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  • 1.
    Addelyan Rasi, Hamideh
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Moula, Alireza
    Department of Sociology & Social Work, Karlstad University, Sweden.
    Puddephatt, Antony J.
    Department of sociology, Lakehead University, Canada.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Empowering newly married women in Iran: A new method of social work intervention that uses a client-directed problem-solving model in both group and individual sessions2013In: Qualitative Social Work, ISSN 1473-3250, E-ISSN 1741-3117, Vol. 12, no 6, p. 765-781Article in journal (Refereed)
    Abstract [en]

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

  • 2.
    Addelyan Rasi, Hamideh
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Moula, Alireza
    Karlstad University, Sweden.
    Puddephatt, Antony J.
    Department of sociology, Lakehead University, Canada.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Empowering Single Mothers in Iran: Applying a Problem-Solving Model in Learning Groups to Develop Participants’ Capacity to Improve Their Lives2013In: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263X, Vol. 43, no 5, p. 833-852Article in journal (Refereed)
    Abstract [en]

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

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

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

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

    Setting: A large urban area in Iran.

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

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

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

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

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

  • 4.
    Alonso, Juan-Manuel
    et al.
    Int Assoc Athlet Federat, Med & Antidoping Commiss, Monaco, Monaco; Qatar Orthoped & Sports Med Hosp, Sports Med Dept, Aspetar, Doha, Qatar.
    Jacobsson, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
    Ronsen, Ola
    Int Assoc Athlet Federat, Med & Antidoping Commiss, Monaco, Monaco; Aker Solut, Lysaker, Norway.
    Kajenienne, Alma
    Int Assoc Athlet Federat, Med & Antidoping Commiss, Monaco, Monaco; Lithuanian Univ Hlth Sci, Inst Sport, Kaunas, Lithuania.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences, The Swedish Institute for Disability Research.
    Spreco, Armin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Edouard, Pascal
    Univ Hosp St Etienne, Fac Med, Sports Med Unity, Dept Clin & Exercise Physiol, St Etienne, France; Univ Lyon, Exercise Physiol Lab, LPE EA 4338, St Etienne, France; French Athlet Federat, Med Commiss, Paris, France.
    Preparticipation injury complaint is a risk factor for injury: a prospective study of the Moscow 2013 IAAF Championships.2015In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 49, no 17, p. 1118-U45Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 5. Andersson, A
    et al.
    Vimarlund, Vivian
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Management perspective on Information and Communication Technology - Requirement specification for process-oriented healthcare2001In: JAMIA Journal of the American Medical Informatics Association, ISSN 1067-5027, E-ISSN 1527-974X, p. 854-854Conference paper (Other academic)
  • 6.
    Andersson, Anna
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Hallberg, Nicklas
    FOI.
    Eriksson, Henrik
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    A management information system-model for process-oriented health care2004In: Medinfo, IOS Press , 2004, p. 1008-1012Conference paper (Refereed)
  • 7.
    Andersson, Anna
    et al.
    Linköping University, Department of Computer and Information Science, MDA. Linköping University, The Institute of Technology.
    Hallberg, Niklas
    Linköping University, Department of Computer and Information Science, MDA. Linköping University, The Institute of Technology.
    Eriksson, Henrik
    Linköping University, Department of Computer and Information Science, MDA. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    A Management Information System Model for Process-Oriented Health Care2003In: Proceedings of Medinfo 2004, 2003Conference paper (Refereed)
  • 8.
    Andersson, Anna
    et al.
    Linköping University, Department of Computer and Information Science, MDA. Linköping University, The Institute of Technology.
    Hallberg, Niklas
    Linköping University, Department of Computer and Information Science, MDA. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    A Model for Interpreting Work and Information Management in Process-Oriented Healthcare Organisations2003In: International Journal of Medical Informatics, ISSN 1386-5056, Vol. 72, no 1-3, p. 47-56Article in journal (Refereed)
    Abstract [en]

    Background: To increase productivity, management in healthcare organisations have introduced different types of process-oriented organisational configurations. Few studies have addressed clinical practice and information management in these settings. Methods: A case study was performed at a paediatric clinic. Data was collected from archives, through interviews, by participatory observation, and by performing a focus group session. The collected data was analysed using a qualitative and interpretative research strategy. Results: A model was developed of care practitioners’ daily work in process-oriented organisations. The model shows that clinical work was deeply integrated; the care activities were dependent on supply activities and tightly connected to management routines. Conclusion: The resulting model can be used to support development of health information system (HIS) embedded in process-oriented healthcare work.

  • 9.
    Andersson, Anna
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Vimarlund, Vivian
    Linköping University, Department of Computer and Information Science, EISLAB - Economic Information Systems. Linköping University, The Institute of Technology.
    Timpka, Tomas
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Management demands on information and communication technology in process- oriented health-care organizations: The importance of understanding managers expectations during early phases of systems design2002In: Journal of Management in Medicine, ISSN 0268-9235, Vol. 16, no 2-3, p. 159-169Article in journal (Refereed)
    Abstract [en]

    There are numerous challenges to overcome before information and communication technology (ICT) can achieve its full potential in process-oriented health-care organizations. One of these challenges is designing systems that meet users’ needs, while reflecting a continuously changing organizational environment. Another challenge is to develop ICT that supports both the internal and the external stakeholders’ demands. In this study a qualitative research strategy was used to explore the demands on ICT expressed by managers from functional and process units at a community hospital. The results reveal a multitude of partially competing goals that can make the ICT development process confusing, poor in quality, inefficient and unnecessarily costly. Therefore, from the perspective of ICT development, the main task appears to be to coordinate the different visions and in particular clarify them, as well as to establish the impact that these visions would have on the forthcoming ICT application.

