published by Elsevier Inc.

  • 26.
    Lindqvist, Anna-Karin
    et al.
    Lulea Univ Technol, Sweden.
    Löf, Marie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Ek, Anna
    Karolinska Inst, Sweden.
    Rutberg, Stina
    Lulea Univ Technol, Sweden.
    Correction: Active School Transportation in Winter Conditions: Biking Together is Warmer (vol 16, 234, 2019)2020In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, Vol. 17, no 5, article id 1524Article in journal (Refereed)
    Abstract [en]

    n/a

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  • 27.
    Marcusson, Jan
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Nord, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Dong, Huan-Ji
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Lyth, Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Operations management Region Östergötland, Research and Development Unit.
    Clinically useful prediction of hospital admissions in an older population2020In: BMC GERIATRICS, Vol. 20, no 1, article id 95Article in journal (Refereed)
    Abstract [en]

    Background The healthcare for older adults is insufficient in many countries, not designed to meet their needs and is often described as disorganized and reactive. Prediction of older persons at risk of admission to hospital may be one important way for the future healthcare system to act proactively when meeting increasing needs for care. Therefore, we wanted to develop and test a clinically useful model for predicting hospital admissions of older persons based on routine healthcare data. Methods We used the healthcare data on 40,728 persons, 75-109 years of age to predict hospital in-ward care in a prospective cohort. Multivariable logistic regression was used to identify significant factors predictive of unplanned hospital admission. Model fitting was accomplished using forward selection. The accuracy of the prediction model was expressed as area under the receiver operating characteristic (ROC) curve, AUC. Results The prediction model consisting of 38 variables exhibited a good discriminative accuracy for unplanned hospital admissions over the following 12 months (AUC 0.69 [95% confidence interval, CI 0.68-0.70]) and was validated on external datasets. Clinically relevant proportions of predicted cases of 40 or 45% resulted in sensitivities of 62 and 66%, respectively. The corresponding positive predicted values (PPV) was 31 and 29%, respectively. Conclusion A prediction model based on routine administrative healthcare data from older persons can be used to find patients at risk of admission to hospital. Identifying the risk population can enable proactive intervention for older patients with as-yet unknown needs for healthcare.

  • 28.
    Migueles, Jairo H.
    et al.
    Univ Granada, Spain.
    Cadenas-Sanchez, Cristina
    Univ Granada, Spain.
    Aguiar, Elroy J.
    Univ Massachusetts, MA 01003 USA.
    Molina-Garcia, Pablo
    Univ Granada, Spain; Katholieke Univ Leuven, Belgium.
    Solis-Urra, Patricio
    Univ Granada, Spain; Pontificia Univ Catolica Valparaiso, Chile.
    Mora-Gonzalez, Jose
    Univ Granada, Spain.
    Garcia-Marmol, Eduardo
    Univ Granada, Spain.
    Shiroma, Eric J.
    NIA, MD 20892 USA.
    Labayen, Idoia
    Univ Publ Navarra, Spain.
    Chillon, Palma
    Univ Granada, Spain.
    Löf, Marie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Tudor-Locke, Catrine
    Univ Massachusetts, MA 01003 USA.
    Ortega, Francisco B.
    Univ Granada, Spain; Karolinska Inst, Sweden.
    Step-Based Metrics and Overall Physical Activity in Children With Overweight or Obesity: Cross-Sectional Study2020In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 8, no 4, article id e14841Article in journal (Refereed)
    Abstract [en]

    Background: Best-practice early interventions to increase physical activity (PA) in children with overweight and obesity should be both feasible and evidence based. Walking is a basic human movement pattern that is practical, cost-effective, and does not require complex movement skills. However, there is still a need to investigate how much walking-as a proportion of total PA level-is performed by children who are overweight and obese in order to determine its utility as a public health strategy. Objective: This study aimed to (1) investigate the proportion of overall PA indicators that are explained by step-based metrics and (2) study step accumulation patterns relative to achievement of public health recommendations in children who are overweight and obese. Methods: A total of 105 overweight and obese children (mean 10.1 years of age [SD 1.1]; 43 girls) wore hip-worn accelerometers for 7 days. PA volumes were derived using the daily average of counts per 15 seconds, categorized using standard cut points for light-moderate-vigorous PA (LMVPA) and moderate-to-vigorous PA (MVPA). Derived step-based metrics included volume (steps/day), time in cadence bands, and peak 1-minute, 30-minute, and 60-minute cadences. Results: Steps per day explained 66%, 40%, and 74% of variance for counts per 15 seconds, LMVPA, and MVPA, respectively. The variance explained was increased up to 80%, 92%, and 77% by including specific cadence bands and peak cadences. Children meeting the World Health Organization recommendation of 60 minutes per day of MVPA spent less time at zero cadence and more time in cadence bands representing sporadic movement to brisk walking (ie, 20-119 steps/min) than their less-active peers. Conclusions: Step-based metrics, including steps per day and various cadence-based metrics, seem to capture a large proportion of PA for children who are overweight and obese. Given the availability of pedometers, step-based metrics could be useful in discriminating between those children who do or do not achieve MVPA recommendations.

