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  • 101.
    Eriksson, Henrik
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Morin, Magnus
    VSL Research Labs, Linköping.
    Ekberg, Joakim
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Jenvald, Johan
    VSL Research Labs, Linköping.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Assumptions management in simulation of infectious disease outbreaks2009In: AMIA ... Annual Symposium proceedings / AMIA Symposium, ISSN 1942-597X, Vol. 2009, p. 173-177Article in journal (Refereed)
    Abstract [en]

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

  • 102.
    Eriksson, Henrik
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Morin, Magnus
    VSL Research Labs.
    Ekberg, Joakim
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Jenvald, Johan
    VSL Research Labs.
    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.
    Simulation modeling using Protégé2009In: Proceedings of the Eleventh International Proégé Conference, 2009Conference paper (Other academic)
  • 103.
    Eriksson, Henrik
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Raciti, Massimiliano
    Linköping University, Department of Computer and Information Science. Linköping University, The Institute of Technology.
    Basile, Maurizio
    Linköping University, Department of Computer and Information Science. Linköping University, The Institute of Technology.
    Cunsolo, Alessandro
    Linköping University, Department of Computer and Information Science. Linköping University, The Institute of Technology.
    Fröberg, Anders
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Leifler, Ola
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Ekberg, Joakim
    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.
    A Cloud-Based Simulation Architecture for Pandemic Influenza Simulation2011In: AMIA Annual Symposium Proceedings 2011, Curran , 2011, p. 364-373Conference paper (Refereed)
    Abstract [en]

    High-fidelity simulations of pandemic outbreaks are resource consuming. Cluster-based solutions have been suggested for executing such complex computations. We present a cloud-based simulation architecture that utilizes computing resources both locally available and dynamically rented online. The approach uses the Condor framework for job distribution and management of the Amazon Elastic Computing Cloud (EC2) as well as local resources. The architecture has a web-based user interface that allows users to monitor and control simulation execution. In a benchmark test, the best costadjusted performance was recorded for the EC2 H-CPU Medium instance, while a field trial showed that the job configuration had significant influence on the execution time and that the network capacity of the master node could become a bottleneck. We conclude that it is possible to develop a scalable simulation environment that uses cloud-based solutions, while providing an easy-to-use graphical user interface.

  • 104.
    Eriksson, Henrik
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    The potential of smart homes for injury prevention among the elderly2002In: Injury control and safety promotion, ISSN 1566-0974, E-ISSN 1744-4985, Vol. 9, no 2, p. 127-131Article in journal (Refereed)
    Abstract [en]

    Smart homes promise to make the lives of elderly people more comfortable and safe. Today, there is a significant interest from industry and policy makers in developing these technologies. In theory, the emerging technologies make it possible to provide a new range of services. So far, however, the goal has often been to develop new services for young people rather than assisting old people to improve their quality of life. Especially important is the potential for using these technologies to promote safety and prevent injury among old people because this group is at home more than the other age groups. Networked devices can collect data from sensors and aid decision-making on intervention and other measures. Furthermore, these devices can instruct and remind individuals about safety-related issues.

  • 105.
    Falk, Magnus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Olsen Faresjö, Åshild
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Sun Exposure Habits and Health Risk-related Behaviours Among Individuals with Previous History of Skin Cancer2013In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 33, no 2, p. 631-638Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the present study was to investigate possible associations between UV exposure and other health risk behaviours in different social environments and in regard to previous history of skin cancer. Patients and Methods: In two closely-located, equally-sized cities in Sweden, representing different social environments (blue collar and white collar), patients aged 55-69 years, diagnosed with skin cancer (study group, n=489) or seborrhoeic keratosis (control group, n=664), were identified through a regional Health Care Register, and were given a questionnaire mapping for sun habits, tobacco smoking, alcohol use, and physical activity. Results: A previous history of skin cancer was associated with reduced UV exposure (pandlt;0.01) and increased UV protection (pandlt;0.00.1), higher alcohol consumption (pandlt;0.05), and higher level of physical activity (pandlt;0.05). Smoking was more common among subjects frequently sunbathing and rarely using sunscreen, but frequent sunbathing was positively associated with physical activity (pandlt;0.05). Daily smoking and risky drinking habits were more common in the blue collar social environment, while no differences were seen for sun habits in this respect. Conclusion: A previous history of skin cancer appears to promote increased UV protection. In contrast to alcohol/smoking habits, no association between social environment and sun habits was found.

  • 106.
    Faresjö, Tomas
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Arvidsson, Lina
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Boberg, Pontus
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Hagert, Britt
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Gursky, Elin A
    ANSER, Arlington, Virginia, USA.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Swedish nursing and medical students high vaccination adherence during the influenza A (H1N1) pandemic 2009: Insights for pandemic preparedness2012In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 44, no 3, p. 237-241Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to analyze Swedish health science student decision-making regarding vaccination against pandemic influenza during a national mass vaccination campaign. A questionnaire was distributed to 430 students during the influenza A (H1N1) pandemic in 2009. The data from medical and nursing students were compared and a multiple logistic regression model was applied to identify items independently associated with the decision to be vaccinated. The overall survey response rate was 90%. More medical (93.2%) than nursing students (84.8%) reported that they had received the vaccine (p andlt; 0.01). Only the perception that benefits can outweigh possible side effects was significantly (p andlt; 0.001) associated with the decision to get vaccinated. We recommend that, during pandemics, health science universities focus vaccination information for students on objective risk communication. It should be taken into account that the pandemic information provided by authorities to the general public also affects health care students.

  • 107.
    Faresjö, Tomas
    et al.
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Faresjö, Åshild
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    To Match or Not to Match in Epidemiological Studies-Same Outcome but Less Power2010In: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, ISSN 1660-4601, Vol. 7, no 1, p. 325-332Article in journal (Refereed)
    Abstract [en]

    This study aimed to analyze the possible resemblance or difference in outcome in a case-control study of quality of life for IBS patients compared to controls free from the disease, when a matching procedure for age and sex was applied for the control group compared to when all participating subjects were included in the control group. The main result was that almost the same and identical results were found irrespective of whether matching or not matching was applied in this epidemiological case-control study. The matching procedure however, slightly diminished the statistical power of the results.

  • 108.
    Faresjö, Åshild
    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, Saga
    Astra Zeneca R&D, Mölndal .
    Faresjö, Tomas
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Roos, Susanne
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Hallert, Claes
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, Department of Internal Medicine VHN.
    Sex differences in dietary coping with gastrointestinal symptoms2010In: EUROPEAN JOURNAL OF GASTROENTEROLOGY and HEPATOLOGY, ISSN 0954-691X, Vol. 22, no 3, p. 327-333Article in journal (Refereed)
    Abstract [en]

    Aim Nutritional changes are often considered first-line treatment in public health diseases that apply to many gastrointestinal (GI) disorders, as different food and beverages may modulate GI motor and sensory functions, and may provoke GI symptoms. The aim of this study was to examine dietary coping and possible changes in food and beverage intake in relation to GI symptoms reported by identified irritable bowel syndrome (IBS) patients compared with healthy controls, and whether any sex differences were observed in these respects. Methods A population-based case-control design was used. Three primary healthcare centres were selected in the city of Linko ping in Sweden. The IBS patients were recruited from the studied primary healthcare centers on the basis of diagnoses from computerized medical records. The controls were randomly selected from the general population in the same region. A questionnaire was used with specific questions about self-reported food and beverage increase or decrease of GI symptoms and self-reported changes in dietary habits. Results Female IBS patients seem to be more willing to change dietary habits because of their GI problems than men. Effects of these nutritional behaviour changes were reported for almost all participants that had made dietary adjustments. Fatty food, certain vegetables, dairy products and eggs were significantly more reported to cause GI complaints among IBS patients compared with their controls. Conclusion Female IBS patients reported more changes in their dietary habits because of GI problems than men with the disease. The majority of both women and men who changed their dietary habits because of GI problems experienced improvement in their symptoms.

