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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.
    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.

  • 2.
    Dalal, Koustuv
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. 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.
    A National Study of the Prevalence and Correlates of Domestic Violence Among Women in India2012In: ASIA-PACIFIC JOURNAL OF PUBLIC HEALTH, ISSN 1010-5395, Vol. 24, no 2, p. 265-277Article in journal (Refereed)
    Abstract [en]

    This article estimates the national prevalence rate of domestic violence in India and examines the demographic and socioeconomic status of the victims of domestic violence. The study used the Indian National Family Health Survey 3, a cross-sectional national survey of 124 385 ever-married women of reproductive age from all the 29 member states. chi(2) Analysis and logistic regression were used. Lifetime experiences of violence among respondents were as follows: emotional violence, 14%; less severe physical violence, 31%; severe physical violence, 10%; and sexual violence, 8%. Women of scheduled castes and Muslim religion were most often exposed to domestic violence. Womens poorer economic background, working status, and husbands controlling behavior emerged as strong predictors for domestic violence in India. Elimination of structural inequalities inherent in the indigenous oppressive institutions of religion, caste, and the traditional male hierarchy in society could prevent domestic violence.

  • 3.
    Glendor, Ulf
    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.
    Jonsson, Dick
    Halling, A.
    Lindqvist, Kent
    Direct and indirect costs of dental trauma in Sweden: a 2-year prospective study of children and adolescents2001In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, Vol. 29, no 2, p. 150-160Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To study total costs, including direct costs (health care service, loss of personal property, medicine and transport) and indirect costs (loss of production or leisure) of dental trauma to children and adolescents with special reference to predictors.

    METHODS: The study was based on a random sample of 192 children and adolescents with a dental trauma reported to an insurance company and prospectively followed up by telephone interviews over a period of 2 years.

    RESULTS: On average, health care service costs represented 2,955 SEK (SD=3,818) and total costs 4,569 SEK (SD=3,053) for dental trauma to permanent teeth, and 837 SEK (SD=898) and 1,746 SEK (SD=1,183) for trauma to primary teeth. The most extensive type of indirect cost was loss of production or leisure, which averaged 1,286 SEK (SD=1,830) for injuries to permanent teeth and 699 SEK (SD=1,239) for injuries to primary teeth. Multiple regression analysis of demographic and dental injury variables showed that complicated trauma was of special importance to costs for permanent and primary teeth injuries. The average relative increase in total costs to patients and companions for complicated injury to permanent teeth was 140% (95% confidence interval [CI], 66-248%) for patients and 132% (95% CI, 54-249%) for companions. Lack of access to a dental clinic near the place of residence could increase the average total costs of injuries to permanent teeth by 91% for companions (95% CI, 20-204%) and for primary teeth by 134% (95% CI, 38-296%).

    CONCLUSIONS: Dental traumas result in both direct and indirect costs, with a predominance of direct costs. The direct costs primarily depend on degree of severity, while indirect costs are mostly due to compromised access to health care service. Traumas to permanent teeth are especially costly and, due to additional maintenance, the care may continue for several years. This study has drawn attention to the significant implications of dental trauma to patient and companion, a new area where further studies are warranted.

  • 4.
    Kullberg, Agneta
    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.
    Karlsson, Nadine
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation.
    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 Public Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Correlates of local safety-related concerns in a Swedish Community: a cross-sectional study2009In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, no 221Article in journal (Refereed)
    Abstract [en]

    Background: Crime in a neighbourhood has been recognized as a key stressor in the residential environment. Fear of crime is related to risk assessment, which depends on the concentration of objective risk in time and space, and on the presence of subjective perceived early signs of imminent hazard. The aim of the study was to examine environmental, socio-demographic, and personal correlates of safety-related concerns at the local level in urban communities. The specific aim was to investigate such correlates in contiguous neighbourhoods in a Swedish urban municipality. Methods: A cross-sectional study design was used to investigate three neighbourhood settings with two pair-wise conterminous but socially contrasting areas within each setting. Crime data were retrieved from police records. Study data were collected through a postal questionnaire distributed to adult residents (n = 2476) (response rate 56%). Composite dimensions of perceived residential safety were derived through a factor analysis. Logistic regression analysis was used to examine associations between high-level scores of the three safety-related dimensions and area-level crime rate, being a victim of crime, area reputation, gender, age, education, country of birth, household civil status and type of housing. Results: Three composite dimensions of perceived residential safety were identified: (I) structural indicators of social disorder; (II) contact with disorderly behavior; and (III) existential insecurity. We found that area-level crime rates and individual-level variables were associated with the dimensions structural indicators of social disorder and existential insecurity, but only individual-level variables were associated with the dimension contact with disorderly behavior. Self-assessed less favorable area reputation was found to be strongly associated with all three factors. Being female accorded existential insecurity more than being a victim of crime. Conclusion: We have identified environmental, socio-demographic, and personal correlates of safety-related concerns in contiguous neighbourhoods in a Swedish community. The results of this study suggest that residents self-assessed area reputation is an important underlying mechanism of perceived safety. We also found a difference in crime rates and safety-related concerns between areas with blocks of flats compared with small-scale areas although the neighbourhoods were close geographically.

  • 5.
    Kullberg, Agneta
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Nordqvist, Cecilia
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Examining quality function deployment in safety promotion in Sweden.2014In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 29, no 3, p. 414-426Article in journal (Refereed)
    Abstract [en]

    The first-hand needs and demands of laypersons are not always considered when safety promotion programmes are being developed. We compared focal areas for interventions identified from residents' statements of safety needs with focal areas for interventions identified by local government professionals in a Swedish urban community certified by the international Safe Community movement supported by the World Health Organization. Quantitative and qualitative data on self-expressed safety needs from 787 housing residents were transformed into an intervention design, using the quality function deployment (QFD) technique and compared with the safety intervention programme developed by professionals at the municipality administrative office. The outcome of the comparison was investigated with regard to implications for the Safe Community movement. The QFD analysis identified the initiation and maintenance of social integrative processes in housing areas as the most highly prioritized interventions among the residents, but failed to highlight the safety needs of several vulnerable groups (the elderly, infants and persons with disabilities). The intervention programme designed by the public health professionals did not address the social integrative processes, but it did highlight the vulnerable groups. This study indicates that the QFD technique is suitable for providing residential safety promotion efforts with a quality orientation from the layperson's perspective. Views of public health professionals have to be included to ascertain that the needs of socially deprived residents are adequately taken into account. QFD can augment the methodological toolbox for safety promotion programmes, including interventions in residential areas.

  • 6.
    Kullberg, Agneta
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nordqvist, Cecilia
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    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.
    Integrating residents’ demands into the design of safety promotion interventions in housing areas: a case study application of quality function deployment in a Safe Community programManuscript (preprint) (Other academic)
    Abstract [en]

    Background: The needs and demands of the residents are rarely considered in community-based design of safety services and planning in housing areas. We therefore set out to compare safety promotion intervention design based on residents’ self-expressed safety needs with interventions designed by local government professionals. A secondary aim was to use the results to suggest improvements for the safety promotion indicators targeting Safe Homes within the Safe Community movement.

    Methods: Case study research methods based on a nested single-case design were used for the study. Data collected from 787 residents in a case study community were analyzed using the quality function deployment (QFD) technique. Quantitative and qualitative data on residents’ self-expressed safety needs were transformed into an intervention design. The resulting design was then compared with the safety intervention program designed by professionals at the municipality administrative office. The results from this comparison were then investigated to identify improvements for the indicators for Safe Homes in the Safe Community program.