  • 29.
    Moldvik, Isa
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Ståhl, Christian
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Educational Sciences.
    Müssener, Ulrika
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Work ethics and societal norms influence sick leave and return to work: tales of transformation2020In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed)
    Abstract [en]

    Purpose: This studys purpose was to explore how people on sick leave manage societal norms and values related to work, and how these influence their perspectives of themselves throughout the rehabilitation process. Materials and methods: This was a longitudinal interview study with a narrative approach, comprising 38 interviews with 11 individuals on long-term sick leave. Data collection was conducted in two phases and analysed iteratively through content analysis. Results: The results suggest that work ethics and societal norms influence individuals views of themselves and the sick leave and rehabilitation process. Conforming ones personal values to the work norm can create internal conflicts and cause feelings of shame for not being able to live up to the established norm. The strong work norm may create unrealistic expectations, which in some cases may result in constraining the return to work process. Conclusion: To transform a sick leave narrative into a positive one, societal norms and their influence on identity needs to be recognised. Stakeholders involved in the process can contribute to a positive transformation by not only supporting return to work, but also to acknowledge and help people manage their self-image as having a disability that limits their ability to work.

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  • 30.
    Mourad, Ghassan
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Alwin, Jenny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Johansson, Peter
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    The associations between psychological distress and health-related quality of life in patients with non-cardiac chest pain2020In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, HEALTH AND QUALITY OF LIFE OUTCOMES, Vol. 18, no 1, article id 68Article in journal (Refereed)
    Abstract [en]

    Background Recurrent chest pain episodes with no clear explanation may affect patients psychological wellbeing and health-related quality of life (HRQoL) negatively. Despite the fact that a significant amount of patients with non-cardiac chest pain (NCCP) might have a history of Cardiac Disease (CD), there is today a lack of knowledge on how CD influences the association between psychological wellbeing and HRQoL in patients with NCCP. Therefore, the aim of this study is to describe HRQoL in patients with NCCP, with or without history of CD, and to explore the association between HRQoL and cardiac anxiety, depressive symptoms, fear of body sensations and somatization. Methods Five hundred fifty-two patients discharged with NCCP from four hospitals in Southeast Sweden completed the EQ-5D, Cardiac Anxiety Questionnaire, Patient Health Questionnaire-9, Body Sensations Questionnaire, and Patient Health Questionnaire-15. Results Fifty precent reported at least moderate problems regarding pain/discomfort and 25% reported at least moderate problems in the HRQoL dimensions mobility, usual activities, and anxiety/depression. Patients with NCCP and history of CD reported significantly lower HRQoL (p amp;lt;= 0.05) compared to patients with NCCP without CD. In the total study population, cardiac anxiety, depressive symptoms, and somatization had weak significant negative associations (beta = 0.187-0.284, p amp;lt; 0.001) with HRQoL. In patients with history of CD, the association between depressive symptoms and HRQoL was moderate (beta = - 0.339, p amp;lt; 0.001), compared to weak association in patients without CD (beta = - 0.193, p amp;lt; 0.001). On the other hand, the association between cardiac anxiety and HRQoL was weak in both patients with history of CD (beta = - 0.156, p = 0.05), and in those without (beta = - 0.229, p amp;lt; 0.001). Conclusions Patients with NCCP, in particular those with history of CD, reported low levels of HRQoL, which was associated with psychological distress. This should be considered when developing psychological interventions aiming to improve HRQoL in patients with NCCP.