  • 109.
    Festin, Karin
    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.
    Alexanderson , Kristina
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    CHANGES IN SICK-LEAVE DIAGNOSES OVER ELEVEN YEARS IN A COHORT OF YOUNG ADULTS INITIALLY SICK-LISTED DUE TO LOW BACK, NECK, OR SHOULDER DIAGNOSES2009In: JOURNAL OF REHABILITATION MEDICINE, ISSN 1650-1977 , Vol. 41, no 6, p. 423-428Article in journal (Refereed)
    Abstract [en]

    Objective: To study future general and diagnoses-specific sickness absence and disability pension among young adults who were initially on long-term sick-leave due to back, neck, or shoulder diagnoses. Design: Eleven-year prospective cohort study. Subjects: All 213 adults in a Swedish municipality who, in 1985, were in the age range 25-34 years and had begun a spell of sick-leave lasting andgt;= 28 days with low back, neck, or shoulder diagnoses. Methods: For the time-period 1985-96, data regarding the dates and diagnoses for all periods of sick-leave, and the dates of disability pension, emigration, and death were obtained. Numbers of days of sick-leave and disability pension were analysed separately for each of the 11 years in relation to the number of days at risk for such benefits. Results: The cohort members were on sick-leave or disability pension for 25% of all days at risk during the 11 years of follow-up. A large difference in the number of sick-leave days between the 220% of subjects who were later granted disability pension and the others was already apparent during the first 2 years. During the entire period, up to 21% of the sick-leave days for women and 24% for men entailed psychiatric diagnoses. Conclusion: This cohort of young adults, initially off sick for 4 weeks due to back, neck, or shoulder diagnoses, also had a high level of sickness absence in the subsequent 11 years with other diagnoses.

  • 110.
    Fuller, Colin W
    et al.
    University of Nottingham.
    Ekstrand, Jan
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Junge, Astrid
    FIFA-Medical Assessment and Research Centre.
    Andersen, Thor E
    Oslo Sports Trauma Research Center.
    Bahr, Roald
    Oslo Sports Trauma Research Center.
    Dvorak, Jiri
    FIFA-Medical Assessment and Research Centre.
    Hägglund, Martin
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    McCrory, Paul
    University of Melbourne.
    Meeuwisse, Willem H
    University of Calgary.
    Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries.2006In: Clinical Journal of Sports Medicine, ISSN 1050-642X, E-ISSN 1536-3724, Vol. 16, no 2, p. 97-106Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football (soccer) injuries; this has made interstudy comparisons difficult. PROCEDURE: An Injury Consensus Group was established under the auspices of Fédération Internationale de Football Association Medical Assessment and Research Centre. Using a nominal group consensus model approach, a working document that identified the key issues related to definitions, methodology, and implementation was discussed by members of the group during a 2-day meeting. After this meeting, iterative draft statements were prepared and circulated to the members of the group for comment before the final consensus statement was produced. RESULTS: Definitions of injury, recurrent injury, severity, and training and match exposures in football, together with criteria for classifying injuries in terms of location, type, diagnosis, and causation are proposed. Proforma for recording players' baseline information, injuries, and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented. CONCLUSIONS: The definitions and methodology proposed in the consensus statement will ensure that consistent and comparable results will be obtained from studies of football injuries.

  • 111.
    Fuller, C.W.
    et al.
    Centre for Sports Medicine, University of Nottingham, Nottingham, United Kingdom, Centre for Sports Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom.
    Ekstrand, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Junge, A.
    FIFA-Medical Assessment and Research Centre, Schulthess Clinic, Zurich, Switzerland.
    Andersen, T.E.
    Oslo Sports Trauma Research Center, Oslo, Norway.
    Bahr, R.
    Oslo Sports Trauma Research Center, Oslo, Norway.
    Dvorak, J.
    FIFA-Medical Assessment and Research Centre, Schulthess Clinic, Zurich, Switzerland.
    Hagglund, M.
    McCrory, P.
    Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Vic., Australia.
    Meeuwisse, W.H.
    Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alta., Canada.
    Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries2006In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 16, no 2, p. 83-92Article, review/survey (Refereed)
    Abstract [en]

    Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football injuries, this has made inter-study comparisons difficult. An Injury Consensus Group was established under the auspices of FIFA Medical Assessment and Research Centre. Using a nominal group consensus model approach, a working document that identified the key issues related to definitions, methodology and implementation was discussed by members of the group during a 2-day meeting. Following this meeting, iterative draft statements were prepared and circulated to members of the group for comment before the final consensus statement was produced. Definitions of injury, recurrent injury, severity and training and match exposures in football together with criteria for classifying injuries in terms of location, type, diagnosis and causation are proposed. Proforma for recording players' baseline information, injuries and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented. The definitions and methodology proposed in the consensus statement will ensure that consistent and comparable results will be obtained from studies of football injuries. Copyright © Blackwell Munksgaard 2006.

  • 112.
    Fuller, C.W.
    et al.
    Centre for Sports Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom.
    Ekstrand, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Junge, A.
    FIFA Medical Assessment and Research Centre, Schulthess Clinic, Zurich, Switzerland.
    Andersen, T.E.
    Oslo Sports Trauma Research Center, Oslo, Norway.
    Bahr, R.
    Oslo Sports Trauma Research Center, Oslo, Norway.
    Dvorak, J.
    FIFA Medical Assessment and Research Centre, Schulthess Clinic, Zurich, Switzerland.
    Hagglund, M.
    McCrory, P.
    Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Vic., Australia.
    Meeuwisse, W.H.
    Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alta., Canada.
    Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries2006In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 40, no 3, p. 193-201Article, review/survey (Refereed)
    Abstract [en]

    Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football (soccer) injuries, making interstudy comparisons difficult. Therefore an Injury Consensus Group was established under the auspices of Federation Internationale de Football Association Medical Assessment and Research Centre. A nominal group consensus model approach was used. A working document on definitions, methodology, and implementation was discussed by the group. Iterative draft statements were prepared and circulated to members of the group for comment before the final consensus statement was produced. Definitions of injury, recurrent injury, severity, and training and match exposures in football together with criteria for classifying injuries in terms of location, type, diagnosis, and causation are proposed. Proforma for recording players' baseline information, injuries, and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented.

  • 113.
    Garvin, Peter
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    SALIVA CORTISOL AND ITS CORRELATIONS WITH CARDIOVASCULAR RISK FACTORS in INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE, vol 17, issue , pp 206-2072010In: INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE, Springer Science Business Media , 2010, Vol. 17, p. 206-207Conference paper (Refereed)
    Abstract [en]

    n/a

  • 114.
    Garvin, Peter
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    SALIVA CORTISOL AND ITS CORRELATIONS WITH INFLAMMATORY MARKERS in INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE, vol 17, issue , pp 207-2072010In: INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE, Springer Science Business Media , 2010, Vol. 17, p. 207-207Conference paper (Refereed)
    Abstract [en]

    n/a

  • 115.
    Garvin, Peter
    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.
    Carstensen, John
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Jonasson, Lena
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
    Nilsson, Lennart
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Association between ambulatory saliva cortisol levels and plasma levels of matrix metalloproteinase-9 in a normal populationManuscript (Other academic)
    Abstract [en]

    Background: Psychosocial strain has been demonstrated to be a risk factor for coronary artery disease (CAD) and also to be associated with a dysfunctional HPA-axis. Based on a proposal on cortisol resistance in maladaptive monocytes as a potential mechanism linking psychosocial strain with CAD, this study aimed at testing the association between levels of salivary cortisol and matrix metalloproteinase-9 (MMP-9) in a normal population.

    Methods: 359 participants (50 % women) aged 45-69 were enrolled to this study, randomly drawn from a normal population in Sweden. Saliva samples were collected thrice per day (at awakening, 30 minutes after awakening, and just before going to bed) during three consecutive days. Cortisol levels at awakening and 30 minutes after awakening were used to estimate the diurnal peak. Cortisol was analyzed using a radioimmunoassay method. MMP-9 was measured in plasma using an ELISA-method.