    Results: The QFD analysis showed that the initiation and maintenance of social integrative processes in housing areas were the most highly prioritized interventions among the residents, but the analysis did not highlight the safety needs of several vulnerable groups (e.g. the old elderly, infants, and persons with disabilities). The Safe Community program designed by professionals did not address the social integrative processes, but did cover the vulnerable groups. Our results indicate that the current Safe Homes concept in the Safe Community program would benefit from being widened to Safe Housing.

    Conclusions: The QFD technique can be added to the methodological toolbox for residential safety promotion. The technique is particularly suitable for providing a quality orientation from the lay perspective of residents. Residents and professionals can contribute with different perspectives on safety promotion and injury prevention in local residential areas. In developing safe housing, these different views should be identified and considered. Socio-economic differences and social inequalities in safety-related housing conditions between areas also need to be considered in the programs.

  • 7.
    Kullberg, Agneta
    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.
    Nordqvist, Cecilia
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    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 Public Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Residents’ perspectives on safety support needs in different types of housing areas2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 6, p. 590-597Article in journal (Refereed)
    Abstract [en]

    Background: Knowledge about conditions that are understood to support safety is important for planning residential safety promotion in interactions with residents. How residents themselves perceive and reason about their own safety needs has seldom been investigated in Scandinavia. Aim: To identify factors perceived to be necessary to feel safe by residents in areas with blocks of flats and detached houses.

    Methods: Residents in a Swedish municipality were asked an open-ended question on the research topic by a mail survey; 787 residents provided narrative data that were fed into a summative qualitative and quantitative content analysis.

    Results: A stable social structure in the housing area was perceived to be the central factor in a safety-supportive residential environment. Whereas maintenance of good and reassuring relations was emphasized in detached housing areas, support for management of poor or even fear-provoking neighbour relations was requested from areas with blocks of flats. This finding emphasizes the need to reduce the differential exposure to safety-related factors in the living environment.

    Conclusions: The results of our study encourage the continued use of a setting-orientated safety promotion approach in which residents and other stakeholders are involved. The policy recommendation that can be drawn from the study is that both the subjective and objective dimensions of safety should be identified and considered when developing local safety promotion interventions in community contexts.

  • 8.
    Kullberg, Agneta
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    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.
    Svensson, Tommy
    Linköping University, Department of Behavioural Sciences and Learning, Sociology. Linköping University, Faculty of Arts and Sciences.
    Karlsson, Nadine
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Does the perceived neighborhood reputation contribute to neighborhood differences in social trust and residential wellbeing?2010In: Journal of community psychology (Print), ISSN 0090-4392, E-ISSN 1520-6629, Vol. 38, no 5, p. 591-606Article in journal (Refereed)
    Abstract [en]

    The authors used a mixed methods approach to examine if the reputation of a housing area has bearing on residential wellbeing and social trust in three pairs of socioeconomically contrasting neighborhoods in a Swedish urban municipality. Multilevel logistic regression analyses were performed to examine associations between area reputation and residential wellbeing and social trust, controlling for the random effect of neighborhood and individual level sociodemographic factors. Qualitative data were analyzed to identify mechanisms of how neighborhood reputations were established. The housing area reputation was found to be strongly associated with wellbeing and social trust. The area reputation also seemed to be a determinant of position in the local social structure; residents were found to position themselves in a rank order The results suggest that area reputation is an important and probably underestimated dimension in the development of residential wellbeing and social trust in housing.

  • 9.
    Lindqvist, Kent
    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.
    Economic impact of injuries according to type of injury2002In: Croatian Medical Journal, ISSN 0353-9504, E-ISSN 1332-8166, Vol. 43, no 4, p. 386-389Article in journal (Other academic)
    Abstract [en]

    Aim. Analysis of the economic impact of injuries that occurred within a year in Motala district - a World Health Organization Safe Community. Method. A survey of all types of injury that occurred in an area with the total population of over 41,000 within a 12-month period (October 1, 1983, to September 30, 1984). All injuries that required medical care were noted. Included in the costs of injuries were the marginal costs to medical care, companies, and the health insurance system. Results. There were 4,926 injuries that required medical care. The costs of injuries were SEK 23.7 million (US$3.59 million) for the health care service (outpatient care, including primary health care and hospital care), SEK 79.7 million (US$12.08 million) for trade and industry, and SEK 9.1 million (US$1.38 million) for health insurance system. Home injuries accounted for the largest share of community costs (29%). Men accounted for the highest share of both the cost to the community (59%) and health insurance expenditures (70%) for injuries. In case of home injuries, the cost of medical care dominated among women (46%), whereas company costs dominated among men (77%). Serious injuries (Abbreviated Injury Scale-AIS-3) accounted for 16% of the total cost to the community, but constituted only 3% of all injuries. Moderate injuries (AIS-2) accounted for 69% of the cost and made up 48% of the injuries, whereas minor injuries (AIS-1) accounted for 12% of the cost and constituted 49% of all injuries. Injuries to the extremities accounted in all for 74% of the cost to the community. Conclusion. The cost of injuries can be analyzed in relation to different characteristics of injuries, which can provide a comprehensive view of the injury profile and its economic impact according to the type of injury.

  • 10.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Motala Municipality - a sustainable Safe Community in Sweden2012In: International Journal of Injury Control and Safety Promotion, ISSN 1745-7300, E-ISSN 1745-7319, Vol. 19, no 3, p. 249-259Article in journal (Refereed)
    Abstract [en]

    An extensive research project concerning injury prevention was planned and initiated in Motala Municipality in the early 1980s. This article summarises 25 years of work for injury prevention and safety promotion in Motala. Evaluation of both process and effect were conducted based on a quasi-experimental study design, as well as cost-effectiveness and cost-benefit analyses of interventions. Initial evaluations results showed an annual incidence of injuries of 118.9/1000 citizens in 1983/1984 consisting of injuries at home (35%), sports injuries (18.9%), injuries at work (13.7%), traffic-related injuries (12.8%) and other injuries (19.5%). The annual social economic costs of injuries were estimated at 116 million Swedish crowns (SEK). By 1989, after two years of preventive work, the incidence of injuries was reduced by 13%. The greatest decrease was among the moderate severity category of injuries (41%). The social economic costs were thereby reduced by 21 million SEK per year. Since then, work with injury prevention has continued and annual evaluations have shown that the incidence of injuries, with some fluctuation, has continued to decrease up to the latest evaluation in 2008. The total decrease during the study period was 37%. This study shows that community-based injury prevention work according to the Safe Community model is a successful and cost-effective way of reducing injuries in the local community.

  • 11.
    Lindqvist, Kent
    Linköping University, Department of health and environment. Linköping University, Faculty of Health Sciences.
    Towards community-based injury prevention: the Motala model1993Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In the Swedish County of Östergötland a comprehensive health policyprogramme including accidents was decided by the health authorities in 1988. An accident prevention programme (the "Motala Accident Prevention Study") had already started with an epidemiological analysis of accidents in the community. The Motala study is based on Bracht and Kingsbury's five-stage model of community development: community analysis, design and initiation,  implementation, maintenance, and reassessment.

    The scientific reporting of the Motala study in this thesis is based on selected parts of the five-stage model and is grouped into reports from the community analysis (the main study) and an intervention study. The aim was to describe the panorama of accidents, their causes and effects in a defined community, and to account for the economic consequences of these accidents. A secondary aim was to provide an epidemiological basis for a sports accident prevention programme and out of that design such a programme, and to evaluate the effects of loan programmes on infant car restraints. In forthcoming papers other parts of the different stages of the model will be presented.