  • 10.
    Angbratt, Marianne
    et al.
    Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Blomberg, Carina
    Vadstena Primary Health Care Centre, Vadstena, Sweden.
    Grahn Kronhed, Ann-Charlotte
    Vadstena Primary Health Care Centre, Vadstena, Sweden.
    Waller, John
    Vadstena Primary Health Care Centre, Vadstena, Sweden.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Wingren, Gun
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Möller, Margareta
    Research and Development Unit, Primary Health Care, Borås, Sweden.
    Calcium intake in a Swedish adult population: relationship to life-style factors and bone mineral density. A descriptive studyManuscript (preprint) (Other academic)
    Abstract [en]

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

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

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

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

  • 11.
    Angbratt, Marianne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Ekberg, Joakim
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Walter, Lars
    Östergötlands Läns Landsting, Center for Health and Developmental Care, Center for Public Health.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Prediction of obesity from infancy to adolescence2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 9, p. 1249-1252Article in journal (Refereed)
    Abstract [en]

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

  • 12.
    Angbratt, Marianne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Blomberg, C.
    Kronhed, A.-C.
    Waller, J.
    Vadstena Primary Care Centre, Vadstena, Sweden.
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine.
    Moller, M.
    Möller, M., Centre for Caring Sciences, ÖrebroCountyCouncil, Örebro, Sweden.
    Prevalence and correlates of insufficient calcium intake in a Swedish population: Populations at risk across the lifespan2007In: Public Health Nursing, ISSN 0737-1209, E-ISSN 1525-1446, Vol. 24, no 6, p. 511-517Article in journal (Refereed)
    Abstract [en]

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

  • 13.
    Backe, S
    et al.
    Karlstad University.
    Ericson, L
    Karlstad University.
    Janson, S
    Karlstad University.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Rock climbing injury rates and associated risk factors in a general climbing population2009In: SCANDINAVIAN JOURNAL OF MEDICINE and SCIENCE IN SPORTS, ISSN 0905-7188, Vol. 19, no 6, p. 850-856Article in journal (Refereed)
    Abstract [en]

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

  • 14.
    Backe, S.
    et al.
    Karlstad University.
    Janson, S.
    Karlstad University.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Governance and implementation of sports safety practices by municipal offices in Swedish communities2012In: International Journal of Injury Control and Safety Promotion, ISSN 1745-7300, E-ISSN 1745-7319, Vol. 19, no 2, p. 163-169Article in journal (Refereed)
    Abstract [en]

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

  • 15.
    Bendtsen, Preben
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Acceptability of computerized self-report of alcohol habits: A patient perspective. 1999In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 34, p. 575-580Article in journal (Refereed)
  • 16.
    Bång, Magnus
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Eriksson, Henrik
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Lindqvist, K
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    An approach to context-sensitive medical applications1999In: JAMIA Journal of the American Medical Informatics Association, ISSN 1067-5027, E-ISSN 1527-974X, p. 1017-1017Conference paper (Other academic)
  • 17.
    Bång, Magnus
    et al.
    Linköping University, Department of Computer and Information Science. Linköping University, The Institute of Technology.
    Eriksson, Henrik
    Linköping University, Department of Computer and Information Science. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Computer and Information Science. Linköping University, The Institute of Technology.
    Supporting cognition in inter-organizational collaborative systems2002In: Proceedings of the Fifth International Conference on the Design of Cooperative Systems, 2002, p. 14-17Conference paper (Refereed)
    Abstract [en]

    LINDA is a tool designed to support inter-organizational collaboration in small health-service teams. We approached the design of LINDA by examining how clinicians worked with documents, markers, and other physical objects in an emergency room. We found that spatial arrangements of patient folders on a desk supported workplace cognition and collaboration in several ways. In the design of LINDA, we tried to capture some of the supporting cognitive properties of the physical collaborative system. For example, virtual case files can be arranged spatially on a desktop, sticker-notes can be glued onto different parts of the system, and annotations can be made on forms. We discuss how we approached the problem of designing a system that allows users to form their own flexible coordination mechanisms to support cognition and collaboration.

  • 18.
    Bång, Magnus
    et al.
    Linköping University, Department of Computer and Information Science. Linköping University, The Institute of Technology.
    Hagdahl, Anneli
    Linköping University, Department of Computer and Information Science. Linköping University, The Institute of Technology.
    Eriksson, Henrik
    Linköping University, Department of Computer and Information Science. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Computer and Information Science. Linköping University, The Institute of Technology.
    Groupware for case management and inter-organizational collaboration: the virtual rehabilitation team2001In: Studies in Health Technology and Informatics, Volume 84: MEDINFO 2001 / [ed] V.L. Patel, R. Rogers, R. Haux, 2001, p. 3-7Conference paper (Refereed)
    Abstract [en]

    This paper presents LINDA, a prototype system designed to support virtual rehabilitation teams. LINDA enables professionals from different welfare-state agencies to collaborate in case management. Our approach to supporting teamwork involves the sharing of minimal case sets across organizational borders needed to provide a shared situation assessment among team members. The system provides a shared workspace for the team; a lightweight client-database, visualization of case histories and plans, and means to communicate effectively in the team using yellow sticker-notes. We present LINDA and discuss how we approached the problem to design groupware to support work under changing and uncertain conditions.

  • 19.
    Bång, Magnus
    et al.
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, The Institute of Technology.
    Prytz, Erik
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, The Institute of Technology.
    Rybing, Jonas
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Center for Public Health.
    Cognitive design of a digital desk for the emergency room setting2014In: 2014 AMIA Annual Symposium / [ed] Westra, Bonnie L, Oxford University Press, 2014Conference paper (Refereed)
  • 20.
    Bång, Magnus
    et al.
    Linköping University, Department of Computer and Information Science. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Computer and Information Science. Linköping University, The Institute of Technology.
    Cognitive tools in medical teamwork: the spatial arrangement of patient records2003In: Methods of Information in Medicine, ISSN 0026-1270, Vol. 42, no 4, p. 331-336Article in journal (Refereed)
    Abstract [en]

    Objectives: As a preliminary for the design of Computer- Based Patient Records, the aim of this paper is to build an understanding of the roles physical artifacts like paper-based patient records play in support-ing cognition and collaboration in the healthcare settings. Method: A small ethnographically-informed study was conducted in the emergency room at a 250-bed hospital in Sweden from the perspective of Distributed Cognition. Results: To track work-in-progress, clinicians placed patient records on a desk to form a shared public display that represented the current problem state for the health-care team. The results of the study suggest that the patient records and other physical artifacts are used by clinicians in different ways to form cognitive tools that offload memory tasks and support joint attention and collaboration. Conclusion: To design Computer-Based Patient Records that more appropriately support cognition and teamwork, it is important to investigate how clinicians make use of the paper-based patient records. Practitioners take advantage of existing tools frequently to deal with cognitively demanding tasks and collaboration issues.