    Results: After adjustment for age and sex, significant trends regarding MMP-9 were found both for cortisol peak quintiles (beta +1.9 ng/mL per quintile, p=0.029) and cortisol evening values (beta +2.1 ng/ml per quintile, p=0.017). These findings were consistent in regressions either excluding participants with known diagnoses of myocardial infarction, angina pectoris, rheumatoid arthritis, diabetes, cancer with ongoing treatment, chronic obstructive lung disease, osteoporosis and hypothyroidism, or adjusting for these diseases, also after adjustment for cardiovascular risk factors.

    Conclusions: The associations found between cortisol levels and MMP-9 in a normal population hint at a potential pathway linking prolonged psychosocial strain with cardiovascular events.

  • 116.
    Garvin, Peter
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science.
    Nilsson, Lennart
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Jonasson, Lena
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Circulating Matrix Metalloproteinase-9 Is Associated with Cardiovascular Risk Factors in a Middle-Aged Normal Population2008In: PLoS ONE, ISSN 1932-6203, Vol. 3, no 3, p. e1774-Article in journal (Refereed)
    Abstract [en]

    Background: Elevated levels of circulating matrix metalloproteinase-9 (MMP-9) have been demonstrated in patients with established coronary artery disease (CAD). The aim of this study was to analyse levels of MMP-9 in a population free from symptomatic CAD and investigate their associations with cardiovascular (CV) risk factors, including C-reactive protein (CRP).

     

    Methods: A cross-sectional study was performed in a population based random sample aged 45–69 (n = 345, 50% women). MMP-9 levels were measured in EDTA-plasma using an ELISA-method. CV risk factors were measured using questionnaires and standard laboratory methods.

    Results: Plasma MMP-9 was detectable in all participants, mean 38.9 ng/mL (SD 22.1 ng/mL). Among individuals without reported symptomatic CAD a positive association (p<0.001) was seen, for both men and women, of MMP-9 levels regarding total risk load of eight CV risk factors i.e. blood pressure, dyslipidemia, diabetes, obesity, smoking, alcohol intake, physical activity and fruit and vegetable intake. The association was significant also after adjustment for CRP, and was not driven by a single risk factor alone. In regression models adjusted for age, sex, smoking, alcohol intake and CRP, elevated MMP-9 levels were independently positively associated with systolic blood pressure (p = 0.037), smoking (p<0.001), alcohol intake (p = 0.003) and CRP (p<0.001). The correlation coefficient between MMP-9 and CRP was r = 0.24 (p<0.001).

     

    Conclusions: In a population without reported symptomatic CAD, MMP-9 levels were associated with total CV risk load as well as with single risk factors. This was found also after adjustment for CRP

     

  • 117.
    Garvin, Peter
    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.
    Nilsson, Lennart
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Carstensen, John
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Jonasson, Lena
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Kristenson, Margareta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Plasma Levels of Matrix Metalloproteinase-9 are Independently Associated With Psychosocial Factors in a Middle-Aged Normal Population2009In: PSYCHOSOMATIC MEDICINE, ISSN 0033-3174, Vol. 71, no 3, p. 292-300Article in journal (Refereed)
    Abstract [en]

    Objective: To test the association between psychosocial factors and circulating levels of matrix metalloproteinase-9 (MMP-9) in a normal population sample. Psychosocial factors have been associated with inflammatory markers and are of prognostic significance for coronary artery disease (CAD). The degrading enzyme MMP-9 is upregulated in inflammatory processes and hypothesized to play a role in the rupture of atherosclerotic plaques. Methods: A total of 402 participants (50% women), aged 45 to 69 years, were drawn randomly from a normal population. Psychosocial instruments covered depression (Center for Epidemiological Studies Depression Questionnaire, CES-D), vital exhaustion, hostile affect, cynicism, mastery, self-esteem, sense of coherence (SOC), emotional support, and social integration. Plasma MMP-9 was measured by an enzyme-linked immunosorbent assay method. Linear regression models were adjusted for age, sex, known CAD, rheumatoid arthritis, cancer, cardiovascular risk factors including C-reactive protein and ongoing medication. Results: After full adjustment, there were independent associations of elevated MMP-9 levels with CES-D (+2.9 ng/ml per SD, p=.02), hostile affect (+3.0 ng/ml per SD, p=.02), cynicism (+3.5 ng/ml per SD, p=.006), and SOC (-2.5 ng/ml per SD, p=.046). A principal component analysis extracted three components. The first was mainly extracted from CES-D, vital exhaustion, self-esteem, mastery, and SOC; the second was mainly extracted from hostile affect and cynicism. Both were independently associated with MMP-9 (p=.02, p=.04) when run in the same model. Conclusions: MMP-9 levels were associated with psychosocial factors in a middle-aged normal population sample, independently of traditional risk factors. The findings may constitute a possible link between psychosocial factors and cardiovascular risk.

  • 118.
    Garvin, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Suska, Anke
    Linköping University, Department of Physics, Chemistry and Biology, Applied Physics. Linköping University, The Institute of Technology.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Lundström, Ingemar
    Linköping University, Department of Physics, Chemistry and Biology, Applied Physics. Linköping University, The Institute of Technology.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    SALIVARY ALPHA-AMYLASE IN A POPULATION BASED SAMPLE. ASSOCIATIONS WITH PSYCHOSOCIAL FACTORS, SELF RATED HEALTH AND INFLAMMATORY MARKERS2010In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 17, no 1 Supplement, p. S181-S181Article in journal (Other academic)
    Abstract [en]

    Objective: In recent years, salivary alpha-amylase (sAA) has beenproposed as a reliable proxy for sympathetic activity. This study aimed at testing the association between sAA to a broad range of psychosocial factors, self rated health, cardiovascular risk factors and inflammatory markers in a normal population sample.

    Methods: 30 participants, all men between 50 and 54 years old, were randomly selected from a normal population based study. Saliva samples were collected at awakening, 30 minutes after awakening and just before going to bed. sAA was measured by a calorimetric method using Phadebas amylase test. Linear regression models were used to test associations between sAA levels and a broad spectrum of psychosocial factors (e.g. depressive symptamology, vital exhaustion, mastery and sense of coherence) self rated health and inflammatory markers (e.g. C-reactive protein). Adjustments were made for physical exercise, smoking, blood  lipids and  time point  when  sample was collected.

    Results: sAA levels at awakening were positively associated with depressive symptamology (p = 0.046), vital exhaustion (p = 0.025) and negatively associated with sense of coherence (p = 0.034). It was further associated positively associated with levels of C-reactive protein (p = 0.024)  and  negatively associated with  self  reported general health (p = 0.010). Samples taken just before going to bed were showing similar results, whereas samples taken 30 minutes after awakening only showed a few significant associations.

    Conclusions: The associations found give further support for the use of salivary alpha amylase as a psychoneuroendocrinological bio- marker. Assessment just after awakening or just before going to bed seems to be more reliable than samples 30 minutes after awakening.