    Total population injury surveillance was performed in an area with apopulation of over 41,000. All accidents (N= 4,926) occurring within a 12-month period and requiring medical care were noted, giving a ratio of 118.9 per 1,000. They consisted of accidents in the home (35.0%), sports accidents (18.9%), accidents at work (13.7%), traffic accidents (12.8%), and "other" accidents (19.5%). Half of the victims covered by health insurance were put on sick leave in connection with the accident, and 12.6% of these were admitted to hospital. The age-group 13-19 years, and men between 20-29 years of age, showed the highest accident rate. The total cost to society for people in the labour force, including treatment cost and production loss, was 103.4 million SEK (15.7 million USD). The cost to society of uninsured people for time lost from "normal activities" because of an accident was estimated at 43.1 million SEK (6.5 million USD). There are three important conclusions with regard to the economic consequences of accidents. Firstly, it appears important to assess not only the productive working time of the injured people, but also other time, in which normal activities are restricted. Secondly, the findings reveal the conflict between the utilitarian and the dutybased ethical basis of health care activities. Thirdly, the results show the need for well-controlled studies with alternatives to show the effects of different actions.

  • 12.
    Lindqvist, Kent
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Dalal, Koustuv
    School of Health & Medical Sciences, Department of Public Health Science, Örebro University, Örebro, Sweden.
    Impact of social standing on traffic injury prevention in a WHO safe community2012In: Health, ISSN 1949-4998, E-ISSN 1949-5005, Vol. 4, no 4, p. 216-221Article in journal (Other academic)
    Abstract [en]

    The objective of the current study was to evalu- ate outcomes of a program to prevent traffic injuries among the different social strata under WHO Safe Community Program. A quasi-experi- mental design was used, with pre- and post- implementation registrations in the program im- plementation area (population 41,000) and in a neighbouring control municipality (population 26,000) in Östergötland County, Sweden. The traffic injury rate in the not vocationally active households was twice than employed or self- employed households in the intervention area. In the employed and not vocationally active households, males showed higher injury rates than females in both areas. In the self-employed households females exhibited higher injury rates than males in the intervention area. Males from not vocationally active households displayed the highest post-intervention injury rate in both the intervention and control areas. After 6 years of Safe Community program activity, the injury rates for males in employed category, injury rates for females in self-employed category, and males/females in non- vocationally active cate- gory displayed a decreasing trend in the inter- vention area. However, in the control area injury rate decreased only for males of employed households. The study indicated that there was almost no change in injury rates in the control area. Reduction of traffic injuries in the inter- vention area between 1983 and 1989 was likely to be attributable to the success of safety pro- motion program. Therefore, the current study concludes that Safe Community program seems to be successful for reducing traffic injuries in different social strata.

  • 13.
    Lindqvist, Kent
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    The impact of child safety promotion on different social strata in a WHO Safe Community2012In: Journal of Injury and Violence Research, ISSN 2008-2053, E-ISSN 2008-4072, Vol. 4, no 1, p. 20-25Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The objective of the current study was to evaluate outcomes of a program to prevent severe and less severe unintentional child injuries among the different social strata under WHO Safe Community program. Specifically, the aim was to study effectiveness of Safe Community program for reducing child injury.

    METHODS: A quasi-experimental design was used, with pre- and post-implementation registrations covering the children (0 -15 years) in the program implementation area (population 41,000) and in a neighboring control municipality (population 26,000) in Ostergotland County, Sweden.

    RESULTS: Boys from not vocationally active households displayed the highest pre-intervention injury rate in both the control and intervention areas. Also in households in which the vocationally significant member was employed, boys showed higher injury rates than girls. Households in which the vocationally significant member was self-employed, girls exhibited higher injury rates than boys in the intervention area. After 6 years of program activity, the injury rates for boys and girls in employed category and injury rates for girls in self-employed category displayed a decreasing trend in the intervention area. However, in the control area injury rate decreased only for boys of employed families.

    CONCLUSIONS: The study indicated that almost no changes in injury rates in the control area suggested that the reduction of child injuries in the intervention area between 1983 and 1989 was likely to be attributable to the safety promotion program. Therefore, the current study indicates that Safe Community program seems to be successful for reducing child injuries.

  • 14.
    Lindqvist, Kent
    et al.
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
    Lindholm, L.
    Department of Public Health and Clinical Medicine, Umeå University, Sweden.
    A cost-benefit analysis of the community-based injury prevention programme in Motala, Sweden—a WHO Safe Community2001In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 115, no 5, p. 317-322Article in journal (Refereed)
    Abstract [en]

    The objective in this study was to calculate costs and benefits caused by a safe community injury prevention programme in Motala, Sweden. The study design was a quasi-experimental evaluation involving an intervention population and a non-random control population. All injuries were recorded before and after an intervention programme. The presented calculations show that costs of injuries in a societal perspective decreased from 116 million Swedish Crowns (SEK) to 96 million SEK, while the cost for the intervention was estimated at approximately 10 million SEK. Thus, the safe community injury prevention programme in Motala should be judged as cost-effective. 

  • 15.
    Lindqvist, Kent
    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.
    Schelp, L
    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.
    Gender aspects of work-related injuries in a Swedish minicipality.2000In: Safety Science, ISSN 0925-7535, E-ISSN 1879-1042, Vol. 31, p. 183-196Article in journal (Refereed)
  • 16.
    Lindqvist, Kent
    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.
    Schelp, L
    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.
    Home injuries in a Swedish municipality - consequences and costs. 1999In: Safety Science, ISSN 0925-7535, E-ISSN 1879-1042, Vol. 31, p. 19-29Article in journal (Refereed)
  • 17.
    Lindqvist, Kent
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Karlsson, Nadine
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Impact of social standing on injury prevention in a World Health Organization Safe Community - Intervention outcome by household employment contract2004In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 33, no 3, p. 605-611Article in journal (Refereed)
    Abstract [en]

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

  • 18.
    Lindqvist, Kent
    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.
    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.
    Schelp, I
    Åhlgren, M
    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.
    Evaluation of a home injury prevention program in a WHO Safe community. 1999In: International journal for consumer and product safety, ISSN 1387-3059, Vol. 6, p. 25-32Article in journal (Refereed)
  • 19.
    Lindqvist, Kent
    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.
    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.
    Schelp, L
    Evaluation of an inter-organizational prevention program against injuries among the elderly in a WHO Safe Community2001In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 115, no 5, p. 308-316Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to evaluate the outcome of a participatory community-based prevention program against injuries among the elderly. A population-based quasi-experimental design was used with pre- and post-implementation measurements in an intervention and a control area. The program was based on cross-sectoral participation in detecting and taking action against injuries among the elderly. Change in the relative risk of injury was estimated by the odds ratio. Morbidity in moderately (AIS 2) severe injury in the study area was reduced from 46 per 1000 population years to 25 per 1000 population years (odds ratio 0.55, 95% confidence interval 0.46-0.65), while the minor (AIS 1) injuries increased (odds ratio 1.55, 95% confidence interval 1.21-1.91). The risk of severe or fatal (AIS 3-6) injuries remained constant. In the study area, only a slight decrease in the total morbidity rate was observed (odds ratio 0.87, 95% confidence interval 0.77-0.99). In the control area, there was no evident change in the total morbidity rates. Falls decreased or showed a tendency to decrease in the age groups 65 to 79-y-old in the study area, while they increased in the older age group. The results indicate that no sharp boundaries should be drawn between safety education, physical conditioning, environmental adjustments and secondary prevention measures when planning safety promotion among the elderly. Future studies should address these issues along with the methodological complexity associated with assessment of participatory community-based safety promotion programs.