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  • 31.
    Müssener, Ulrika
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Linderoth, Catharina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Thomas, Kristin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    mHealth smoking cessation intervention among high school students: 3-month primary outcome findings from a randomized controlled trial2020In: PLoS ONE, E-ISSN 1932-6203, Vol. 15, no 3, article id e0229411Article in journal (Refereed)
    Abstract [en]

    Background

    Smoking among adolescents remains a global public health issue as youth continue to maintain high prevalence rates. The evidence for the efficacy of text messaging interventions to reduce smoking behavior is well established, yet there is still a need for studies targeting high school students. The aim of the study was to determine the effectiveness of a text-based smoking cessation intervention among high school students in Sweden.

    Methods

    The study was a two-arm randomized trial conducted from January 10 2018 to January 11 2019, data were analysed from April 12 2019 to May 21 2019. Inclusion criteria were high school students who were daily or weekly smokers willing to attempt to quit smoking and owned a mobile phone. The study invited all students at 630 high schools units throughout Sweden. The intervention group received text messages based on components of effective smoking cessation interventions for 12 weeks. The control group were offered treatment as usual. The primary outcomes were self-reported prolonged abstinence (not having smoked more than 5 cigarettes over the last 8 weeks) and 4-week point prevalence of smoking abstinence.

    Findings

    A total of 535 participants, with a median age of 17 (IQR 16–18), were randomized into the study; 276 (164 [59.4%] women) were allocated to the intervention and 259 (162 [62.5%] women) to the control group. The outcomes of the trial were analyzed on a total of 212 (76.8%) participants in the intervention group and 201 (77.6%) participants in the control group. Prolonged abstinence at the 3-month follow-up was reported by 49 (23.1%) individuals in the intervention group and 39 (19.4%) individuals in the control group (adjusted OR, 1.21; 95% CI, 0.73–2.01; P value, .46). Four-week point prevalence of complete smoking cessation was reported by 53 (25.0%) individuals in the intervention group and 31 (15.4%) individuals in the control group (adjusted OR, 1.87; 95% CI, 1.12–3.17; P value, .018).

    Conclusions

    Estimates of 4-week point prevalence of complete cessation was 10 percentage points higher in the group that were given access to the intervention compared to the control. Findings provide confirmation that text messaging-based smoking cessation programs can affect quit rates among adolescents.

    Trial registration

    ISRCTN15396225; registration date October 13, 2017, https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-3028-2.

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  • 32.
    Müssener, Ulrika
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Löf, Marie
    Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.
    Bendtsen, Preben
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Using Mobile Devices to Deliver Lifestyle Interventions Targeting At-Risk High School Students: Protocol for a Participatory Design Study2020In: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 1, no 9Article in journal (Refereed)
    Abstract [en]

    Background: Unhealthy lifestyle behaviors such as insufficient physical activity, unhealthy diet, smoking, and harmful use of alcohol tend to cluster (ie, individuals may be at risk from more than one lifestyle behavior that can be established in early childhood and adolescence and track into adulthood). Previous research has underlined the potential of lifestyle interventions delivered via mobile phones. However, there is a need for deepened knowledge on how to design mobile health (mHealth) interventions taking end user views into consideration in order to optimize the overall usability of such interventions. Adolescents are early adopters of technology and frequent users of mobile phones, yet research on interventions that use mobile devices to deliver multiple lifestyle behavior changes targeting at-risk high school students is lacking.

    Objective: This protocol describes a participatory design study with the aim of developing an mHealth lifestyle behavior intervention to promote healthy lifestyles among high school students.

    Methods: Through an iterative process using participatory design, user requirements are investigated in terms of technical features and content. The procedures around the design and development of the intervention, including heuristic evaluations, focus group interviews, and usability tests, are described.

    Results: Recruitment started in May 2019. Data collection, analysis, and scientific reporting from heuristic evaluations and usability tests are expected to be completed in November 2019. Focus group interviews were being undertaken with high school students from October through December, and full results are expected to be published in Spring 2020. A planned clinical trial will commence in Summer 2020. The study was funded by a grant from the Swedish Research Council for Health, Working Life, and Welfare.

    Conclusions: The study is expected to add knowledge on how to design an mHealth intervention taking end users’ views into consideration in order to develop a novel, evidence-based, low-cost, and scalable intervention that high school students want to use in order to achieve a healthier lifestyle.