  • 119.
    Geirsson, M.
    et al.
    Norrmalms Health Center, Skövde, Sweden, Ekängsvägen 15, 541 40 Skövde, Sweden.
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Spak, F.
    Department of Social Medicine, Institute of Community Medicine, Göteborg University, Göteborg, Sweden.
    Attitudes of swedish general practitioners and nurses to working with lifestyle change, with special reference to alcohol consumption2005In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 40, no 5, p. 388-393Article in journal (Refereed)
    Abstract [en]

    Aims: To explore the attitudes of Swedish general practitioners (GPs) a nd nurses to secondary alcohol prevention (early identification of, and intervention for, alcohol-related problems) and compare it to their attitudes to other important lifestyle behaviours such as smoking, stress, exercise, and overweight. Methods: An adjusted version of The WHO Collaborative Study Questionnaire for General Practitioners was posted to all GPs and nurses in the County of Skaraborg, Sweden, 68 GPs and 193 nurses responded. Results: The importance of drinking alcohol moderately, counselling skills on reducing alcohol consumption and perceived current effectiveness in helping patients change lifestyle behaviours ranked lower than working with all the other lifestyle behaviours. The nurses rated their potential effectiveness in helping patients change lifestyle higher than that of GPs for all the lifestyle behaviours. Nurses receiving more alcohol-related education had more positive attitudes than nurses with less education. For alcohol, the GPs assessed their role adequacy, role legitimacy and motivation higher than that of the nurses. The main obstacles for the GPs to carry out alcohol intervention were lack of training in counselling for reducing alcohol consumption, time constraints, and the fact that the doctors did not know how to identify problem drinkers who have no obvious symptoms of excess consumption. Conclusion: GPs and the nurses estimated their alcohol-related competence as lower than working with many other health-related lifestyles. These results can be explained by lack of practical skills, lack of training in suitable intervention techniques, and unsupportive working environments. All these elements must be considered when planning secondary alcohol prevention programs in primary health care. © The Author 2005. Published by Oxford University Press on behalf of the Medical Council on Alcohol. All rights reserved.

  • 120.
    Gjesdal, Sturla
    et al.
    University of Bergen.
    Svedberg, Pia
    Karolinska Institute.
    Hagberg, Jan
    Karolinska Institute.
    Alexanderson , Kristina
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Mortality among disability pensioners in Norway and Sweden 1990-96: Comparative prospective cohort study2009In: SCANDINAVIAN JOURNAL OF PUBLIC HEALTH, ISSN 1403-4948 , Vol. 37, no 2, p. 168-175Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the study was to assess excess mortality related to disability pension (DP) status and DP diagnoses in Norway and Sweden during 1990-96. Methods: Representative samples of the population aged 30-59 years, without DP at baseline 1 January 1990, 71,293 women and 76,928 men from Norway, and 68,181 women and 71,950 men from Sweden, were followed up during 1990-96. Granting of DP, DP diagnosis, age and gender were explanatory variables in Cox proportional hazards analysis with death from all causes as the outcome variable. Results: Among women, 10.4% in Sweden and 7.1% in Norway obtained DP, as compared to 7.5% and 5.6% of the men. In Sweden, 66% of female and 49% of male DP recipients had musculoskeletal diagnoses, as compared to 40% and 27% in Norway. In Sweden, 3.0% of the women and 6.1% of the men with DP died, as compared to 4.6% and 8.5% in Norway. Hazard ratios (HRs) for women with DP vs. the non-DP group were 3.2 (95% confidence interval (CI) 2.7-3.8) in Sweden, and 4.9 (95% CI = 4.1-5.7) in Norway. Among men with DP, there was no difference in mortality rate between the countries. HRs for men with musculoskeletal diagnoses vs. the non-DP group were 1.5 (95% CI = 1.1-2.0) in Norway and 1.4 (95% CI = 1.1-1.8) in Sweden. In both countries, the mortality rate among female disability pensioners with musculoskeletal diagnoses was not increased. Conclusions: The study confirmed an increased mortality rate among disability pensioners, except for women with musculoskeletal diagnoses. The mortality pattern related to DP diagnoses was similar in the two countries. A high frequency of musculoskeletal DP diagnoses among women with DP in Sweden explained a lower mortality rate as compared to Norway.

  • 121.
    Glendor , Ulf
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Aetiology and risk factors related to traumatic dental injuries - a review of the literature2009In: DENTAL TRAUMATOLOGY, ISSN 1600-4469 , Vol. 25, no 1, p. 19-31Article, review/survey (Other academic)
    Abstract [en]

    During the past 30 years, the number of aetiologies of traumatic dental injuries (TDIs) has increased dramatically in the literature and now includes a broad spectrum of variables, including oral and environmental factors and human behaviour. The aim of this study is to present an international review of well-known as well as less well-known unintentional and intentional causes of TDIs. Moreover, some models that are useful in investigating contact sport injuries are presented.

    The databases of Medline, Cochrane, Social Citation Index, Science Citation Index and CINAHL from 1995 to the present were used.

    Oral factors (increased overjet with protrusion), environmental determinants (material deprivation) and human behaviour (risk-taking children, children being bullied, emotionally stressful conditions, obesity and attention-deficit hyperactivity disorder) were found to increase the risk for TDIs. Other factors increasing the risk for TDIs are presence of illness, learning difficulties, physical limitations and inappropriate use of teeth. A new cause of TDIs that is of particular interest is oral piercing. In traffic facial injury was similar in unrestrained occupants (no seat belts) and occupants restrained only with an air bag. Amateur athletes have been found to suffer from TDIs more often than professional athletes. Falls and collisions mask intentional TDIs, such as physical abuse, assaults and torture. Violence has increased in severity during the past few decades and its role has been underestimated when looking at intentional vs unintentional TDIs. There are useful models to prevent TDIs from occurring in sports. WHO Healthy Cities and WHO Health Promoting Schools Programmes offer a broad solution for dental trauma as a public health problem.

    The number of known causes of TDIs has grown to alarming levels, probably because of increased interest of the causes and the underlying complexity of a TDI. Accepted oral, environmental and human aetiological factors must therefore be included in the registration of TDIs.

  • 122.
    Glendor , Ulf
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Has the education of professional caregivers and lay people in dental trauma care failed?2009In: DENTAL TRAUMATOLOGY, ISSN 1600-4469 , Vol. 25, no 1, p. 12-18Article, review/survey (Other academic)
    Abstract [en]

    Several reports have been published during the past decades showing a lack of care of traumatic dental injuries (TDIs) as well as dentists and lay people having insufficient knowledge on how to manage TDIs. This situation could seriously affect the outcome of TDIs, especially a complicated TDI. The overall aim of this study was to present a review of dental trauma care with focus on treatment and dentists and lay persons lack of knowledge on how to manage a TDI. A further aim is to introduce the actors involved and the outcome of their education.

    The databases Medline, Cochrane, SSCI, SCI and CINAHL from the year 1995 to the present were used. Focus was on treatment need, inadequate care, lack of knowledge and poor organization of emergency care.

    Studies from different countries demonstrated that treatment needs were not properly met despite the fact that not all untreated teeth needed treatment. Treatment in emergency dental care was often inadequate or inappropriate. With the exception of lay people, teachers, medical personnel and even dentists performed inadequate care. Furthermore, information to the public was insufficient. Despite a low level of knowledge, lay people expressed a strong interest in helping someone with a TDI.

    The conclusion from this review is that consideration must be given the problematic results from different studies on education or information about dental trauma care. Despite that the studies reviewed were from different countries and groups of people, the results seem to be consistent, i.e. that a large part of the educational process of professional caregivers and lay people has failed. Too much hope seems to be put on lay people to handle difficult cases such as tooth avulsion. Education of caregivers and lay people is a field where much remains to be explored.

  • 123.
    Glendor, Ulf
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Attitudes towards the use of mouth and face guards in Swedish ice hockey: part 2. Results2013In: Dental Traumatology, ISSN 1600-4469, E-ISSN 1600-9657, Vol. 29, no 6, p. 432-444Article in journal (Refereed)
    Abstract [en]

    Background/AimThe yearly cost of sports injuries, which affects Swedish society, is estimated to 3billion SEK (460 million USD). Injuries in ice hockey represent at least 270 million SEK (42 million USD). Despite the high number of injuries, mouth and face guards are rarely used in Swedish ice hockey. The major aim of this study was to examine the attitudes of mouth and face guards in two ice hockey clubs in Sweden (one elite and one division 3 club). A second purpose was to determine why some players use mouth and face guards, while others do not. A third goal was to present a material that ice hockey clubs could use for further discussions. less thanbrgreater than less thanbrgreater thanMaterials and methodA phenomenographic analysis of focus groups interviews. less thanbrgreater than less thanbrgreater thanResultsThe phenomenographic analysis of the data resulted in 12 categories. Within each category, issues, activities and engagement of the participants were described. Further, similarities and differences in the discussions between the elite club and the division 3 club were described. The following categories were found to engage the participants the most: Ice hockey is a high-velocity collision sport in which injuries are expected, Attitudes towards personal protection guards and Suggested measures. less thanbrgreater than less thanbrgreater thanConclusionsThe participants were aware of the risk of playing ice hockey, but they know little about the consequences of a dental injury. Although ice hockey players wish to protect themselves, they refuse to accept just any mouth or face guard. Through the discussions about reducing dental and jaw injuries by routine use of protection devices, many reform proposals were presented that could be useful in future discussions.