  • 21.
    Bång, Magnus
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Ubiquitous computing to support co-located clinical teams: Using the semiotics of physical objects in system design2007In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 76, no SUPPL. 1, p. 58-64Article in journal (Refereed)
    Abstract [en]

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

  • 22.
    Bång, Magnus
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Eriksson, Henrik
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Holm, Einar
    Nordin, Conny
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Psychiatry. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Mobile phone computing for in-situ cognitive-behavioral therapy2007In: MedINFO 2007,2007, IOS Press, 2007, p. 1078-1082Conference paper (Refereed)
    Abstract [en]

    Cognitive behavioral therapy (CBT) for psychological disorders is becoming increasingly popular on the Internet. However when using this workstation approach, components such as training and learning relaxation skills, problem solving, exposure exercises, and sleep management guidance must be done in the domestic environment. This paper describes design concepts for providing spatially explicit CBT with mobile phones. We reviewed and analyzed a set of treatment manuals to distinguish elements of CBT that can be improved and supported using mobile phone applications. The key advantage of mobile computing support in CBT is that multimedia can be applied to record, scale, and label anxiety-provoking situations where the need arises, which helps the CBT clients formulate and convey their thoughts and feelings to relatives and friends, as well as to therapists at subsequent treatment sessions.

  • 23.
    Dahlström, Örjan
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Backe, Stefan
    Karlstad University, Sweden Skövde University, Sweden .
    Ekberg, Joakim
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Janson, Staffan
    Karlstad University, Sweden .
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Health and Developmental Care, Centre for Public Health.
    Is "Football for All" Safe for All? Cross-Sectional Study of Disparities as Determinants of 1-Year Injury Prevalence in Youth Football Programs2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 8Article in journal (Refereed)
    Abstract [en]

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

  • 24.
    Dahlström, Örjan
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Jacobsson, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
    Overcoming the organization-practice barrier in sports injury prevention: A nonhierarchical organizational model2015In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 25, no 4, p. e414-e422Article in journal (Refereed)
    Abstract [en]

    The organization of sports at the national level has seldom been included in scientific discussions of sports injury prevention. The aim of this study was to develop a model for organization of sports that supports prevention of overuse injuries. The quality function deployment technique was applied in seminars over a two-season period to develop a national organizational structure for athletics in Sweden that facilitates prevention of overuse injuries. Three central features of the resulting model for organization of sports at the national level are (a) diminishment of the organizational hierarchy: participatory safety policy design is introduced through annual meetings where actors from different sectors of the sporting community discuss training, injury prevention, and sports safety policy; (b) introduction of a safety surveillance system: a ubiquitous system for routine collection of injury and illness data; and (c) an open forum for discussion of safety issues: maintenance of a safety forum for participants from different sectors of the sport. A nonhierarchical model for organization of sports at the national level - facilitated by modern information technology - adapted for the prevention of overuse injuries has been developed. Further research is warranted to evaluate the new organizational model in prospective effectiveness studies.

  • 25.
    Dahlström, Örjan
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Hass, Ursula
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Skogh, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Rheumatology . Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Designing a decision support system for existing clinical organizational structures: Considerations from a rheumatology clinic2006In: Journal of medical systems, ISSN 0148-5598, E-ISSN 1573-689X, Vol. 30, no 5, p. 325-331Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to identify the social and organizational requirements for a decision support system (DSS) to be implemented in a clinical rheumatology setting, utilizing data-mining techniques. Field observations and focus group interviews were used for data collection. The decision-making was found to be situated, patient-focused, and long-term in nature. At the same time, the main part of peer-to-peer communication was informal. Patient records were involved in almost every decision. The conclusion is that the main challenges, when introducing a DSS at a rheumatology unit, are adapting the system to informal communication structures and integrating it with patient records. Considering incentive structures, understanding workflow and incorporating awareness are relevant issues when addressing these issues in future studies.

  • 26.
    Dahlström, Örjan
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Pain and Rehabilitation Centre.
    Skogh, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Rheumatology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Rheumatology in Östergötland.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Prognostic rule generation controlling for treatment in early rheumatoid arthritis2009Conference paper (Other academic)
  • 27.
    Dahlström, Örjan
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Cognition, Development and Disability. Linköping University, Faculty of Arts and Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Hass, Ursula
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Skogh, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Rheumatology. Linköping University, Faculty of Health Sciences.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    A simple method for heuristic modeling of expert knowledge in chronic disease: identification of prognostic subgroups in rheumatology2008In: eHealth Beyond the Horizon – Get IT There, IOS Press, 2008, Vol. 136, p. 157-162Conference paper (Refereed)
    Abstract [en]

    Identification of prognostic subgroups is of key clinical interest at the early stages of chronic disease. The aim of this study is to examine whether representation of physicians' expert knowledge in a simple heuristic model can improve data mining methods in prognostic assessments of patients with rheumatoid arthritis (RA). Five rheumatology consultants' experiences of clinical data patterns among RA patients, as distinguished from healthy reference populations, were formally represented in a simple heuristic model. The model was used in K-mean-clustering to determine prognostic subgroups. Cross-sectional validation using physician's global assessment scores indicated that the simple heuristic model performed better than crude data made in identification of prognostic subgroups of RA patients. A simple heuristic model of experts' knowledge was found useful for semi-automatic data mining in the chronic disease setting. Further studies using categorical baseline data and prospective outcome variables are warranted and will be examined in the Swedish TIRA-program.