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  • 33.
    Neher, Margit
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Rehabilitation Center HMC.
    Landén Ludvigsson, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Region Östergötland, Local Health Care Services in West Östergötland, Department of Rehabilitation in Motala. Linköping University, Faculty of Medicine and Health Sciences.
    Enblom, Anna
    Region Östergötland.
    Preparedness to Implement Physical Activity and Rehabilitation Guidelines in Routine Primary Care Cancer Rehabilitation: Focus Group Interviews Exploring Rehabilitation Professionals Perceptions2020In: Journal of Cancer Education, ISSN 0885-8195, E-ISSN 1543-0154Article in journal (Refereed)
    Abstract [en]

    To explore primary care professionals perceptions of physical activity and other cancer rehabilitation practice in cancer survivors, investigating the preparedness to implement guidelines regarding cancer rehabilitation. We collected qualitative data through seven semi-structured focus group interviews with 48 rehabilitation professionals, with mean 9 years of experience in primary care rehabilitation (32 physiotherapists, 15 occupational therapists, and 1 rehabilitation assistant) in a primary care setting. Data was analyzed using content analysis. Primary care rehabilitation professionals expressed limited experience of cancer survivors, experienced lack of knowledge of cancer-related disability, and had doubts concerning how to treat cancer survivors. They also experienced uncertainty about where to find collaboration and support in the healthcare system outside their own rehabilitation clinic. There is a need to combine different implementation strategies to tackle multiple barriers for effective cancer survivor rehabilitation in primary care, to boost individual rehabilitation professionals knowledge and self-efficacy, to clarify roles and responsibilities for cancer rehabilitation across levels of care, and to develop and strengthen organizational bridges to provide adequate access to rehabilitation for cancer survivors.

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  • 34.
    Nilsen, Per
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Seing, Ida
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Ericsson, Carin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Birken, Sarah A.
    Univ N Carolina, NC 27515 USA.
    Schildmeijer, Kristina
    Linnaeus Univ, Sweden.
    Characteristics of successful changes in health care organizations: an interview study with physicians, registered nurses and assistant nurses2020In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, BMC HEALTH SERVICES RESEARCH, Vol. 20, no 1, article id 147Article in journal (Refereed)
    Abstract [en]

    Background

    Health care organizations are constantly changing as a result of technological advancements, ageing populations, changing disease patterns, new discoveries for the treatment of diseases and political reforms and policy initiatives. Changes can be challenging because they contradict humans’ basic need for a stable environment. The present study poses the question: what characterizes successful organizational changes in health care? The aim was to investigate the characteristics of changes of relevance for the work of health care professionals that they deemed successful.

    Methods

    The study was based on semi-structured interviews with 30 health care professionals: 11 physicians, 12 registered nurses and seven assistant nurses employed in the Swedish health care system. An inductive approach was applied using questions based on the existing literature on organizational change and change responses. The questions concerned the interviewees’ experiences and perceptions of any changes that they considered to have affected their work, regardless of whether these changes were “objectively” large or small changes. The interviewees’ responses were analysed using directed content analysis.

    Results

    The analysis yielded three categories concerning characteristics of successful changes: having the opportunity to influence the change; being prepared for the change; valuing the change. The interviewees emphasized the importance of having the opportunity to influence the organizational changes that are implemented. Changes that were initiated by the professionals themselves were considered the easiest and were rarely resisted. Changes that were clearly communicated to allow for preparation increased the chances for success. The interviewees did not support organizational changes that were perceived to be implemented unexpectedly and/or without prior communication. They conveyed that it was important for them to understand the need for and benefits of organizational changes. They particularly valued and perceived as successful organizational changes with a patient focus, with clear benefits to patients.

    Conclusions

    Organizational changes in health care are more likely to succeed when health care professionals have the opportunity to influence the change, feel prepared for the change and recognize the value of the change, including perceiving the benefit of the change for patients.

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  • 35.
    Ong, Kwok Leung
    et al.
    Univ New South Wales, Australia.
    Chung, Rosanna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hui, Nicholas
    Univ New South Wales, Australia.
    Festin, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Lundberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Rye, Kerry-Anne
    Univ New South Wales, Australia.
    Jonasson, Lena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Kristenson, Margareta
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Usefulness of Certain Protein Biomarkers for Prediction of Coronary Heart Disease2020In: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 125, no 4, p. 542-548Article in journal (Refereed)
    Abstract [en]