  • 124.
    Glendor, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Epidemiology of traumatic dental injuries--a 12 year review of the literature2008In: Dental traumatology, ISSN 1600-4469, Vol. 24, no 6, p. 603-611Article, review/survey (Refereed)
    Abstract [en]

    Several reports have been published during the past decades showing a lack of care of traumatic dental injuries (TDIs) as well as dentists and lay people having insufficient knowledge on how to manage TDIs. This situation could seriously affect the outcome of TDIs, especially a complicated TDI. The overall aim of this study was to present a review of dental trauma care with focus on treatment and dentists and lay persons lack of knowledge on how to manage a TDI. A further aim is to introduce the actors involved and the outcome of their education.

    The databases Medline, Cochrane, SSCI, SCI and CINAHL from the year 1995 to the present were used. Focus was on treatment need, inadequate care, lack of knowledge and poor organization of emergency care.

    Studies from different countries demonstrated that treatment needs were not properly met despite the fact that not all untreated teeth needed treatment. Treatment in emergency dental care was often inadequate or inappropriate. With the exception of lay people, teachers, medical personnel and even dentists performed inadequate care. Furthermore, information to the public was insufficient. Despite a low level of knowledge, lay people expressed a strong interest in helping someone with a TDI.

    The conclusion from this review is that consideration must be given the problematic results from different studies on education or information about dental trauma care. Despite that the studies reviewed were from different countries and groups of people, the results seem to be consistent, i.e. that a large part of the educational process of professional caregivers and lay people has failed. Too much hope seems to be put on lay people to handle difficult cases such as tooth avulsion. Education of caregivers and lay people is a field where much remains to be explored.

  • 125.
    Glendor, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    On Dental Trauma in Children and Adolescents: Incidence, Risk, Treatment, Time and Costs2000Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Dental trauma occur in childhood and adolescence with consequences in time and costs for both patient and family. The scientific knowledge of these matters is scarce. For some individuals, dental trauma will result in long, time-consuming and costly treatments in childhood which will continue into adulthood.

    Aim: The thesis aimed to increase the knowledge of incidence, risk, treatment, time and costs spent on dental traumas to primary and permanent teeth in children and adolescents.

    Material and method: The material for the studies emanated from the county of Västmanland, Sweden, and the municipality of Copenhagen, Denmark, and from a Swedish nation-wide material (Folksam). The material was collected from accident reports, dental files, dental trauma forms, questionnaires and telephone interviews. Descriptive, prospective and analytical methods were used. A classification of uncomplicated and complicated dental traumas was presented.

    Results: The incidence of dental trauma to boys was higher, compared to girls, in the county of Västmanland in almost all age groups. For both sexes, the first years in life and the first years in school were the most accident prone periods with incidence twice as high as the average incidence for all children and adolescents in the county. Every third trauma was complicated with injuries to the pulp or periodontal ligaments. Every second patient with a dental trauma to permanent teeth suffered from multiple dental trauma episodes (MDTE) during a period of 12 years. In almost every second patient with MDTE, at least one of the affected teeth had sustained repeated trauma episodes. The risk of sustaining MDTE increased when the first trauma episode occurred in the age interval of 6-10, compared to 11-18 year olds. During a 12-year period, treatment times for complicated traumas were 2.0 and 2.7 times higher for primary and permanent teeth, respectively, compared to corresponding values for uncomplicated traumas. On average, direct time (treatment time) represented 11% and 16% of the total time, while the direct costs (health are service, transport, loss of personal property and medicine) represented 60% and 72% of the total costs of traumas to primary and permanent teeth, respectively, during a 2-year period for cases of a nation-wide material.

    Conclusion: Dental traumas are frequent and some individuals are injured several times. Besides treatment time, efforts from the family are substantial in time and costs. Parameters such as degree of severity, access to treatment and place of injury are of major importance to both patient and family and should be considered when calculating time and costs of dental trauma in children and adolescents.

    List of papers
    1. Incidence of traumatic tooth injuries in children and adolescents in the county of Vastmanland, Sweden
    Open this publication in new window or tab >>Incidence of traumatic tooth injuries in children and adolescents in the county of Vastmanland, Sweden
    1996 (English)In: Swedish Dental Journal, ISSN 0347-9994, Vol. 20, no 1-2, p. 15-28Article in journal (Refereed) Published
    Abstract [en]

    The study reports the total incidence as well as the incidence of different types of traumatic tooth injuries in a Swedish county in the age interval 0-19 years during 1989/90. The incidence of individuals experiencing tooth injuries was 13 per 1000 per year. Boys were more frequently injured in the age-groups 3-4 years and 7-9 years and girls, in the age-group 5-6 years. A method is presented defining uncomplicated and complicated tooth injuries as a basis for estimating the economic consequences of these injuries in the community. Boys more often suffered uncomplicated injuries to permanent teeth and girls, to primary teeth (p < 0.05). The same distribution was found for uncomplicated multiple tooth injuries. Boys sustained more uncomplicated hard tissue injuries and girls, more uncomplicated luxation injuries (p < 0.01). Using a classification according to the most serious tooth injury in each episode, 33% of the episodes had resulted in complicated injuries in which the pulpal tissue and/or periodontal membrane was severely damaged.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13543 (URN)
    Available from: 1999-02-27 Created: 1999-02-27 Last updated: 2009-02-12
    2. Risk evaluation and type of treatment of multiple dental trauma episodes to permanent teeth
    Open this publication in new window or tab >>Risk evaluation and type of treatment of multiple dental trauma episodes to permanent teeth
    2000 (English)In: Endodontics & dental traumatology., ISSN 0109-2502, Vol. 16, no 5, p. 205-210Article in journal (Refereed) Published
    Abstract [en]

    Studies have shown that some children and adolescents are effected only once with a dental trauma, while others seem to be accident-prone and suffer from multiple dental trauma episodes (MDTE). Studies have also shown that dental traumas mostly affect upper permanent and medial incisors. Less is known about treatment consequences related to teeth with repeated dental trauma episodes. The aim was therefore to evaluate the risk of MDTE to permanent teeth among children and adolescents by age and gender and to compare types of dental treatment modalities used for patients with one episode and those with MDTE and with single and repeated traumatized teeth. The study was based on a random sample of 83 Danish 6-18-year-old children and adolescents born in 1970 who suffered from dental trauma episodes. All patients were followed during a 12-year period (1976-1988). Forty-one of the patients were registered with MDTE with a range of 2-7 episodes and a mean of 2.9 episodes/patient (SD = 1.1). The mean age at single and MDTE was 11.4 years (SD = 3.6) and 8.6 years (SD = 2.1), respectively. No significant differences were found between age at first episode and the number of MDTE per patient. The number of patients with MDTE was significantly higher among those who suffered their first trauma episode in the age interval 6-10 years than in the age interval 11-18 years (P < 0.001). A survival analysis showed that the risk of sustaining another trauma episode increased by 14.9-30.3% when the first trauma occurred before the age of 11, compared to 0-7.4% after the age of 10. The risk of sustaining multiple injuries was 8.4 times higher when the first trauma episode occurred at 9 years of age, compared with those occurring at age 12. The survival analysis also showed that for every new trauma episode, the interval between them became closer. Forty-five per cent of the MDTE affected teeth had already sustained an injury. With an increased number of trauma episodes per patient followed an increase in the number of follow-ups, filling therapy, information and prosthetics, whereas the rates of endodontics, surgery, and consultations were unchanged or even decreased.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13544 (URN)
    Available from: 1999-02-27 Created: 1999-02-27
    3. Type of treatment and estimation of time spent on dental trauma--a longitudinal and retrospective study
    Open this publication in new window or tab >>Type of treatment and estimation of time spent on dental trauma--a longitudinal and retrospective study
    Show others...
    1998 (English)In: Swedish Dental Journal, ISSN 0347-9994, Vol. 22, no 1-2, p. 47-60Article in journal (Refereed) Published
    Abstract [en]