  • 20.
    Lindqvist, Kent
    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.
    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.
    Schelp, L
    Evaluation of inter-organizational traffic injury prevention in a WHO safe community2001In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 33, no 5, p. 599-607Article in journal (Refereed)
    Abstract [en]

    The objective of the study was to examine the effect of a community-based injury prevention program on traffic injuries. A population-based quasi-experimental design was used with pre- and post-implementation measurements in an intervention and a control area. The program was based on inter-organizational participation in detecting and taking action against traffic injuries. The total relative risk for traffic injury in the study area showed only a tendency to decrease following program exposure (odds ratio 0.91, 95% confidence interval 0.81-1.02). No change in relative risk was observed in the control area. The analyses of program impact on injury severity showed that the relative risk for moderate injuries in the study area was reduced by almost half (odds ratio 0.59, 95% confidence interval 0.49-0.69), the risk for severe or fatal injuries remained constant (odds ratio 1.27, 95% confidence interval 0.80-2.02), and the risk for minor injuries increased (odds ratio 1.34, 95% confidence interval 1.13-1.59). The relative risk for moderate injuries was reduced by at least half for mopedists, cyclists, pedestrians, and those leaving or entering a motor vehicle. Community-based injury prevention can be a complement to national traffic safety programs. ⌐ 2001 Elsevier Science Ltd.

  • 21.
    Lindqvist, Kent
    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.
    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.
    Schelp, L.
    arolinska Institute, Department of Public Health Sciences, Division of Social Medicine, Norrbacka, Stockholm, and National Institute of Public Health, Stockholm, Sweden .
    Risto, Olof
    Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences.
    Evaluation of a child safety program based on the WHO Safe Community model2002In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 8, no 1, p. 23-26Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the outcome of the World Health Organization (WHO) Safe Community model with respect to child injuries.

    Study design: A population based quasiexperimental design was used. Cross sectional pre-implementation and post-implementation data were collected in intervention (Motala municipality) and control (Mjölby municipality) areas, both in Östergötland county, Sweden.

    Results: The total relative risk of child injury in the intervention community decreased more (odds ratio 0.74; 95% confidence interval (CI) 0.68 to 0.81) than in a control community exposed only to national level injury prevention programs (0.93; 95% CI 0.82 to 1.05). The relative risk of moderately (abbreviated injury scale (AIS) 2) severe injury in the study area was reduced to almost a half (odds ratio 0.49; 95% CI 0.41 to 0.57), whereas the risk of minor (AIS 1) injuries decreased only slightly (odds ratio 0.89; 95% CI 0.80 to 0.99). The risk of severe or fatal (AIS 3–6) injuries remained constant.

    Conclusions: After introduction of an injury prevention program based on the WHO Safe Community model, the relative risk for child injury in the intervention community decreased significantly more than in a control community exposed only to national injury prevention programs.

  • 22.
    Lindqvist, Kent
    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.
    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.
    Schelp, Å
    Schelp, L
    Åhlgren, M
    Åhlgren, M
    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.
    Evaluation of an inter-organizational program for prevention of work-related injuries in a WHO Safe Community.1999In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 13, p. 89-96Article in journal (Refereed)
  • 23.
    Nilsen, Per
    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.
    Ekman, Robert
    Karolinska Institute, Department of Public Health Science, Division of Social Medicine, Stockholm, Sweden.
    Stark Ekman, Diana
    Karolinska Institute, Department of Public Health Science, Division of Social Medicine, Stockholm, Sweden.
    Ryen, Linda
    Swedish Rescue Services Agency, National Centre for Learning from Incidents and Accidents (NCO), Karlskoga, Sweden.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Effectiveness of Community-Based Injury Prevention: Injury Rate Levels, Changes, and Trends for 14 Swedish WHO-Designated Safe Communities2007In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 39, no 2, p. 267-273Article in journal (Refereed)
    Abstract [en]

    This study investigates the injury rate levels, changes, and trends between 1987 and 2002 for the 14 Swedish municipalities designated as WHO Safe Communities. The injury rate was defined as the number of injured patients discharged from hospital per 1000 persons. Injury rates were age standardised. Each municipality was compared with its respective municipality group, according to a classification of Sweden's 288 municipalities into nine groups based on numerous structural parameters.

    The average injury rate levels for the 14 WHO-designated Safe Community municipalities ranged from 11.54 to 19.09 per 1000 population during the study period, which was defined as the time period during which a municipality's injury prevention program has been operational. Eleven of 14 municipalities had higher levels than their corresponding municipality groups. Five of the 14 municipalities “outperformed” their respective municipality groups and achieved a greater relative injury rate decrease during the study period. The trends for the 14 municipalities in relation to their municipality groups showed an inconsistent pattern, with only four municipalities exhibiting overall favourable trends for the study period.

  • 24.
    Nilsen, Per
    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.
    Hudson, D S
    Socialmedicin Karolinska institutet.
    Kullberg, Agneta
    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.
    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.
    Ekman, R
    Socialmedicin Karolinska institutet.
    Lindqvist, Kent
    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.
    Making sense of safety2004In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 10, p. 71-73Article in journal (Refereed)
  • 25.
    Nilsen, Per
    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.
    Hudson, Diana
    Gabrielsson, Felicia
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Strategies and goals of community-based injury prevention programmes: a mixed-methods study of 25 Scandinavian WHO Safe Communities2006In: International Journal of Injury Control and Safety Promotion, ISSN 1745-7300, Vol. 13, no 1, p. 27-33Article in journal (Refereed)
    Abstract [en]

    Documentation and analysis of prevention goals and interventions employed by community-based injury prevention programmes is vital to advance the knowledge and understanding of synergistic multi-strategy injury prevention programmes. This study examined the goals and interventions of 25 Scandinavian community-based injury prevention programmes in WHO-designated Safe Communities. Collection and analysis of quantitative data from survey questionnaires to the programme coordinators was followed by collection and analysis of qualitative data from structured interviews with programme coordinators from eight of the programmes. The results demonstrated that the programmes under study predominantly relied on 'intuitive' and subjective methods for selecting interventions. The programmes largely failed to transform injury surveillance data into information and knowledge that could prioritize community safety strategies and measures, due to insufficient time and personnel resources. The results demonstrated the importance of combining passive approaches with active interventions. Educational efforts were considered essential to the programmes. The programmes preferred to rely on broadly stated goals rather than specific objectives.

  • 26.
    Nilsen, Per
    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.
    Hudson, Diana
    Lindqvist, Kent
    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.
    Economic analysis of injury prevention - applying results and methodologies from cost- of- injury studies2006In: International journal of injury control and safety promotion, ISSN 1745-7300, Vol. 13, no 1Article in journal (Refereed)
  • 27.
    Nilsen, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Hudson, D.S.
    Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, Stockholm, Sweden.
    Kullberg, Agneta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, FHVC - Folkhälsovetenskapligt centrum.
    Ekman, R.
    Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, Stockholm, Sweden, Swedish Rescue Services Agency, Natl. Ctr. for Lrng. from Accidents, Skövde, Sweden.
    Lindqvist, Kent
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Making sense of safety2004In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 10, no 2, p. 71-73Other (Other academic)
    Abstract [en]

    [No abstract available]

  • 28.
    Nilsen, Per
    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.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekonomisk analys av säkerhetsfrämjande arbete2007Report (Other academic)
    Abstract [sv]

    Ekonomiska analyser av säkerhetsfrämjande arbete kan beskrivas som systematiska vägningar av kostnader och effekter av detta arbete. En vanlig fråga i dessa sammanhang är huruvida det är etiskt försvarbart att bry sig om ekonomiska aspekter när man diskuterar säkerhetsfrämjande arbete. Livet i sig är ju ovärderligt och det måste få kosta att rädda liv, förebygga skador och minska mänskligt lidande. Behöver man verkligen anlägga ett ekonomiskt perspektiv när det handlar om att främja hälsa och säkerhet? Frågor som dessa är inte ovanliga, men de bygger egentligen på ett antagande om att samhällets resurser är mer eller mindre obegränsade. I realiteten är resurser knappa och det finns alltid alternativ användning för dem. Därmed föreligger risken att begränsade resurser används suboptimalt, t.ex. genom att stora belopp satsas på områden där vinsterna vid prevention eller behandling är marginella. Samtidigt förnekas då andra grupper resurser där ett ökat resursutnyttjande kanske skulle bidra till markant förbättrad hälsa och säkerhet. Således är det snarare oetiskt att inte beakta ekonomiska aspekter på säkerhetsfrämjande arbete.