  • 28.
    Dahlström, Örjan
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Skogh, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Rheumatology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Rheumatology in Östergötland.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Prognostic components and predictive modelling of prognosis in early RAManuscript (preprint) (Other academic)
    Abstract [en]

    Introduction: There is a need for tools that are easy to use in clinical practice supporting decision making upon treatment in early rheumatoid arthritis (RA). Aim: The aim was to identify components of prognosticators in early RA and to identify individual patients with a poor prognosis as early as possible.

    Methods: Two cohorts from the Swedish TIRA project including 320+408 patients with recent onset RA were included in the study. Disease activity was measured by C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and the 28-joint count disease activity score (DAS-28), and by the physicians’ global assessment of disease activity (PGA). Disability was assessed as activity limitation by the Swedish version of the Health Assessment Questionnaire (HAQ) and impairment was reported by pain on a visual analogue scale of 0–100 mm. Serological markers were rheumatoid factor (RF) and anti-CCP. RF was measured at the time for diagnosis, and anti-CCP at the time of diagnosis or at one or some of the follow-ups. If at least one anti-CCP test was positive, the patient was judged to be anti-CCP-positive. Assuming different clinical practice in the different cohorts, two different treatment strategies were assumed based on clinical practice in real-world settings. Principal Component Analysis and Multiple Linear Regression Analysis were used to identify prognosticators. Prediction rules were identified by data-driven approach, controlling for different treatment strategies.

    Results: Progression of disease and disability measures and inflammation measures the first three months after inclusion predicted a considerable part of DAS-28 at the 1-year follow-up. Serological markers had a larger explanatory power for men than for women. Anti-CCP was a significant predictor for men, but not for women. Two versions of rules, one for women and one for men, predicting good or poor prognosis at one year after inclusion were produced by using measures of disability (Health Assessment Questionnaire), DAS-28, relative change in DAS-28 during first three months, sex, and test of anti-CCP. The rules demanded high prognostic specificity but the prognostic sensitivity was moderate.

    Conclusion: A considerable part of DAS-28 at one year after inclusion could be explained by the first 3 months’ progression of disease, disability and inflammation. Anti-CCP was predictive for men but not for women, and needs further investigation. A decision tree predicting poor prognosis among individual early RA-patients showed high specificity and moderate sensitivity on a validationcohort. The medical informatics approach used, controlling for different treatment strategies, yields promising results and further studies will control for more specific differences in treatment strategies, e.g. different DMARDs initiated.

  • 29.
    Dalal, K.
    et al.
    University of Skövde, Sweden.
    Shabnam, J.
    Independent Researcher, Copenhagen, Denmark.
    Andrews-Chavez, J.
    Tufts University, Boston, USA.
    Mårtensson, L.B.
    University of Skövde, Sweden.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences. University of Skövde, Sweden.
    Economic empowerment of women and utilization of maternal delivery care in Bangladesh2012In: International Journal of Preventive Medicine, ISSN 2008-7802, E-ISSN 2008-8213, Vol. 3, no 9, p. 628-636Article in journal (Refereed)
    Abstract [en]

    Objective:

    Maternal mortality is a major public health problem in low-income countries, such as Bangladesh. Women's empowerment in relation to enhanced utilization of delivery care is underexplored. This study investigates the associations between women's economic empowerment and their utilization of maternal health care services in Bangladesh.

    Methods:

    In total, 4925 women (15–49 years of age) with at least one child from whole Bangladesh constituted the study sample. Home delivery without skilled birth attendant and use of institutional delivery services were the main outcome variables used for the analyses. Economic empowerment, neighborhood socioeconomic status, household economic status, and demographic factors were considered as explanatory variables. The chi square test and unadjusted and adjusted logistic regression analyses were applied at the collected data.

    Results:

    In the adjusted model, respondent's and husband's education, household economic status, and residency emerged as important predictors for utilization of delivery care services. In the unadjusted model, economically empowered working and microfinanced women displayed more home delivery.

    Conclusion:

    The current study shows that use of delivery care services is associated with socioeconomic development and can be enhanced by societies that focus on general issues such as schooling, economic wellbeing, and gender-based discrimination.

  • 30.
    Dalal, Koustuv
    et al.
    University of Örebro, Sweden .
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Center for Public Health.
    Interactions between microfinance programmes and non-economic empowerment of women associated with intimate partner violence in Bangladesh: a cross-sectional study2013In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 12, p. 2941-Article in journal (Refereed)
    Abstract [en]

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

  • 31.
    Davidson, Kristina
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Trell, Erik
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Lionis, C
    University of Crete, Heraklion, Greece .
    Koutis, A
    University of Crete, Heraklion, Greece .
    Faresjö, Tomas
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Fioretos, M
    University of Crete, Heraklion, Greece .
    Following the thread of Ariadne to the health of women1996In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 17, no 3, p. 201-208Article in journal (Refereed)
    Abstract [en]

    The health of women has risen to a priority position in medical research. Comparative studies of female morbidity are called for as an intermediary stage for generation of hypotheses and design of deeper studies of determinants, such as social, ecological, and individual factors. In previous studies, we have noted differences in female hospitalization between Heraklion in Greece and Linköping in Sweden. They were related to age and to urban versus rural dwelling, and fit projections for a more archaic and a more technocratic society, respectively. This paper aims at showing how the study of women's health may proceed from relevant hospitalization observations to the next level, of exploring already available indicators of self‐perceived health in elderly females.