    Identification of biomarkers can help monitor and prevent cardiovascular disease (CVD) risk. We performed an exploratory analysis to identify potential biomarkers for coronary heart disease (CHD) in participants from the Life Conditions, Stress, and Health study. A total of 1,007 participants (50% women), randomly selected from the general population, were followed for incident CHD at 8 and 13 years of follow-up. Plasma levels of 184 CVD-related biomarkers were measured in samples collected at baseline in 86 cases with CHD and 184 age- and sex-matched controls by proximity extension assay. Biomarker levels were presented as normalized protein expression values (log 2 scale). After adjusting for confounding factors, 6 biomarkers showed significant association with incident CHD at 13 years. In a sensitivity analysis, this association remained significant at 8 years for 3 biomarkers; collagen alpha-1(I) chain (COL1A1), bone morphogenetic protein-6 (BMP-6), and interleukin-6 receptor alpha chain (IL-6R alpha). When entering these biomarkers in the full adjustment model simultaneously, their association with incident CHD at 13 years remained significant, hazards ratio being 0.671, 0.335, and 2.854, respectively per unit increase in normalized protein expression values. Subjects with low COL1A1, low BMP-6, and high IL-6R alpha levels had a hazards ratio of 5.097 for incident CHD risk (p = 0.019), compared with those without. In conclusion, we identified COL1A1, BMP-6 and IL-6Ra as biomarkers for incident CHD over a long-term follow-up in this exploratory analysis. For COL1A1 and BMP-6 this has not been previously reported. Further studies are needed to confirm our findings and establish their clinical relevance. (C) 2019 Elsevier Inc. All rights reserved.

  • 36.
    Persson, Lennart
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Respiratory Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Lyth, Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Region Östergötland, Operations management Region Östergötland, Research and Development Unit.
    Lind, Leili
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    The Health Diary Telemonitoring and Hospital-Based Home Care Improve Quality of Life Among Elderly Multimorbid COPD and Chronic Heart Failure Subjects2020In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 15, p. 527-541Article in journal (Refereed)
    Abstract [en]

    Background: Elderly, multimorbid patients with advanced chronic obstructive pulmonary disease (COPD) and/or chronic heart failure (CHF) exhibit poor health-related quality of life (HRQoL). Telemonitoring, based on digital pen technology, supported by hospital-based home care (HBHC) significantly reduces the number of hospitalizations. We hypothesized that the same intervention would prevent the deterioration of HRQoL that follows upon disease progression. Methods: Elderly computer-illiterate subjects with amp;gt;= 2 hospitalizations the previous year were included. HRQoL was assessed at inclusion (baseline) and at 1, 6 and 12 months employing EuroQol-5 Dimensions (EQ-5D) and RAND-36 for general HRQoL, and Minnesota Living with Heart Failure Questionnaire (MLHFQ) and St. Georges Respiratory Questionnaire (SGRQ) for disease-specific HRQoL. Healthcare contacts, hospitalizations, as-needed medications, prescription changes and healthcare costs were registered. Results: Ninety-four patients were enrolled of which 53 subjects completed the 12-month study period. Compared to baseline, most domains of RAND-36 were improved significantly at 1 time-point or more. Only among COPD subjects, the disease-specific HRQoL was worsened at the 12 month evaluation. Measures of healthcare dependency were associated with poor HRQoL. Conclusion: The Health Diary system and HBHC together improve general HRQoL, and measures of healthcare dependency are associated with HRQoL variables.

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  • 37.
    Sandman, Lars
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Hofmann, Bjorn
    Norwegian Univ Sci and Technol NTNU Gjovik, Norway.
    Bognar, Greg
    Stockholm Univ, Sweden.
    Rethinking patient involvement in healthcare priority setting2020In: Bioethics, ISSN 0269-9702, E-ISSN 1467-8519, Vol. 34, no 4, p. 403-411Article in journal (Refereed)
    Abstract [en]

    With healthcare systems under pressure from scarcity of resources and ever-increasing demand for services, difficult priority setting choices need to be made. At the same time, increased attention to patient involvement in a wide range of settings has given rise to the idea that those who are eventually affected by priority setting decisions should have a say in those decisions. In this paper, we investigate arguments for the inclusion of patient representatives in priority setting bodies at the policy level. We find that the standard justifications for patient representation, such as to achieve patient-relevant decisions, empowerment of patients, securing legitimacy of decisions, and the analogy with democracy, all fall short of supporting patient representation in this context. We conclude by briefly outlining an alternative proposal for patient participation that involves patient consultants.