    Syftet med hälsoekonomiska analyser är att få förbättrade underlag för beslut och prioriteringar. Hälsoekonomisk forskning har expanderat kraftigt i takt med att man alltmer uppmärksammat att sjuk- och hälsovårdens resurser är begränsade. Världshälsoorganisationen (WHO) har genom sitt internationella Safe Community-nätverk förordat ökad användning av ekonomiska analyser av lokalt säkerhetsfrämjande arbete. Tanken är att ökad medvetenhet om ekonomiska konsekvenser av skador bättre kan förmå beslutsfattare att inse vidden av skadeproblemet. Ekonomiska analyser av säkerhetsfrämjande arbete på lokal nivå skulle kunna bidra till ökat gehör hos beslutsfattare och möjliggöra bättre beslut. Trots dessa användningsområden är det sällsynt med ekonomiska analyser inom området för säkerhetsfrämjande arbete. Ekonomiska analyser anses vara mycket komplexa och den ”språkbarriär” som skapats av ekonomisk terminologi försvårar för icke-ekonomer att ge sig i kast med hälsoekonomi.

    Frågan är emellertid om ekonomiska analyser av säkerhetsfrämjande arbete med nödvändighet måste vara så komplicerade. Enligt vårt förmenande finns det möjligheter att göra vissa förenklande antaganden, utan att för den skull ge avkall på ekonomiska principer eller analysens trovärdighet. Syftet med denna text är att kortfattat beskriva hur hälsoekonomiska analyser av lokalt säkerhetsfrämjande arbete kan genomföras med utgångspunkt från vissa förenklade antaganden.

  • 29.
    Nilsen, Per
    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.
    Nordenfelt, Lennart
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Towards improved understanding of injury prevention program sustainability2005In: Safety Science, ISSN 0925-7535, Vol. 43, no 10, p. 815-833Article in journal (Refereed)
    Abstract [en]

    As policy makers and funders have become more concerned with allocating scarce resources effectively, attention to the sustainability of health intervention programs has increased. However, the empirical knowledge base about factors facilitating or working against sustainability remains at an early stage. The aim of this study was to contribute to improved understanding of the conditions under which community-based injury prevention programs are most likely to attain sustainability. Ten Swedish community-based injury prevention programs were analysed with respect to factors that contribute to or detract from program sustainability. All the programs are integrated within existing municipality structures. Data were collected by means of semi-structured telephone interviews with key informants.

    The results suggested that different factors are interrelated, with no one factor being either primary or by itself sufficient for program sustainability. Financial, human, and relational resources lay the groundwork for the long-term operation of a program. The “integrated” program model appears to facilitate sustainability, but program intensity is vulnerable to changes in the financial status of the municipality and the priority-setting by municipality political decision makers. Sustainability may be compromised if a program becomes too dependent on a few key individuals. In contrast to financial, human, and relational resources, structural resources (e.g., injury surveillance and goals) appeared to have limited influence on sustainability. The programs were sustained with little evidence of effectiveness, resulting in limited feedback about how to improve a program in order to achieve and maintain long-term effectiveness.

  • 30.
    Nolén, Sixten
    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.
    Ekman, Robert
    Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, Stockholm, Sweden and Swedish Rescue Services Agency, National Centre for Learning from Accidents (NCO), Karlskoga, Sweden .
    Lindqvist, Kent
    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.
    Bicycle helmet use in Sweden during the 1990s and in the future2005In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 20, no 1, p. 33-40Article in journal (Refereed)
    Abstract [en]

    This paper describes how the use of bicycle helmets in Sweden has changed for different categories of cyclists from 1988 to 2002, and it also estimates future trends in voluntary wearing of bicycle helmets up to the year 2010. Observational studies of the use of bicycle helmets were conducted once a year from 1988 to 2002 at 157 sites in 21 cities. The subjects observed were children cycling to school (average n = 5471/year) and in their free time (average n = 2191/year), and adults cycling to workplaces and on public bike paths (average n = 29 368/year). The general trend in helmet use from 1988 to 2002 was determined by linear regression analysis, and the results were also employed to estimate future helmet wearing for the period 2003–2010. Differences in helmet use according to gender and size of city were analysed by chi-square tests. From 1988 to 2002, all categories of cyclists showed an upward trend in helmet use (p < 0.01, p < 0.001). Helmet wearing increased from about 20 to 35% among children (≤10 years) cycling during free time, from approximately 5 to 33% among school children, and from around 2 to 14% in adults. Total average helmet use rose from about 4 to 17%. However, during the last 5 years of the study period (1998–2002), none of the categories of cyclists studied showed an upward trend in helmet wearing. It is estimated that ∼30% of cyclists will wear helmets voluntarily by the year 2010, if helmet promotion activities are continued at the same level as previously. The results suggest that Sweden will probably not reach its official goal of 80% helmet use unless a national bicycle helmet law is passed.

  • 31.
    Nolén, Sixten
    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.
    Lindqvist, Kent
    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.
    A local bicycle helmet ‘law’ in a Swedish municipality: effects on children's attitudes, beliefs and self-reported behaviorManuscript (preprint) (Other academic)
    Abstract [en]

    The municipality of Motala, Sweden, has a non-compulsary bicycle helmet "law" that is supported by promotional activities. The applies to children aged 6-12 but is intended to increase helmet use by all cyclists.

    This study evaluate the effects of the law on children's attitudes, beliefs, and self-reported behavior. Questionnaires were sent to a random sample of 6-12-year-old children in the intervention area (n = 1,277) and the control area (n = 2,198), one to two months before and two years after the intervention. The avarage response rates were 76.5% in the intervention area and 79.3% in the control area. Data were analyzed by t-tests and ANOVA.

    The study showed only one positive long-term effect on children's self-reported behavior or on factors supposed to precede their behavior. Children in the intervention area indicated a stronger intention to ride a bicycle if a national compulsory helmet law in introduced. There were no other changes in Motala that differed from changes in the control area. However, the overall responses, irrespective of test occasions, were often more positive or "better" among children in the intervention area that in the control area. This is probably due to helmet promotion programs conducted before the pre-test, which makes it more difficult to find effects of the intervention. Nonetheless, the findings suggest that the non-compulsory local helmet "law" in Motala is not a realistic alternative to a mandatory national helmet law for Sweden.