  • 32.
    Delisle, Christine
    et al.
    Karolinska Institute, Sweden.
    Sandin, Sven
    Karolinska Institute, Sweden.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Henriksson, Hanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Institute, Sweden.
    Trolle-Lagerros, Ylva
    Karolinska Institute, Sweden.
    Larsson, Christel
    University of Gothenburg, Sweden.
    Maddison, Ralph
    University of Auckland, New Zealand.
    Ortega, Francisco B.
    University of Granada, Spain.
    Ruiz, Jonatan R.
    University of Granada, Spain.
    Silfvernagel, Kristin
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Center for Public Health.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Karolinska Institute, Sweden.
    A web- and mobile phone-based intervention to prevent obesity in 4-year-olds (MINISTOP): a population-based randomized controlled trial2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, no 95Article in journal (Refereed)
    Abstract [en]

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

  • 33.
    Delisle Nystrom, Christine
    et al.
    Novum, Sweden.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Henriksson, Hanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Trolle-Lagerros, Ylva
    Karolinska Institute, Sweden.
    Larsson, Christel
    University of Gothenburg, Sweden.
    Maddison, Ralph
    University of Auckland, New Zealand.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Novum, Sweden.
    A Mobile Phone Based Method to Assess Energy and Food Intake in Young Children: A Validation Study against the Doubly Labelled Water Method and 24 h Dietary Recalls2016In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 8, no 1, p. 50-Article in journal (Refereed)
    Abstract [en]

    Mobile phones are becoming important instruments for assessing diet and energy intake. We developed the Tool for Energy Balance in Children (TECH), which uses a mobile phone to assess energy and food intake in pre-school children. The aims of this study were: (a) to compare energy intake (EI) using TECH with total energy expenditure (TEE) measured via doubly labelled water (DLW); and (b) to compare intakes of fruits, vegetables, fruit juice, sweetened beverages, candy, ice cream, and bakery products using TECH with intakes acquired by 24 h dietary recalls. Participants were 39 healthy, Swedish children (5.5 +/- 0.5 years) within the ongoing Mobile-based Intervention Intended to Stop Obesity in Preschoolers (MINISTOP) obesity prevention trial. Energy and food intakes were assessed during four days using TECH and 24 h telephone dietary recalls. Mean EI (TECH) was not statistically different from TEE (DLW) (5820 +/- 820 kJ/24 h and 6040 +/- 680kJ/24 h, respectively). No significant differences in the average food intakes using TECH and 24 h dietary recalls were found. All food intakes were correlated between TECH and the 24 h dietary recalls (r = 0.665-0.896, p &lt; 0.001). In conclusion, TECH accurately estimated the average intakes of energy and selected foods and thus has the potential to be a useful tool for dietary studies in pre-school children, for example obesity prevention trials.

  • 34.
    Delisle Nyström, Christine
    et al.
    Karolinska Institute, Sweden.
    Sandin, Sven
    Karolinska Institute, Sweden; Icahn School Medical Mt Sinai, NY 10029 USA; Icahn School Medical Mt Sinai, NY 10029 USA.
    Henriksson, Pontus
    University of Granada, Spain.
    Henriksson, Hanna
    University of Granada, Spain.
    Trolle-Lagerros, Ylva
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Larsson, Christel
    University of Gothenburg, Sweden.
    Maddison, Ralph
    Deakin University, Australia.
    Ortega, Francisco B.
    University of Granada, Spain.
    Pomeroy, Jeremy
    Marshfield Clin Research Fdn, WI USA.
    Ruiz, Jonatan R.
    University of Granada, Spain.
    Silfvernagel, Kristin
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Business support and Development, Department of Health and Care Development.
    Löf, Marie
    Karolinska Institute, Sweden.
    Mobile-based intervention intended to stop obesity in preschool-aged children: the MINISTOP randomized controlled trial2017In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 105, no 6, p. 1327-1335Article in journal (Refereed)
    Abstract [en]

    Background: Traditional obesity prevention programs are time-and cost-intensive. Mobile phone technology has been successful in changing behaviors and managing weight; however, to our knowledge, its potential in young children has yet to be examined. Objective: We assessed the effectiveness of a mobile health (mHealth) obesity prevention program on body fat, dietary habits, and physical activity in healthy Swedish children aged 4.5 y. Design: From 2014 to 2015, 315 children were randomly assigned to an intervention or control group. Parents in the intervention group received a 6-mo mHealth program. The primary outcome was fat mass index (FMI), whereas the secondary outcomes were intakes of fruits, vegetables, candy, and sweetened beverages and time spent sedentary and in moderate-to-vigorous physical activity. Composite scores for the primary and secondary outcomes were computed. Results: No statistically significant intervention effect was observed for FMI between the intervention and control group (mean +/- SD: -0.23 +/- 0.56 compared with -0.20 +/- 0.49 kg/m(2)). However, the intervention group increased their mean composite score from baseline to follow-up, whereas the control group did not (+ 0.36 +/- 1.47 compared with -0.06 +/- 1.33 units; P = 0.021). This improvement was more pronounced among the children with an FMI above the median (4.11 kg/m(2)) (P = 0.019). The odds of increasing the composite score for the 6 dietary and physical activity behaviors were 99% higher for the intervention group than the control group (P = 0.008). Conclusions: This mHealth obesity prevention study in preschool-aged children found no difference between the intervention and control group for FMI. However, the intervention group showed a considerably higher postintervention composite score (a secondary outcome) than the control group, especially in children with a higher FMI. Further studies targeting specific obesity classes within preschool-aged children are warranted.

  • 35.
    Dinka, David
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Nyce, James M
    Ball State University.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Situated cognition in clinical visualization: the role of transparency in GammaKnife neurosurgery planning.2009In: Artificial intelligence in medicine, ISSN 1873-2860, Vol. 46, no 2, p. 111-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to investigate how the clinical use of visualization technology can be advanced by the application of a situated cognition perspective. METHODS AND MATERIALS: The data were collected in the GammaKnife radiosurgery setting and analyzed using qualitative methods. Observations and in-depth interviews with neurosurgeons and physicists were performed at three clinics using the Leksell GammaKnife. RESULT: The users' ability to perform cognitive tasks was found to be reduced each time visualizations incongruent with the particular user's perception of clinical reality were used. The main issue here was a lack of transparency, i.e. a black box problem where machine representations "stood between" users and the cognitive tasks they wanted to perform. For neurosurgeons, transparency meant their previous experience from traditional surgery could be applied, i.e. that they were not forced to perform additional cognitive work. From the view of the physicists, on the other hand, the concept of transparency was associated with mathematical precision and avoiding creating a cognitive distance between basic patient data and what is experienced as clinical reality. The physicists approached clinical visualization technology as though it was a laboratory apparatus--one that required continual adjustment and assessment in order to "capture" a quantitative clinical reality. CONCLUSION: Designers of visualization technology need to compare the cognitive interpretations generated by the new visualization systems to conceptions generated during "traditional" clinical work. This means that the viewpoint of different clinical user groups involved in a given clinical task would have to be taken into account as well. A way forward would be to acknowledge that visualization is a socio-cognitive function that has practice-based antecedents and consequences, and to reconsider what analytical and scientific challenges this presents us with.