    The consequences of traumatic tooth injuries (dental trauma) are time-consuming and costly treatment and follow-ups, of which our knowledge is scarce. Consequently the aim of the present study was to measure the total time of treatment of uncomplicated and complicated traumas to primary and permanent teeth. The study was performed in three steps based on a randomly selected sample of Danish children and adolescents living in the municipality of Copenhagen, Denmark: (I) A descriptive analysis of traumas affecting 106 children and adolescents all born in 1970 and randomly chosen among the total number of patients treated. Treatments took place between 1972 and 1988. (II) A study of the time and frequency of different types of emergency and planned treatment estimated by 14 dentists employed by the municipal dental service. (III) Calculation of the total treatment time on the basis of the results from (I) and (II). The most common traumas were luxations of primary teeth and fractures of permanent teeth. The most frequent treatments dealt with were uncomplicated crown fractures and luxations followed by other different diagnoses of complicated traumas. The treatment time for primary teeth for uncomplicated traumas were used mostly for information, while the time for complicated traumas was used for follow-ups. The treatment time for traumas to permanent teeth was dominated by follow-ups, irrespective of the complication status. Only 3% of uncomplicated traumas of permanent teeth resulted in endodontic treatment, compared to 67% with complicated traumas. Uncomplicated traumas to primary teeth required a total of 2.5 visits and 0.8 hrs treatment time, while 4.3 visits and 1.6 hrs per individual were used for complicated traumas. For permanent teeth with uncomplicated traumas 9.2 visits and 3.2 hrs were required, and for complicated traumas 16.4 visits and 8.5 hrs per individual. The respective treatment times for complicated traumas for primary and permanent teeth were 2.0 and 2.7 times higher, compared to the corresponding uncomplicated traumas. There were no gender differences in type of injury and number of visits for injuries to primary and permanent teeth.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13545 (URN)
    Available from: 1999-02-27 Created: 1999-02-27 Last updated: 2009-02-12
    4. Direct and indirect time spent on care of dental trauma: a 2-year prospective study of children and adolescents
    Open this publication in new window or tab >>Direct and indirect time spent on care of dental trauma: a 2-year prospective study of children and adolescents
    Show others...
    2000 (English)In: Endodontics and dental traumatology, ISSN 0109-2502, Vol. 16, no 1, p. 16-23Article in journal (Refereed) Published
    Abstract [en]

    The aim was to account for the total time spent by professional care-givers (direct time) and by patients and companions engaged as support and help (indirect time) to treat and otherwise attend to children and adolescents with dental trauma to primary and permanent teeth. The study was based on a random sample of 192 children and adolescents with dental traumas reported to an insurance company and prospectively followed up by telephone interviews over a period of 2 years after the trauma episode. On average, direct time represented 16% of total time for all visits for dental trauma to permanent teeth and 11% for trauma to primary teeth. The most extensive type of indirect time was transport time, which took up 30% of the total time spent on injuries to permanent teeth and 36% for injuries to primary teeth. Multiple regression analysis of the impact of dental and demographic injury variables on the time variables showed that complicated trauma was associated with extended time, direct as well as indirect, for permanent and primary teeth injuries. Our estimate of the average relative increase in total time spent by patients and companions in cases of complicated injury to permanent teeth was 117% (95% confidence interval [CI], 52-211) for patients and 112% (95% CI, 42-217) for companions. For transport time a strong predictor was access to a dental clinic near the place of residence. Lack of access could extend the average transport time by 180% (95% CI, 80-335) for patients and 163% (95% CI, 67-317) for their companions in cases of injuries to primary teeth.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13546 (URN)
    Available from: 1999-02-27 Created: 1999-02-27 Last updated: 2009-02-12
    5. Direct and indirect costs of dental trauma in Sweden: a 2-year prospective study of children and adolescents
    Open this publication in new window or tab >>Direct and indirect costs of dental trauma in Sweden: a 2-year prospective study of children and adolescents
    2001 (English)In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, Vol. 29, no 2, p. 150-160Article in journal (Refereed) Published
    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.

    Keywords
    adolescence, child, tooth injuries, costs, permanent dentition, primary dentition, regression analysis
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13547 (URN)10.1111/j.1600-0528.2001.290210.x (DOI)
    Available from: 1999-02-27 Created: 1999-02-27 Last updated: 2009-05-15
  • 126.
    Glendor, Ulf
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Göransson, Anne
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Attitudes towards the use of mouth and face guards in Swedish ice hockey: part I. Materials and method2013In: Dental Traumatology, ISSN 1600-4469, E-ISSN 1600-9657, Vol. 29, no 5, p. 355-359Article in journal (Refereed)
    Abstract [en]

    Background/aimThe most common method to study the use and attitudes of mouth and face guards is a limited number of preprepared questions. This approach, however, risks information restriction and lowers the general value of the study. The aim of this study was therefore to present a phenomenographic approach to capture the use and attitudes towards mouth and face guards in two Swedish ice hockey clubs. less thanbrgreater than less thanbrgreater thanMaterials and methodThe phenomenographic study was set up as 12 focus group interviews: six interviews with one elite and six interviews with one division 3 ice hockey club in Sweden. A number of categories were identified, which became the basis for how the results are presented. less thanbrgreater than less thanbrgreater thanResultsThe participants inspired each other to speak freely, which allowed for much wider and deeper discussions than was expected. In comparison with the use of a preprepared questionnaire with a limited number of questions sent home by post, this method included comments from the participants and revealed new angles of approach in 12 identified categories. less thanbrgreater than less thanbrgreater thanConclusionsUsing a phenomenographic research method, more variations and different apprehensions could be revealed than what would be possible with a set of preprepared questions sent by post or used in individual interviews.

  • 127.
    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.
    Halling, A.
    Andersson, L.
    Andreasen, J.O.
    Klitz, I.
    Type of treatment and estimation of time spent on dental trauma--a longitudinal and retrospective study1998In: Swedish Dental Journal, ISSN 0347-9994, Vol. 22, no 1-2, p. 47-60Article in journal (Refereed)
    Abstract [en]

    The consequences of traumatic tooth injuries (dental trauma) are time-consuming and costly treatment and follow-ups, of which our knowledge is scarce. Consequently the aim of the present study was to measure the total time of treatment of uncomplicated and complicated traumas to primary and permanent teeth. The study was performed in three steps based on a randomly selected sample of Danish children and adolescents living in the municipality of Copenhagen, Denmark: (I) A descriptive analysis of traumas affecting 106 children and adolescents all born in 1970 and randomly chosen among the total number of patients treated. Treatments took place between 1972 and 1988. (II) A study of the time and frequency of different types of emergency and planned treatment estimated by 14 dentists employed by the municipal dental service. (III) Calculation of the total treatment time on the basis of the results from (I) and (II). The most common traumas were luxations of primary teeth and fractures of permanent teeth. The most frequent treatments dealt with were uncomplicated crown fractures and luxations followed by other different diagnoses of complicated traumas. The treatment time for primary teeth for uncomplicated traumas were used mostly for information, while the time for complicated traumas was used for follow-ups. The treatment time for traumas to permanent teeth was dominated by follow-ups, irrespective of the complication status. Only 3% of uncomplicated traumas of permanent teeth resulted in endodontic treatment, compared to 67% with complicated traumas. Uncomplicated traumas to primary teeth required a total of 2.5 visits and 0.8 hrs treatment time, while 4.3 visits and 1.6 hrs per individual were used for complicated traumas. For permanent teeth with uncomplicated traumas 9.2 visits and 3.2 hrs were required, and for complicated traumas 16.4 visits and 8.5 hrs per individual. The respective treatment times for complicated traumas for primary and permanent teeth were 2.0 and 2.7 times higher, compared to the corresponding uncomplicated traumas. There were no gender differences in type of injury and number of visits for injuries to primary and permanent teeth.