  • 32.
    Nolén, Sixten
    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.
    Lindqvist, Kent
    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.
    A local bicycle helmet ‘law’ in a Swedish municipality: the effects on helmet use2004In: Injury control and safety promotion, ISSN 1566-0974, E-ISSN 1744-4985, Vol. 11, no 1, p. 39-46Article in journal (Refereed)
    Abstract [en]

    The municipality of Motala in Sweden introduced a local bicycle helmet ‘law’ on May 1, 1996. This is not a legally enacted ordinance, but instead a legislated recommendation backed up by information and education. Formally, the law applies to children (aged 6–12 years), although the intention is to increase helmet use by all cyclists. The objective of the present study was to quantitatively evaluate the impact of the Motala helmet law on observed use of helmets by children and adults. Bicycle helmet use was monitored in Motala (n = 2,458/year) and in control towns (n = 17,818/year) both before and after adoption of the helmet law (1995–1998). Chi-square tests showed that helmet wearing 1995–1998 increased in Motala among all bicyclists (from 6.1% to 10.5%) and adults biking on cycle paths (from 1.8% to 7.6%). Helmet use by school children aged 6–12 increased during the first 6 months after introduction of the law (from 65.0% to 75.7%) but then progressively decreased to the pre-law level. Considering children cycling on cycle paths and for recreation in housing areas, there was a tendency towards increased helmet use during the first post-law year, but this was followed by a reduction to a lower level in 1998 than in 1995. Logistic regression analysis taking into account data from the control towns indicated that the helmet law had a positive effect on children cycling to schools during the first 6 months, and a weak delayed but more long-term positive effect on adult cyclists on cycle paths. There were no positive effects on children in housing areas and on cycle paths. The Motala helmet law probably would have had greater and more lasting effects on helmet use by bicyclists, if certain problems had been avoided during the initiation phase. Moreover, although it did have a positive influence on both school children and adults, it is not legally binding, and hence no penalties can be imposed. Presumably, compulsory legislation would have a more substantial impact on helmet wearing than a non-mandatory helmet ‘law’ such as that introduced in Motala.

  • 33.
    Nolén, Sixten
    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.
    Lindqvist, Kent
    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.
    A local bicycle helmet ‘law’ in a Swedish municipality: the structure and process of initiation and implementation2002In: Injury control and safety promotion, ISSN 1566-0974, E-ISSN 1744-4985, Vol. 9, no 2, p. 89-98Article in journal (Refereed)
    Abstract [en]

    On May 1, 1996, the Municipality of Motala in Sweden introduced a local bicycle helmet ‘law.’ It is, however, not an official law in a legal sense, but a municipally endorsed recommendation supported by promotional activities. This ‘law’ applies to children (ages 6–12), although the objective is to increase helmet use among cyclists of all ages. The study is a qualitative evaluation of the structure and process during initiation and implementation of the Motala bicycle helmet law. The aim was to describe the activities that were carried out, which actors took part and the opinions of the most closely involved actors. The results are based on analysis of written material and on interviews with eight of the actors. The mass media focused much attention on the bicycle helmet law, especially during the first six months after its introduction. The name helmet law was presumably of significance in this context. It is essential that relevant target groups provide sufficient support and that committed individuals initiate and promote the work, which, however, must not become dependent on a single individual. All issues concerning bicycle helmets should be coordinated with the law. Also, continuous engagement of the municipal government and a strategy for the control and follow-up of the law are needed. Local bicycle helmet laws of this type have a potential to produce a long-lasting effect on helmet use, provided some of the problems encountered can be avoided and some of the promotional activities are intensified.

  • 34.
    Nordqvist, Cecilia
    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.
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Beroendekliniken IHS. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Dependency.
    Johansson, Kjell
    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.
    Lindqvist, Kent
    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.
    Sekundärprevention av alkoholproblem på Motala lasaretts akutmottagning2002In: Riksstämman 2002,2002, 2002Conference paper (Refereed)
  • 35.
    Nordqvist, Cecilia
    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.
    Holmqvist, Marika
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Usual drinking pattern and non‐fatal injury among patients seeking medical care2006In: Public Health, ISSN 0033-3506, Vol. 120, no 11, p. 1064-1073Article in journal (Refereed)
    Abstract [en]

    Objectives

    To explore the association between drinking patterns, irrespective of whether alcohol was consumed in the event of the injury or not, and different injury variables; and to identify settings and situations in which risky drinkers have an increased likelihood of injury.

    Study design

    The study population consisted of all patients aged 18–70 years registered for an injury according to ICD-10 at a Swedish emergency department during an 18-month period. After informed consent, the injury patients were screened for drinking habits by the AUDIT-C questionnaire. The gender, age and drinking pattern of injury patients were compared with the general population.

    Methods

    A total of 2782 patients aged 18–70 years were registered for an injury during the study period. The number of drop-outs was 631. Drop-outs include those who did not consent to participate, were severely injured, too intoxicated or did not fill out the questionnaire satisfactory. Thus, 77.3% of the target group were included for further analysis (1944 drinkers and 207 abstainers). The patients were categorized into three drinking categories: abstainers, non-risky and risky drinkers. Risky drinkers were defined according to usual weekly consumption of 80 g or more of alcohol for women and 110 g or more for men and/or heavy episodic drinking (i.e. having six glasses or more one glass=12 g alcohol), or both, on one occasion at least once a month, valid for both women and men. To estimate the relationship between drinking patterns and the injury variables (environment, cause of injury, activity and diagnosis), odds ratios (OR) were calculated by logistic regression. Multiple logistic regression was used in order to control for age and sex differences between the various drinking and injury categories.

    Results

    The proportion of risky drinkers was higher in the study population compared with the general population in the same area. When controlling for age and sex, risky drinkers (OR 6.4adj Confidence interval CI 1.9–21.2) and non-risky drinkers (OR .4.5adj CI 1.4–14.5) displayed an increased risk for injury compared with abstainers, in amusement locations, parks, by or on lakes or seas, especially while engaged in play, hobby or other leisure activities (risky drinkers: OR 2.8adj CI 1.3–5.6; non-risky drinkers: OR 2.4adj CI 1.2–4.6). All differences between drinking patterns in external cause of injury disappeared when age and sex were considered. During rest, meals and attending to personal hygiene, the non-risky drinkers had a lower probability of injury compared with abstainers (OR 0.3adj CI 0.1–0.8). Non-risky drinkers had a higher probability than abstainers of suffering luxation (dislocation) or distortion (OR 1.6adj CI 1.1–2.5). Nine per cent of the study population reported that they believed that their injury was related to intake of alcohol. Half of this group were non-risky drinkers (CI for the 13.7% difference was 9.7–17.6).

    Conclusions

    Few significant associations between drinking pattern and injury remained when age and sex were controlled for.

  • 36.
    Nordqvist, Cecilia
    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.
    Johansson, Kjell
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Alcohol prevention measures at an emergency department: physicians` perspectives. Short communication2005In: Public Health, ISSN 0033-3506, Vol. 119, no 9, p. 789-791Article in journal (Refereed)
  • 37.
    Nordqvist, Cecilia
    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.
    Johansson, Kjell
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Attitude changes among emergency department triage staff after conducting routine alcohol screening2006In: Addictive Behaviors, ISSN 0306-4603, Vol. 31, no 2, p. 191-202Article in journal (Refereed)
    Abstract [en]

    Excessive alcohol consumption is common among injury patients, but routine alcohol interventions seem to be difficult to implement in emergency departments. An obstacle seen in previous studies is the limited time available in a real-world setting for staff to participate in routine alcohol screening and interventions. In the present study, ordinary staff participated in a simple alcohol screening procedure. The aim of the study was to evaluate the feasibility of this procedure and if there was any change in attitudes and practices among triage staff after the implementation. We analyzed interviews with six staff members and questionnaires completed by 29 nurses and medical secretaries before and after a period of systematic routine screening. The staff reported that the routine worked well and that few patients reacted negatively. A positive change was seen in attitudes towards alcohol preventive measures in general. However, this seems not to be sufficient for the staff to spontaneously engage more actively. In fact, more of the staff were uncertain after the study period whether the emergency department is an appropriate place for alcohol screening and intervention despite an increased role legitimacy and perceived competence. There is a need for further development of alcohol prevention models that are acceptable for the staff to implement as part of the daily routine.