  • 36.
    Dinka, David
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Nyce, J.M.
    Department of Library and Information Management, Emporia State, Emporia, KS 66801, United States.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    The need for transparency and rationale in automated systems2006In: Interacting with computers, ISSN 0953-5438, E-ISSN 1873-7951, Vol. 18, no 5, p. 1070-1083Article in journal (Refereed)
    Abstract [en]

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

  • 37.
    Dinka, David
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Nyce, J.M.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Holmberg, K.
    Adding value with 3D visualization and haptic forces to radiosurgery - A small theory-based, quasi-experimental study2006In: Journal of medical systems, ISSN 0148-5598, E-ISSN 1573-689X, Vol. 30, no 4, p. 293-301Article in journal (Refereed)
    Abstract [en]

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

  • 38.
    Edouard, Pascal
    et al.
    University Hospital St Etienne, France; University of Lyon, France; French Athlet Federat FFA, France.
    Jacobsson, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Swedish Athlet Assoc, Sweden.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
    Alonso, Juan-Manuel
    Int Assoc Athlet Federat, Monaco; Qatar Orthoped and Sports Medical Hospital, Qatar.
    Kowalski, Jan
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Swedish Athlet Assoc, Sweden.
    Nilsson, Sverker
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Swedish Athlet Assoc, Sweden.
    Karlsson, David
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Depiesse, Frederic
    French Athlet Federat FFA, France; Larrey Hospital University, France; European Athlet Assoc, Switzerland.
    Branco, Pedro
    Int Assoc Athlet Federat, Monaco; European Athlet Assoc, Switzerland.
    Extending in-competition Athletics injury and illness surveillance with pre-participation risk factor screening: A pilot study2015In: Physical Therapy in Sport, ISSN 1466-853X, E-ISSN 1873-1600, Vol. 16, no 2, p. 98-106Article in journal (Refereed)
    Abstract [en]

    Objectives: To explore the performance of retrospective health data collected from athletes before Athletics championships for the analysis of risk factors for in-competition injury and illness (IandI). Methods: For the 2013 European Athletics Indoor Championships, a self-report questionnaire (PHQ) was developed to record the health status of 127 athletes during the 4 weeks prior to the championship. Physician-based surveillance of in-competition IandI among all 577 athletes registered to compete was pursued during the championships. Results: 74 athletes (58.3%) from the sample submitted a complete PHQ, 21 (28%) of these athletes sustained at least one injury and/or illness during the championships. Training more than 12 h/week predisposed for sustaining an in-competition injury, and a recent health problem for in-competition illness. Among the 577 registered athletes, 60 injuries (104/1000 registered athletes) were reported. 31% of injuries were caused by the track, and 29% by overuse. 29 illnesses were reported (50/1000 registered athletes); upper respiratory tract infection and gastro-enteritis/diarrhoea were the most reported diagnoses. Conclusions: Pre-participation screening using athletes self-report PHQ showed promising results with regard to identification of individuals at risk. Indoor injury types could be attributed to extrinsic factors, such as small track size, track inclination, and race tactics. (C) 2014 Elsevier Ltd. All rights reserved.

  • 39.
    Ekberg, Joakim
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Angbratt, Marianne
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Valter, L.
    Östergötlands Läns Landsting, Center for Health and Developmental Care, Center for Public Health.
    Nordwall, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Center for Public Health.
    History matters: childhood weight trajectories as a basis for planning community-based obesity prevention to adolescents2012In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 36, no 4, p. 524-528Article in journal (Refereed)
    Abstract [en]

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

  • 40.
    Ekberg, Joakim
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ericson, Leni
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Eriksson, Henrik
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Nordfeldt, Sam
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Hanberger, Lena
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Web 2.0 Systems Supporting Childhood Chronic Disease Management: Design Guidelines Based on Information Behaviour and Social Learning Theories2010In: JOURNAL OF MEDICAL SYSTEMS, ISSN 0148-5598, Vol. 34, no 2, p. 107-117Article in journal (Refereed)
    Abstract [en]

    Self-directed learning denotes that the individual is in command of what should be learned and why it is important. In this study, guidelines for the design of Web 2.0 systems for supporting diabetic adolescents every day learning needs are examined in light of theories about information behaviour and social learning. A Web 2.0 system was developed to support a community of practice and social learning structures were created to support building of relations between members on several levels in the community. The features of the system included access to participation in the culture of diabetes management practice, entry to information about the community and about what needs to be learned to be a full practitioner or respected member in the community, and free sharing of information, narratives and experience-based knowledge. After integration with the key elements derived from theories of information behaviour, a preliminary design guideline document was formulated.