  • 38.
    Seyyedi, Navisa
    et al.
    Urmia Univ Med Sci, Iran; Urmia Univ Med Sci, Iran.
    Rahimi, Bahlol
    Urmia Univ Med Sci, Iran.
    Eslamlou, Hamid Reza Farrokh
    Urmia Univ Med Sci, Iran.
    Afshar, Hadi Lotfnezhad
    Urmia Univ Med Sci, Iran.
    Spreco, Armin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
    Timpka, Toomas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
    Smartphone-Based Maternal Education for the Complementary Feeding of Undernourished Children Under 3 Years of Age in Food-Secure Communities: Randomised Controlled Trial in Urmia, Iran2020In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, NUTRIENTS, Vol. 12, no 2, article id 587Article in journal (Refereed)
    Abstract [en]

    The mothers nutritional literacy is an important determinant of child malnourishment. We assessed the effect of a smartphone-based maternal nutritional education programme for the complementary feeding of undernourished children under 3 years of age in a food-secure middle-income community. The study used a randomised controlled trial design with one intervention arm and one control arm (n = 110; 1:1 ratio) and was performed at one well-child clinic in Urmia, Iran. An educational smartphone application was delivered to the intervention group for a 6-month period while the control group received treatment-as-usual (TAU) with regular check-ups of the childs development at the well-child centre and the provision of standard nutritional information. The primary outcome measure was change in the indicator of acute undernourishment (i.e., wasting) which is the weight-for-height z-score (WHZ). Children in the smartphone group showed greater wasting status improvement (WHZ +0.65 (95% Confidence Interval (CI) +/- 0.16)) than children in the TAU group (WHZ +0.31 (95% CI +/- 0.21); p = 0.011) and greater reduction (89.6% vs. 51.5%; p = 0.016) of wasting caseness (i.e., WHZ &lt; 2; yes/no). We conclude that smartphone-based maternal nutritional education in complementary feeding is more effective than TAU for reducing undernourishment among children under 3 years of age in food-secure communities.

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  • 39.
    Siverskog, Jonathan
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Henriksson, Martin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Mutually Exclusive Interventions in the Cost-Effectiveness Bookshelf2020In: Medical decision making, ISSN 0272-989X, E-ISSN 1552-681X, article id 0272989X20912261Article in journal (Refereed)
    Abstract [en]

    n/a

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  • 40.
    Sommarö, Susanna
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Andersson, Agneta
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Region Östergötland, Operations management Region Östergötland, Research and Development Unit. Linköping University, Faculty of Medicine and Health Sciences.
    Skagerström, Janna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Region Östergötland, Operations management Region Östergötland, Research and Development Unit. Linköping University, Faculty of Medicine and Health Sciences.
    A deviation too many? Healthcare professionals knowledge and attitudes concerning patients with intellectual disability disrupting norms regarding sexual orientation and/or gender identity2020In: JARID: Journal of applied research in intellectual disabilities, ISSN 1360-2322, E-ISSN 1468-3148Article in journal (Refereed)
    Abstract [en]

    Background

    People with intellectual disability (ID) have few role models for sexual expression and behaviour, and those who identify as LGBTQ experience dual marginalization. The aim of this study is to explore knowledge and attitudes concerning patients with both ID and norm‐breaking sexuality and/or gender identity among healthcare professionals in habilitation centres.

    Method

    Data were collected from four focus group interviews that included 19 healthcare professionals from child and adult teams at two Swedish habilitation centres. Data were analysed using thematic analysis.

    Results

    Three themes were identified as follows: heteronormative treatment in health care, barriers for inclusion and possibilities for inclusion.

    Conclusions

    Norm‐breaking sexuality and gender identity are still relatively invisible in habilitation centres. People with ID are still predominately desexualized and perceptions regarding their sexuality are lagging behind the rest of society. Conditions that allow for more LGBTQ‐affirmative practice were described by the teams that have undergone LGBTQ training.

  • 41.
    Thomas, Kristin
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Evalill
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Festin, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Henriksson, Pontus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Lowén, Mats
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Löf, Marie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Kristenson, Margareta
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Associations of Psychosocial Factors with Multiple Health Behaviors: A Population-Based Study of Middle-Aged Men and Women2020In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, Vol. 17, no 4, article id 1239Article in journal (Refereed)
    Abstract [en]