  • 38.
    Nordqvist, Cecilia
    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.
    Lindqvist, Kent
    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.
    Wilhelm, Elisabeth
    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.
    Bendtsen, Preben
    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, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Olycksfall och alkoholvanor2004In: Svenska läkarsällskapets riksstämma,2004, Katrineholm: Sörmlands grafiska Quebecor AB , 2004, p. 46-46Conference paper (Other academic)
  • 39.
    Nordqvist, Cecilia
    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, Centre for Public Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    What promotes sustainability in Safe Community programmes?2009In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 9, no 4Article in journal (Refereed)
    Abstract [en]

    Background: The theory and practice of safety promotion has traditionally focused on the safety of individuals. This study also includes systems, environments, and organizations. Safety promotion programmes are designed to support community health initiatives taking a bottom-up approach. This is a long-term and complex process. The aim of this study was to try to empirically identify factors that promote sustainability in the structures of programmes that are managed and coordinated by the local government.

    Methods: Four focus group sessions with local government politicians and administrators in designated Safe Communities were conducted and analyzed using qualitative content analysis.

    Results: Collaboration was found to be the basis for sustainability. Networks, enabling municipalities to exchange ideas, were reported to positively influence the programmes. Personal contacts rather than organizations themselves, determine whether collaboration is sustained. Participants reported an increase in cross-disciplinary collaboration among staff categories. Administrators and politicians were reported to collaborate well, which was perceived to speed up decision-making and thus to facilitate the programme work. Support from the politicians and the county council was seen as a prerequisite. Participants reported an increased willingness to share information between units, which, in their view, supports sustainability. A structure in which all local authorities offices were located in close proximity to one another was considered to support collaboration. Appointing a public health coordinator responsible for the programme was seen as a way to strengthen the relational resources of the programme.

    Conclusion: With a public health coordinator, the external negotiating power was concentrated in one person. Also, the internal programme strength increased when the coordination was based on a bureaucratic function rather than on one individual. Increased relational resources facilitated the transfer of information. A regular flow of information to policy-makers, residents, and staff was needed in order to integrate safety programmes into routines. Adopting a bottom-up approach requires that informal and ad hoc activities in information management be replaced by formalized, organizationally sanctioned routines. In contrast to injury prevention, which focuses on technical solutions, safety promotion tries to influence attitudes. Collaboration with the media was an area that could be improved.

  • 40.
    Nordqvist, Cecilia
    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.
    Wilhelm, Elisabeth
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Can screening and simple written advice reduce excessive alcohol consumption among emergency care patients?2005In: Alcohol & Alcoholism, ISSN 0735-0414 (print) 1464-3502 (online), Vol. 40, no 5, p. 401-408Article in journal (Refereed)
    Abstract [en]

    Aims: Emergency care patients have an overrepresentation of risky drinkers. Despite the evidence on the effectiveness of a short feedback on screening or self-help material, most studies performed so far have required considerable time from staff and thus been difficult to implement in the real world. The present study evaluates the effect of the screening and whether simple written advice has any additional effect on risky drinking.

    Methods: An alcohol screening routine was implemented among injury patients in a Swedish emergency care department. Over 12 months, two cohorts were invited to answer an alcohol screening questionnaire in the waiting room. In the first 6 months, 771 patients were screened without any written advice (cohort A) and in the following 6 months, 563 were screened and in addition received simple written advice about sensible drinking (cohort B). None of the patients received one-to-one feedback. Six months after the screening, a follow-up interview by telephone explored the changes in drinking.

    Results: In cohort A 182 (24%) of the patients were defined as risky drinkers and in cohort B 125 (22%). Reached at follow-up after 6 months were 81 (44%) risky and 278 (47%) non-risky drinkers in cohort A, and 40 (32%) risky and 220 (50%) non-risky drinkers in cohort B. The number of patients with heavy episodic drinking decreased significantly in cohort A from 76 (94% of the risky drinkers) to 49 (59%). In cohort B a similar change was seen from 37 (92%) to 27 (68%). Only in cohort B, was a significant increase in readiness to change drinking habits seen [from 3 (8%) to 9 (23%)]. The reduction in heavy episodic drinking was comparable with previous reports from more extensive interventions. However, at the time of follow-up, drinking among non-risky drinkers at baseline had increased. When considering the greater numbers of non-risky drinkers, the total consumption in the study group increased during the study period.

    Conclusions: Owing to the reported difficulties of integrating more time-consuming alcohol interventions in emergency departments, it is suggested that at least screening for drinking should be implemented as routine in emergency departments. More research is needed in order to establish the optimal balance between effective alcohol intervention, and acceptable time and effort requirement from staff.

  • 41.
    Olofsson, Niclas
    et al.
    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.
    Danielsson, I
    Vasternorrland County Council.
    Fear of crime and psychological and physical abuse associated with ill health in a Swedish population aged 65-84 years2012In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 126, no 4, p. 358-364Article in journal (Refereed)
    Abstract [en]

    Objectives: To assess the association between fear of crime and/or psychological and/or physical abuse in relation to self-reported physical and psychological health, using a large representative sample of elderly women and men in Sweden. less thanbrgreater than less thanbrgreater thanStudy design: Cross-sectional national survey. less thanbrgreater than less thanbrgreater thanMethods: Data were taken from a nationwide representative public health survey (2006). Men and women between the ages of 65 and 84 years were selected for the present analyses (4386 men and 4974 women). The response rate for this age group was 59% for men and 70% for women. less thanbrgreater than less thanbrgreater thanResults: Psychological and physical abuse against elderly women and men led to higher odds ratios for negative health outcomes, independently of socio-economic status. Strong correlation was found between psychological abuse and negative health outcomes in both men and women, while the correlation was less strong for physical abuse, especially among women. The men had high odds ratios for suicidal thoughts and even for attempted suicide in connection with physical and psychological abuse and fear of crime. less thanbrgreater than less thanbrgreater thanConclusions: The study provides representative results addressing an extensive negative health outcome panorama caused by fear of crime and exposure to abuse.

  • 42.
    Olofsson, Niclas
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Vasternorrland County Council, Sweden.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Danielsson, Ingela
    Vasternorrland County Council, Sweden; Umeå University, Sweden.
    Higher Risk of Violence Exposure in Men and Women With Physical or Sensory Disabilities: Results From a Public Health Survey2015In: Journal of Interpersonal Violence, ISSN 0886-2605, E-ISSN 1552-6518, Vol. 30, no 10, p. 1671-1686Article in journal (Refereed)
    Abstract [en]

    The World Health Organization has declared that violence is a global public health problem. The prevalence of violence exposure among adults with intellectual and unspecific disabilities has been demonstrated in several studies, whereas only a few articles on people with sensory disabilities have been published. The aim of this study was to investigate the prevalence and risk for exposure to physical violence, psychological offence, or threats of violence in people with physical and/or sensory disabilities, compared with people with no such disabilities, controlling for socioeconomic data. Data from a public health survey were analyzed. A nationally representative sample of women and men aged 16 to 84 years had answered a questionnaire. In the present study, the whole sample, comprised of 25,461 women and 21,545 men, was used. Women with auditory disabilities were generally more often violence exposed than non-disabled women, whereas men with physical disabilities were more often violence exposed than non-impaired men. Some age groups among both women and men with visual disabilities had higher prevalence rates than women and men without disabilities. The adjusted odds ratios (ORs) were significantly higher among the auditory impairment group for exposure to physical (OR = 1.4, confidence interval [CI] = [1.1, 1.9]) and psychological (OR = 1.4, CI = [1.1, 1.8]) violence among women. Men with physical disabilities had raised odds ratios for physical violence (OR = 1.7, CI = [1.2, 2.4]) and psychological violence (OR = 1.4, CI = [1.0, 2.0]) compared with the non-disabled group. Both men and women with a physical or sensory disability showed higher odds of being exposed to violence than men and women without a disability. The results indicated that socioeconomic situation, smoking, and hazardous drinking strengthened the association between impairment and violence.