  • 41.
    Ekberg, Joakim
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Eriksson, Henrik
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Morin, Magnus
    VSL Research Labs.
    Holm, Einar
    Umeå University.
    Strömgren, Magnus
    Umeå University.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Impact of precautionary behaviors during outbreaks of pandemic influenza: modeling of regional differences2009In: AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, ISSN 1942-597X, Vol. 2009, p. 163-167Article in journal (Refereed)
    Abstract [en]

    Using time geographic theory for representation of population mixing, we set out to analyze the relative impact from precautionary behaviors on outbreaks of pandemic influenza in Europe and Asia. We extended an existing simulator environment with behavioral parameters from a population survey to model different behaviors. We found that precautionary behaviors even among a minority of the population can have a decisive effect on the probability of the outbreak to propagate. The results also display that assumptions strongly influences the outcome. Depending on the interpretation of how many "children" are kept from "school", R(0) changes from a range where outbreak progression is possible to a range where it is improbable in both European (R(0)=1.77/1.23) and Asian (R(0)=1.70/1.05) conditions. We conclude that unprompted distancing can have a decisive effect on pandemic propagation. An important response strategy can be to promote voluntary precautionary behavior shown to reduce disease transmission.

  • 42.
    Ekberg, Joakim
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Gursky, Elin A.
    Analytic Services Inc., Arlington, VA, USA.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Center for Public Health.
    Pre-launch evaluation checklist for online health-promoting communities2014In: Journal of Biomedical Informatics, ISSN 1532-0464, E-ISSN 1532-0480, Vol. 47, p. 11-17Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

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

    METHODS:

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

    RESULTS:

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

    CONCLUSIONS:

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

  • 43.
    Ekberg, Joakim
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Gursky, Elin
    Analytic Services Inc., Arlington, VA, USA.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Checklist for online health promoting communitiesManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Disease prevention via web-based interventions has matured into a relatively inexpensive health intervention alternative; however, few studies on web-based health promotion have been published. Despite the apparent potential of online health promoting communities (OHPC), not much guidance is available for developers on the basic design features that characterize successful applications. The aim of this study was to develop a checklist for a pre-launch evaluation of OHPCs. The checklist is required to take the perspectives of both the user community and the health services into account.

    Methods: The study was based on an action research design. Constructs used in an evaluation for information system success, applicable before the introduction of the OHPC to the end users, were used as the basis for a checklist. Each construct was contextually adapted for the OHPC context and formatively evaluated in the case study project, and then organized into a checklist applicable to both the end-user community and the health care services.

    Results: The checklist applicable to OHPC included the following constructs: information quality, service quality, and subjective norms. The contextual adaptation of the information quality construct resulted in items for content area, trust, and format. The contextual adaptation of the service quality construct resulted in items for staff competence, prompt service and empathy. The contextual adaptation of the subject norms construct resulted in items for social facilitation, interconnectivity and communication.

    Conclusions: The most important result from the formative evaluation was the delicate balance between community autonomy and quality control in the formulation of the information and service quality constructs. Before the checklist is implemented, a comparison of the infrastructure and processes of the study context and the target context is needed to determine what aspects of the checklist are irrelevant. Future studies addressing health outcome constructs for use in OHPC evaluations are warranted.

  • 44.
    Ekberg, Joakim
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, The Institute of Technology.
    Angbratt, Marianne
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Frank, Linda
    Department of Health, Jönköping County Council, Jönköping, Sweden.
    Norén, Anna-Maria
    Centre for Public Health, Kalmar County Council, Oskarshamn, Sweden.
    Andersen, Emelie
    Department of Health, Jönköping County Council, Jönköping, Sweden.
    Gursky, Elin
    Analytic Services Inc., Arlington, VA, USA.
    Andersson Gäre, Boel
    Futurum, Jönköping County Council, Jönköping, Sweden.
    Design of an online health-promoting community: negotiating user community needs with public health goals and service capabilities2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 258Article in journal (Refereed)
    Abstract [en]

    Background

    An online health-promoting community (OHPC) has the potential to promote health and advance new means of dialogue between public health representatives and the general public. The aim of this study was to examine what aspects of an OHPC that are critical for satisfying the needs of the user community and public health goals and service capabilities.

    Methods

    Community-based participatory research methods were used for data collection and analysis, and participatory design principles to develop a case study OHPC for adolescents. Qualitative data from adolescents on health appraisals and perspectives on health information were collected in a Swedish health service region and classified into categories of user health information exchange needs. A composite design rationale for the OHPC was completed by linking the identified user needs, user-derived requirements, and technical and organizational systems solutions. Conflicts between end-user requirements and organizational goals and resources were identified.

    Results

    The most prominent health information needs were associated to food, exercise, and well-being. The assessment of the design rationale document and prototype in light of the regional public health goals and service capabilities showed that compromises were needed to resolve conflicts involving the management of organizational resources and responsibilities. The users wanted to discuss health issues with health experts having little time to set aside to the OHPC and it was unclear who should set the norms for the online discussions.

    Conclusions

    OHPCs can be designed to satisfy both the needs of user communities and public health goals and service capabilities. Compromises are needed to resolve conflicts between users’ needs to discuss health issues with domain experts and the management of resources and responsibilities in public health organizations.

  • 45.
    Ekberg, Joakim
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Bång, Magnus
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Fröberg, Anders
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Halje, Karin
    Unga vuxna Clinic .
    Eriksson, Henrik
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Cell phone-supported cognitive behavioural therapy for anxiety disorders: a protocol for effectiveness studies in frontline settings.2011In: BMC medical research methodology, ISSN 1471-2288, Vol. 11, p. 3-Article in journal (Refereed)
    Abstract [en]

    The resulting protocol (NCT01205191 at clinicaltrials.gov) for use in frontline clinical practice in which effectiveness, adherence, and the role of the therapists are analyzed, provides evidence for what are truly valuable cell phone-supported CBT treatments and guidance for the broader introduction of CBT in health services.

  • 46.
    Ekberg, Joakim
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Gursky, Elin A.
    ANSER/Analytic Services Inc.
    Elicitation of Pandemic Coping Strategiesamong Health Care Workers: ContextualAdaptation of a Mental Models Method2009In: Journal of Homeland Security and Emergency Management, ISSN 1547-7355, Vol. 6, no 1, p. 78-Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to develop and formatively evaluate a method of eliciting health care workers' understanding of pandemics and their forecasted behaviors during an outbreak. Qualitative methods were used for the evaluation. The results demonstrate that it was possible to identify specific points during the subject interviews when the health care worker seemed to turn from provision of frank data on self-efficacy to that of speculation. Considering this observation, the re-designed method allowed collection and analysis of data critical for pandemic planning. The results imply that more reliable predictions of health care workers' behavior during a pandemic are possible, albeit sensitive to elicit. Use of realistic mental exercises can provide important insights into the level of pandemic preparedness, but these methods will require additional research to reliably differentiate between prediction and speculation.