  • 128.
    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.
    Halling, A.
    Andersson, L.
    Eilert-Petersson, E.
    Incidence of traumatic tooth injuries in children and adolescents in the county of Vastmanland, Sweden1996In: Swedish Dental Journal, ISSN 0347-9994, Vol. 20, no 1-2, p. 15-28Article in journal (Refereed)
    Abstract [en]

    The study reports the total incidence as well as the incidence of different types of traumatic tooth injuries in a Swedish county in the age interval 0-19 years during 1989/90. The incidence of individuals experiencing tooth injuries was 13 per 1000 per year. Boys were more frequently injured in the age-groups 3-4 years and 7-9 years and girls, in the age-group 5-6 years. A method is presented defining uncomplicated and complicated tooth injuries as a basis for estimating the economic consequences of these injuries in the community. Boys more often suffered uncomplicated injuries to permanent teeth and girls, to primary teeth (p < 0.05). The same distribution was found for uncomplicated multiple tooth injuries. Boys sustained more uncomplicated hard tissue injuries and girls, more uncomplicated luxation injuries (p < 0.01). Using a classification according to the most serious tooth injury in each episode, 33% of the episodes had resulted in complicated injuries in which the pulpal tissue and/or periodontal membrane was severely damaged.

  • 129.
    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.
    Halling, A.
    Bodin, L.
    Andersson, L.
    Nygren, Å.
    Karlsson, G.
    Koucheki, B.
    Direct and indirect time spent on care of dental trauma: a 2-year prospective study of children and adolescents2000In: Endodontics and dental traumatology, ISSN 0109-2502, Vol. 16, no 1, p. 16-23Article in journal (Refereed)
    Abstract [en]

    The aim was to account for the total time spent by professional care-givers (direct time) and by patients and companions engaged as support and help (indirect time) to treat and otherwise attend to children and adolescents with dental trauma to primary and permanent teeth. The study was based on a random sample of 192 children and adolescents with dental traumas reported to an insurance company and prospectively followed up by telephone interviews over a period of 2 years after the trauma episode. On average, direct time represented 16% of total time for all visits for dental trauma to permanent teeth and 11% for trauma to primary teeth. The most extensive type of indirect time was transport time, which took up 30% of the total time spent on injuries to permanent teeth and 36% for injuries to primary teeth. Multiple regression analysis of the impact of dental and demographic injury variables on the time variables showed that complicated trauma was associated with extended time, direct as well as indirect, for permanent and primary teeth injuries. Our estimate of the average relative increase in total time spent by patients and companions in cases of complicated injury to permanent teeth was 117% (95% confidence interval [CI], 52-211) for patients and 112% (95% CI, 42-217) for companions. For transport time a strong predictor was access to a dental clinic near the place of residence. Lack of access could extend the average transport time by 180% (95% CI, 80-335) for patients and 163% (95% CI, 67-317) for their companions in cases of injuries to primary teeth.

  • 130.
    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.

  • 131.
    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.
    Koucheki, B.
    Halling, A.
    Risk evaluation and type of treatment of multiple dental trauma episodes to permanent teeth2000In: Endodontics & dental traumatology., ISSN 0109-2502, Vol. 16, no 5, p. 205-210Article in journal (Refereed)
    Abstract [en]

    Studies have shown that some children and adolescents are effected only once with a dental trauma, while others seem to be accident-prone and suffer from multiple dental trauma episodes (MDTE). Studies have also shown that dental traumas mostly affect upper permanent and medial incisors. Less is known about treatment consequences related to teeth with repeated dental trauma episodes. The aim was therefore to evaluate the risk of MDTE to permanent teeth among children and adolescents by age and gender and to compare types of dental treatment modalities used for patients with one episode and those with MDTE and with single and repeated traumatized teeth. The study was based on a random sample of 83 Danish 6-18-year-old children and adolescents born in 1970 who suffered from dental trauma episodes. All patients were followed during a 12-year period (1976-1988). Forty-one of the patients were registered with MDTE with a range of 2-7 episodes and a mean of 2.9 episodes/patient (SD = 1.1). The mean age at single and MDTE was 11.4 years (SD = 3.6) and 8.6 years (SD = 2.1), respectively. No significant differences were found between age at first episode and the number of MDTE per patient. The number of patients with MDTE was significantly higher among those who suffered their first trauma episode in the age interval 6-10 years than in the age interval 11-18 years (P < 0.001). A survival analysis showed that the risk of sustaining another trauma episode increased by 14.9-30.3% when the first trauma occurred before the age of 11, compared to 0-7.4% after the age of 10. The risk of sustaining multiple injuries was 8.4 times higher when the first trauma episode occurred at 9 years of age, compared with those occurring at age 12. The survival analysis also showed that for every new trauma episode, the interval between them became closer. Forty-five per cent of the MDTE affected teeth had already sustained an injury. With an increased number of trauma episodes per patient followed an increase in the number of follow-ups, filling therapy, information and prosthetics, whereas the rates of endodontics, surgery, and consultations were unchanged or even decreased.

  • 132.
    Goine, H
    et al.
    Uppsala University.
    Söderberg, Elsy
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Engstrom, P
    Uppsala University.
    Palmer, E
    Uppsala University.
    Improving the quality of information on GPs certificates for sickness insurance-results of an experiment in Sweden in EUROPEAN JOURNAL OF PUBLIC HEALTH, vol 20, issue , pp 282-2822010In: EUROPEAN JOURNAL OF PUBLIC HEALTH, Oxford University Press , 2010, Vol. 20, p. 282-282Conference paper (Refereed)
    Abstract [en]

    n/a

  • 133.
    Grahn Kronhed, Ann-Charlotte
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Primary Health Care Centres.
    Community-based osteoporosis prevention: Physical activity in relation to bone density, fall prevention, and the effect of training programmes: The Vadstena Osteoporosis Prevention Project2003Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis is based on studies of the ten-year community-based intervention programme entitled, the Vadstena Osteoporosis Prevention Project (VOPP). The specific aims of the research were to describe the effects of physical activity and training programmes on bone mass and balance performance in adults, to determine whether a fall risk prevention programme could motivate personal actions among the elderly, to ascertain whether the intervention programme could reduce the incidence of forearm and hip fractures.

    Two studies addressed training programmes for middle-aged and old people. First, VOPP participants who were aged 40–70 years and had low forearm bone mineral density (BMD) values were invited to take part in a one-year weight-bearing training study. Thirty of those individuals were included in the investigation. Additional bone mass measurements were performed at the hip and the lumbar spine, and balance and aerobic capacity were also tested. The training programme was performed twice a week (I). In the second study, healthy persons aged 70–75 years were invited to participate in a balance-training study. Fifteen persons joined an exercise group, and another fifteen were controls. The training programme comprised specific balance exercises and was carried out twice a week for nine weeks (II). The association between forearm BMD values and several lifestyle factors was explored in random samples of the population aged 20–72 years (n=880) in a cross-sectional study (III). Another study explored the association between calcaneal stiffness, forearm BMD, and lifestyle factors amongst participants aged 20–79 years (n=956) at the final registration of the VOPP (V). Effects of the VOPP interventions directed at environmental risk factors for falls and the promotion of physical activity were examined in people aged ≥ 65 years (IV). The incidence of forearm and hip fractures was studied amongst middle-aged and elderly individuals in the intervention and the control communities during the study period 1987–2001 (VI).