    Background: The health behaviors smoking, risky alcohol consumption, insufficient physical activity, and poor diet constitute the main contributors to non-communicable diseases. Clustering of risk behaviors is common and increases the risk of these diseases. Despite health benefits, it is difficult to change health behaviors. Psychosocial factors could play a role in health behavior change, with research showing relationships between unfavorable psychosocial factors and health risk behaviors. However, many studies only investigated one or two health behaviors at a time. The present study, therefore, aimed to investigate associations between a broad range of psychosocial factors and multiple health risk behaviors in a general middle-aged population in Sweden. Methods: A cross-sectional design was used to investigate a random sample from the general population in Sweden (n = 1007, 45-69 years, 50% women). Questionnaire data on health behaviors (smoking, alcohol consumption, physical activity, and fruit/vegetable intake) and psychosocial factors, with both psychological and social resources (social integration, emotional support, perceived control, self-esteem, sense of coherence and trust) and psychological risk factors (cynicism, vital exhaustion, hopelessness and depressiveness), were analyzed. Logistic and ordinal logistic regression were used to analyze associations between psychosocial factors and multiple (0-1, 2 or 3-4) health risk behaviors. Results: A total of 50% of the sample had two health risk behaviors and 18% had three health risk behaviors. After adjusting for age, sex, education, employment status, and immigrant status, eight out of 10 psychosocial factors (exceptions: social integration and self-esteem) showed significant odds ratios (ORs) in the expected directions; low levels of psychosocial resources and high levels of psychosocial risk factors were associated with multiple risk behaviors. The strongest associations with multiple risk behaviors were seen for vital exhaustion (adjusted (adj.) OR 1.28; confidence interval (CI) 1.11-1.46), depressiveness (adj. OR 1.32, CI 1.14-1.52), and trust (adj. OR 0.80, CI 0.70-0.91). When controlling for all psychosocial factors in the same model, only the association with trust remained statistically significant (adj. OR 0.89, CI 0.73-1.00, p = 0.050). Associations with individual health behaviors were fewer and scattered, with no psychosocial factor being related to all four behaviors. Conclusions: Examining associations between a broad range of psychosocial factors and multiple health risk behaviors revealed consistent and significant associations for almost all psychosocial factors. These associations were stronger compared to associations to single health risk behaviors. Our findings support the relevance of considering psychosocial aspects in interventions aimed at health behavior change, especially for people with multiple health risk behaviors.

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  • 42.
    Westas, Mats
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Lundgren, Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Psychiatry in Norrköping.
    Mourad, Ghassan
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health.
    Neher, Margit
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Johansson, Peter
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    How Healthcare Professionals in Cardiac Care Address Depressive Symptoms: Experiences of Patients With Cardiovascular Disease2020In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Depressive symptoms are common in patients with cardiovascular disease (CVD) and are associated with a poorer quality of life and prognosis. Despite the high prevalence and negative consequences, the recognition of depressive symptoms is low. More knowledge about patients' perceptions of how depressive symptoms are addressed by healthcare professionals is therefore needed.

    OBJECTIVES: The aim of this study was to explore the experiences of patients with CVD of how healthcare professionals address and manage depressive symptoms in clinical cardiac care encounters.

    METHODS: A qualitative, semistructured interview study was performed. Data were analyzed using inductive thematic analysis.

    RESULTS: In total, 20 patients with CVD previously treated for depressive symptoms were included (mean age, 62 [range, 34-79] years; 45% women). Three main themes emerged: (1) "not being seen as a whole person," (2) "denying depressive symptoms," and (3) "being provided with help." The patients perceived that healthcare professionals mainly focused on somatic symptoms and disregarded their need for help for depressive symptoms when patients raised the issue. Some patients stated that they received help for depressive symptoms, but this depended on the patients' own ability to communicate their needs and/or having social support that could alert them to the importance of doing so. Patients also described that they downplayed the burden of depressive symptoms and/or did not recognize themselves as having depressive symptoms.

    CONCLUSION: Depressive symptoms were overlooked in patients with CVD, and psychological needs had not been met. A good ability to address needs and having good social support were useful for receiving help with depressive symptoms.

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  • 43.
    Yasmeen, Najeeda
    et al.
    Symmetron Ltd, England.
    Sawyer, Laura M.
    Symmetron Ltd, England.
    Malottki, Kinga
    Symmetron Ltd, England.
    Levin, Lars-Åke
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Apol, Eydna Didriksen
    LEO Pharma AS, Denmark.
    Jemec, Gregor B.
    Sjaellands Univ Hosp, Denmark.
    Targeted therapies for patients with moderate-to-severe psoriasis: a systematic review and network meta-analysis of PASI response at 1 year2020In: Journal of dermatological treatment (Print), ISSN 0954-6634, E-ISSN 1471-1753Article, review/survey (Refereed)
    Abstract [en]