  • 47.
    Ekberg, Joakim
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Morin, Magnus
    VSL Research Labs.
    Jenvald, Johan
    VSL Research Labs.
    Nyce, James
    Ball State University.
    Gursky, Elin
    Analytical Service Inc.
    Eriksson, Henrik
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Transparency and documentation in simulations of infectious disease outbreaks: Towards evidence-based public health decisions and communications2009In: Proceedings of the Second International ICST Conference on Electronic Healthcare for the 21st century, 2009, p. 28-34Conference paper (Refereed)
    Abstract [en]

    Computer simulations have emerged as important tools in the preparation for outbreaks of infectious disease. To support the collaborative planning and responding to the outbreaks, reports from simulations need to be transparent (accessible) with regard to the underlying parametric settings. This paper presents a design for generation of simulation reports where the background settings used in the simulation models are automatically visualized. We extended the ontology-management system Protégé to tag different settings into categories, and included these in report generation in parallel to the simulation outcomes. The report generator takes advantage of an XSLT specification and collects the documentation of the particular simulation settings into abridged XMLs including also summarized results. We conclude that even though inclusion of critical background settings in reports may not increase the accuracy of infectious disease simulations, it can prevent misunderstandings and less than optimal public health decisions.

  • 48.
    Ekberg, Joakim
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ramel, Henrik
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Valter, Lars
    Östergötlands Läns Landsting.
    Injury rates and risk-factors associated with eventing: a total cohort study of injury events among adult Swedish eventing athletes2011In: International Journal of Injury Control and Safety Promotion, ISSN 1745-7300, E-ISSN 1745-7319, Vol. 18, no 4, p. 261-267Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to examine injury events and risk-factors among Swedish adult eventing athletes. A cross-sectional study design with retrospective recording of 1-year sports-specific exposure and injury data was used. The invited study population consisted of all members of the Swedish Equestrian Federation with eventing as their primary discipline (n = 513). The participation rate was 70.0%. The total 1-year injury prevalence was 26.6%; the specific 1-year prevalence of traumatic injury was 19.3% and of overuse injury 10.9%. The incidence of traumatic injury events was 0.54 injury events/1000 eventing hours (95% confidence interval (CI), 0.35-0.73 injury events/1000 eventing hours) for novices and 0.35 injury events/1000 eventing hours for qualified riders (95% CI, 0.21-0.49 injury events/1000 eventing hours). A total of 27.9% of the traumatic injury events led to severe injuries (causing more than 3 weeks absence from riding). Attitude to risk-taking was the only factor predicting an athlete becoming injured (p = 0.023), and qualification level was the only risk factor for additional injuries among injured riders (p = 0.003). Our results suggest that injury prevention programs in eventing should also give attention to overuse injuries and that care should be taken when eventing athletes are licensed into higher qualification groups.

  • 49.
    Ekstrand, Jan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science.
    Hägglund, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy.
    Risk of injury in elite football played on artificial turf versus natural grass: a prospective two-cohort study.2006In: British journal of sports medicine, ISSN 1473-0480, Vol. 40, no 12, p. 975-80Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare injury risk in elite football played on artificial turf compared with natural grass.

    DESIGN: Prospective two-cohort study.

    SETTING: Male European elite football leagues.

    PARTICIPANTS: 290 players from 10 elite European clubs that had installed third-generation artificial turf surfaces in 2003-4, and 202 players from the Swedish Premier League acting as a control group.

    MAIN OUTCOME MEASURE: Injury incidence.

    RESULTS: The incidence of injury during training and match play did not differ between surfaces for the teams in the artificial turf cohort: 2.42 v 2.94 injuries/1000 training hours and 19.60 v 21.48 injuries/1000 match hours for artificial turf and grass respectively. The risk of ankle sprain was increased in matches on artificial turf compared with grass (4.83 v 2.66 injuries/1000 match hours; rate ratio 1.81, 95% confidence interval 1.00 to 3.28). No difference in injury severity was seen between surfaces. Compared with the control cohort who played home games on natural grass, teams in the artificial turf cohort had a lower injury incidence during match play (15.26 v 23.08 injuries/1000 match hours; rate ratio 0.66, 95% confidence interval 0.48 to 0.91).

    CONCLUSIONS: No evidence of a greater risk of injury was found when football was played on artificial turf compared with natural grass. The higher incidence of ankle sprain on artificial turf warrants further attention, although this result should be interpreted with caution as the number of ankle sprains was low.

  • 50.
    Eriksson, Henrik
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Morin, Magnus
    VSL Research Labs, Linköping.
    Ekberg, Joakim
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Jenvald, Johan
    VSL Research Labs, Linköping.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Assumptions management in simulation of infectious disease outbreaks2009In: AMIA ... Annual Symposium proceedings / AMIA Symposium, ISSN 1942-597X, Vol. 2009, p. 173-177Article in journal (Refereed)
    Abstract [en]

    Simulation of outbreaks of infectious disease is an important tool for understanding the dynamics of the outbreak process, the impact of disease and population properties, and the potential effect of interventions. However, the interpretation of the simulation results requires a clear understanding of the assumptions made in the underlying model. Typical simulation tasks, such as exploring the space of different scenarios for population and disease properties, require multiple runs with varying model parameters. For such complex tasks, the management of the assumptions made becomes a daunting and potentially error-prone undertaking. We report explicit assumptions management as an approach to capture, model, and document the assumptions for simulator runs. It was found possible to extend ontology-based simulation, which uses an ontological model to parameterize the simulator, to incorporate an assumptions model in the ontology. We conclude that explicit assumptions modeling should be part of any infectious disease simulation architecture from start.

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