  • 43.
    Olofsson, Niclas
    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.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Gillander Gadin, Katja
    University Sundsvall.
    Danielsson, Ingela
    Sundsvall Hospital.
    Violence Against Young Men and Women: A Vital Health Issue2009In: The Open Public Health Journal, ISSN 1874-9445, Vol. 2, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Objectives: Violence is regarded as a major health issue in an increasing amount of literature and is known as an important factor in women's ill health. Little however is known about violence against young men and women and its impact on their health. The principal aim of this study was to analyze health outcomes and health care utilization as reported among men and women aged 18-25 exposed and not exposed to physical and/or emotional violence.

    Study design: A cross-sectional national health survey in Sweden.

    Methods: Postal questionnaires were sent to nearly 3,000 men and women. Three questions were used to ask about violence. Sociodemographic characteristics for those exposed to violence during the past 12 months were analyzed and compared to those not exposed. Crude and adjusted odds ratios were calculated for health outcomes and medical care utilization.

    Results: Increased odds ratios were found for most health outcomes, and health care utilization for those exposed to violence compared to non-exposed. After adjusting for socioeconomic factors, smoking, and use of alcohol and cannabis, most variables were principally unchanged for women but considerably lower for men. Socioeconomic factors, smoking, and the use of drugs were all correlated to victimization.

    Conclusions: A strong association between those exposed to violence and physical and mental ill health was demonstrated also after adjusting for possible confounders, specifically for women. It is time to include questions about violence in public health questionnaires aimed at young people, but also to start asking about it more frequently in health care settings.

  • 44.
    Olofsson, Niclas
    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.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Gådin, Katja Gillander
    Department of Health Sciences, Mid-Sweden University Sundsvall Sweden.
    Bråbäck, Lennart
    Pediatrik Umeå universitet.
    Danielsson, Ingela
    Obstetrics and Gynaecology, Umeå universitet.
    Physical and psychological symptoms and learning difficulties in children of women exposed and non-exposed to violence: a population-based study.2011In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 56, no 1, p. 89-96Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To analyse the association between violence against mothers and the health of their children as reported by the mothers. METHODS: The data originate from a multistage sampling health-questionnaire survey, distributed to a representative sample of women in Sweden. The health of 283 children (aged 0-18 years), as reported by women who had been exposed to violence at home or outside home during the past 12 months, was compared with that of 4,664 children of non-exposed mothers. RESULTS: Odds ratios regarding most registered physical symptoms showed that children of violence-exposed mothers had a significant higher risk of ill health than children of non-exposed mothers. Regarding psychological symptoms and learning difficulties, the odds were raised for girls for most symptoms, but not for boys. A twofold increase in health-care utilisation and an overall general increase in the risk of pharmaceutical consumption were shown for both girls and boys of exposed mothers. CONCLUSIONS: This population-based study shows an increased risk of poorer health amongst boys and girls aged 0-18 years, as reported by mothers exposed to violence.

  • 45.
    Olofsson, Niclas
    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.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Shaw, Benjamin A.
    Department of Health Policy, Management and Behavior, University at Albany, SUNY, Albany, NY, USA.
    Danielsson, Ingela
    Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå.
    Long-term health consequences of violence exposure in adolescence: A 26–year prospective study2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, no 411Article in journal (Refereed)
    Abstract [en]

    Background: Violence victimization represents a serious risk factor for health related symptoms, for both men and women. The aim of this study was to evaluate the long-term effects of violence exposure in late adolescence and early adulthood on adult health, physical as well as mental, using a long-term prospective population-based study, with a follow up of 9, 19, and 26 years.

    Methods: The primary data source is a longitudinal panel from one of the longest running social science surveys in the world, the Swedish Level-of-Living surveys (LNU). We analyzed three cohorts, individuals aged 15-19 in 1974 and 1981, and individuals aged 18-19 in 1991 which were followed up 2000. Structured interviews on childhood, family relationships, life-events, living conditions, health history and status, working conditions, behavioral, psychosocial, and demographic variables were repeatedly used in all cohorts.

    Results: Multivariate models of violence exposures in adolescence in the 1974-91 cohorts as predictors of adult health in 2000 are reported for both men and women. Women exposed to violence had raised odds ratios for ill health, measured as heavy illness burden, and poor self rated health, after controlling for possible confounders. No such associations were found for men.

    Conclusions: This study’s findings provide additional empirical support for the importance of policies and practices to identify and prevent violence exposure in adolescence and young adulthood and to supply treatments for adolescence exposed to violence and above all the young women.

  • 46.
    Timpka, Toomas
    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.
    Lindqvist, Kent
    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.
    Evidence based prevention of acute injuries during physical exercise in a WHO safe community2001In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 35, no 1, p. 20-27Article in journal (Refereed)
    Abstract [en]

    Objective - To evaluate a community based programme for evidence based prevention of injuries during physical exercise. Design - Quasi-experimental evaluation using an intervention population and a non-random control population. Participants - Study municipality (population 41 000) and control municipality (population 26 000) in Sweden. Main outcome measures - Morbidity rate for sports related injuries treated in the health care system, severity classification according to the abbreviated injury scale (AIS). Results - The total morbidity rate for sports related injuries in the study area decreased by 14% from 21 to 18 injuries per 1000 population years (odds ratio 0.87, 95% confidence interval (CI) 0.79 to 0.96). No tendency towards a decrease was observed in people over 40. The rate of moderately severe injury (AIS 2) decreased to almost half (odds ratio 0.58, 95% CI 0.50 to 0.68), whereas the rate of minor injuries (AIS 1) increased (odds ratio 1.22, 95% CI 1.06 to 1.40). The risk of severe injuries (AIS 3-6) remained constant. The rate of total sports injury in the control area did not change (odds ratio 0.93, 95% CI 0.81 to 1.07), and the trends in the study and control areas were not statistically significantly different. Conclusion - An evidence based prevention programme based on local safety rules and educational programmes can reduce the burden of injuries related to physical exercise in a community. Future studies need to look at adjusting the programme to benefit all age groups.

  • 47.
    Timpka, Toomas
    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.
    Lindqvist, Kent
    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.
    Ekstrand, Jan
    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.
    Karlsson, Nadine
    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.
    Impact of social standing on sports injury prevention in a WHO safe community: intervention outcome by household employment contract and type of sports.2005In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 39, no 7, p. 453-457Article in journal (Refereed)
  • 48.
    Timpka, Toomas
    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.
    Lindqvist, Kent
    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.
    Schelp, L
    Åhlgren, M
    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.
    Community-based injury prevention: effects on health care utilization.2000In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 28, p. 502-508Article in journal (Refereed)
  • 49.
    Timpka, Toomas
    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.
    Nilsen, Per
    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.
    Lindqvist, Kent
    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.
    The impact of home safety promotion on different social strata in a WHO safe community.2006In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 120, p. 427-433Article in journal (Refereed)
    Abstract [en]

      

  • 50.
    Timpka, Toomas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Health and Developmental Care, Centre for Public Health.
    Nordqvist, Cecilia
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Festin, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Quality indicators for implementation of safety promotion: Towards valid and reliable global certification of local programmes2012In: Global Public Health, ISSN 1744-1692, E-ISSN 1744-1706, Vol. 7, no 6, p. 588-602Article in journal (Refereed)
    Abstract [en]

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

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