    Purpose: To compare PASI outcomes of approved biologics and apremilast after 1 year of treatment. Methods: A systematic review identified RCTs and long-term extensions reporting PASI 75, 90, and 100 responses in adults with moderate-to-severe psoriasis. Data for analysis were modeled using a Bayesian multinomial likelihood model with probit link. Results: Twenty-eight studies reporting PASI responses were included in the network meta-analysis. Differences in study design led to a stepwise approach to synthesis, consisting of two analyses. The primary analysis included nine RCTs investigating comparative efficacy at 1 year. Results indicated risankizumab, brodalumab, and guselkumab were the most effective therapies, followed by ixekizumab and secukinumab; all demonstrated superiority to ustekinumab and etanercept. The secondary analysis extended the primary analysis with 19 further studies comparing active interventions to placebo outcomes extrapolated from induction. The interventions generating the highest PASI response were the same as the primary analysis. These therapies were more effective than apremilast, ustekinumab, adalimumab, certolizumab, etanercept, and infliximab. Conclusions: This NMA demonstrated that evaluated IL-17 and IL-23 inhibitors outperformed other biological therapies after 1 year. Risankizumab had a higher probability of achieving PASI outcomes than all other biologics, except brodalumab and guselkumab, where no significant difference could be concluded.

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  • 44.
    Östgren, Carl Johan
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Ödeshög.
    Soderberg, Stefan
    Umea Univ, Sweden.
    Festin, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Angeras, Oskar
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Bergstrom, Goran
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Blomberg, Anders
    Umea Univ, Sweden.
    Brandberg, John
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Cederlund, Kerstin
    Karolinska Inst, Sweden.
    Eliasson, Mats
    Umea Univ, Sweden.
    Engstrom, Gunnar
    Lund Univ, Sweden.
    Erlinge, David
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Fagman, Erika
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Hagstrom, Emil
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    Lind, Lars
    Uppsala Univ, Sweden.
    Mannila, Maria
    Karolinska Univ Hosp, Sweden.
    Nilsson, Ulf
    Umea Univ, Sweden.
    Oldgren, Jonas
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    Ostenfeld, Ellen
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Persson, Anders
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Persson, Jonas
    Danderyd Hosp, Sweden.
    Persson, Margaretha
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Rosengren, Annika
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Sundstrom, Johan
    Uppsala Univ, Sweden; Univ New South Wales, Australia.
    Swahn, Eva
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Engvall, Jan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Jernberg, Tomas
    Danderyd Hosp, Sweden.
    Systematic Coronary Risk Evaluation estimated risk and prevalent subclinical atherosclerosis in coronary and carotid arteries: A population-based cohort analysis from the Swedish Cardiopulmonary Bioimage Study2020In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, article id UNSP 2047487320909300Article in journal (Refereed)
    Abstract [en]

    Background It is not clear if the European Systematic Coronary Risk Evaluation algorithm is useful for identifying prevalent subclinical atherosclerosis in a population of apparently healthy individuals. Our aim was to explore the association between the risk estimates from Systematic Coronary Risk Evaluation and prevalent subclinical atherosclerosis. Design The design of this study was as a cross-sectional analysis from a population-based study cohort. Methods From the general population, the Swedish Cardiopulmonary Bioimage Study randomly invited individuals aged 50-64 years and enrolled 13,411 participants mean age 57 (standard deviation 4.3) years; 46% males between November 2013-December 2016. Associations between Systematic Coronary Risk Evaluation risk estimates and coronary artery calcification and plaques in the carotid arteries by using imaging data from a computed tomography of the heart and ultrasonography of the carotid arteries were examined. Results Coronary calcification was present in 39.5% and carotid plaque in 56.0%. In men, coronary artery calcium score amp;gt;0 ranged from 40.7-65.9% and presence of carotid plaques from 54.5% to 72.8% in the age group 50-54 and 60-65 years, respectively. In women, the corresponding difference was from 17.1-38.9% and from 41.0-58.4%. A doubling of Systematic Coronary Risk Evaluation was associated with an increased probability to have coronary artery calcium score amp;gt;0 (odds ratio: 2.18 (95% confidence interval 2.07-2.30)) and to have amp;gt;1 carotid plaques (1.67 (1.61-1.74)). Conclusion Systematic Coronary Risk Evaluation estimated risk is associated with prevalent subclinical atherosclerosis in two major vascular beds in a general population sample without established cardiovascular disease or diabetes mellitus. Thus, the Systematic Coronary Risk Evaluation risk chart may be of use for estimating the risk of subclinical atherosclerosis.

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