    The exercise group (n=15) in the weight-bearing training study showed increases in BMD at the greater trochanter (p<0.01), one-leg stance balance with the eyes closed and coordination tests (p<0.05), and aerobic capacity (p<0.05). No significant difference was found when the groups were compared concerning changes in the different tests during the intervention period (I). In the balance-training study, the exercise group showed post-training improvement in the following tests: standing on the right leg with eyes closed (p<0.01), standing on the right leg (p<0.01) and on the left leg (p<0.05) while turning the head, and walking 30 metres (p<0.01). There were significant differences between the groups in these tests when changes were compared at the post-intervention test (II). Age (p<0.0001) and body mass index (p≤.0001) were associated with forearm BMD in both sexes. Reported moderate physical activity levels in men were positively associated with forearm BMD (p<0.05) (III). In both sexes, reported moderate (p<0.05) and high (women p<0.05 and men p<0.001) physical activity levels were positively associated with calcaneal stiffness. The correlation coefficient between forearm BMD and calcaneal stiffness was 0.58 in women and 0.34 in men (V). Persons aged ≥ 65 years at the follow-up in 1994 reported more use of shoe/cane spikes

    and moderate physical activity levels compared to controls (IV). There was no change in the general incidence of forearm and hip fractures between the communities for the study period. However, there was a tendency towards decreasing incidence of forearm and trochanteric hip fracture in both sexes during the late intervention period in the intervention community (VI).

    A community-based intervention programme aimed at reducing the incidence of osteoporotic fractures must be regarded as a long-term project and should preferably be monitored over an extended post-intervention period.

    List of papers
    1. Effects of physical exercise on bone mass, balance skill and aerobic capacity in women and men with low bone mineral density, after one year capacity in women and men with low bone mineral density, after one year: a prospective study
    Open this publication in new window or tab >>Effects of physical exercise on bone mass, balance skill and aerobic capacity in women and men with low bone mineral density, after one year capacity in women and men with low bone mineral density, after one year: a prospective study
    1998 (English)In: Scandinavian journal of medicine & science in sports, ISSN 0905-7188, Vol. 8, no 5 Pt 1, p. 290-298Article in journal (Refereed) Published
    Abstract [en]

    Vadstena is a small community in the county of Ostergötland, Sweden, where a project began in 1989 to prevent osteoporosis and to lower the expected incidence of osteoporotic fractures. Persons aged 40-70 years who had a low bone mineral density (BMD) value at screening of the distal radius by single-photon absorptiometry (SPA) were invited to participate in a training study during one year. The definition of low BMD was a densitometry value below -1 SD (standard deviation) from a sex- and age-specific reference value (z-score). Fifteen persons wanted to exercise in a group and 15 persons wanted to become a control group. All participants answered a questionnaire about lifestyle, occupation, diseases, medication and heredity. Clinical tests were made regarding mobility of the joints and muscles, balance and physical fitness. BMD for the hip and the lumbar spine were assessed by dual-energy X-ray absorptiometry (DXA) before and after the investigation period. The training programme was carried out for 60 min twice a week during one year and had the intention to improve bone mass, muscle strength and flexibility, balance skill and aerobic capacity. After the training period there was a significant increase in BMD at the greater trochanter (P < 0.01), in balance skill (standing on one leg with closed eyes and "ski step"-test) (P < 0.05) and in oxygen uptake capacity (P < 0.05) in the exercise group. In the control group, there was a significant increase in BMD at the lumbar spine (P < 0.05). However, these results should be judged with caution because several participants were over the age of 60, and at that age degenerative changes in the lumbar spine may increase to a greater or lesser extent. Regular weight-bearing exercises during one year seem to influence BMD at the greater trochanter in a training group comprising both women and men. However, our study was small in number and further training studies are needed to assess the effect of weight-bearing training on bone mass in different sex- and age-specific groups.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13678 (URN)
    Available from: 2003-05-19 Created: 2003-05-19
    2. The effect of short-term balance training on community-dwelling older adults
    Open this publication in new window or tab >>The effect of short-term balance training on community-dwelling older adults
    2001 (English)In: Journal of Aging & Physical Activity, ISSN 1063-8652, Vol. 9, no 1, p. 19-31Article in journal (Refereed) Published
    Abstract [en]

    This study evaluated a balance-training program's influence in healthy older adults. Fifteen community-dwelling participants aged 70Ð75 years were randomized to an exercise group, and 15 gender- and age-matched participants, to a control group. The 9-week training program comprised ordinary-life balance, vestibular-habituation, and ball exercises and station training. Clinical balance tests were conducted before and after training. Tests that showed significant improvement in the exercise group after the intervention included standing on the right leg with eyes closed, standing on the right leg and the left leg while turning the head and walking 30 m. Significant between-group differences were found at posttest. A significant decrease was seen in the control group in the walking-forward test, and this change was significantly different between groups. The study indicates that balance performance in healthy older adults might be improved by balance training including exercises that stimulate multiple sensory systems and their central integration.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13679 (URN)
    Available from: 2003-05-19 Created: 2003-05-19 Last updated: 2009-05-15
    3. Association between physical activity and forearm bone mineral density in 20-72-year-olds
    Open this publication in new window or tab >>Association between physical activity and forearm bone mineral density in 20-72-year-olds
    Show others...
    2002 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 4, no 2, p. 87-96Article in journal (Refereed) Published
    Abstract [en]

    Physical activity may influence bone mineral density (BMD) in different ways. In the present study the amount of physical activity and the associations between forearm BMD, body mass index, physical activity and several other lifestyle factors were explored. A random sample of the population in a Swedish municipality was invited to the study and examined by a questionnaire and by forearm bone mineral measurements using single photon absorptiometry. Forearm BMD was measured in 880 subjects. Forearm BMD was stable from 20 to 50 years of age in women and from 20 to 60 years of age in men. Reported moderate leisure-time physical activity levels in men were significantly associated with higher forearm BMD than low leisure-time physical activity levels ( p = 0.042). The findings that moderate levels of leisure-time physical activity in men were associated with higher forearm BMD, give some support to the hypothesis that increased amount of physical activity in a population might be of benefit in the prevention of osteoporosis. Further longitudinal studies of the effect of physical activity in the prevention of osteoporosis, falls and fractures are warranted.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2002
    Keywords
    Body Mass Index, Cross-SECTIONAL, Osteoporosis, Population-BASED, Prevention
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13680 (URN)10.1080/140381902320141498 (DOI)
    Available from: 2003-05-19 Created: 2003-05-19 Last updated: 2018-05-22
    4. Evaluation of an osteoporosis and fall risk intervention program for community-dwelling elderly.: a quasi-experimental study of behavioural modifications
    Open this publication in new window or tab >>Evaluation of an osteoporosis and fall risk intervention program for community-dwelling elderly.: a quasi-experimental study of behavioural modifications
    Show others...
    2006 (English)In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 18, no 3, p. 235-241Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND AND AIMS: Osteoporosis and fall fractures are increasing problems amongst the elderly. The aim of this study was to explore whether combined population-based and individual interventions directed at risk factors for osteoporosis and falls result in behavioral changes in an elderly population.

    METHODS: A quasi-experimental design was used for the study. Persons aged >or=65 years were randomly selected in the intervention and control community. An intervention program was managed from the primary health care center and delivered to the community. Health education was designed to increase awareness of risk factors for the development of osteoporosis and falling. Questionnaires about lifestyle, health, previous fractures, safety behavior and physical activity level were distributed at baseline in 1989 and at the follow-ups in 1992 and 1994 in both communities.

    RESULTS: There was a difference of 17.7% between the dual intervention (receiving both population-based and individual interventions) and the control samples regarding the self-reported use of shoe/cane spikes, and a difference of 20.5% regarding the reported "moderate level" of physical activity in 1994. There was an increase in the number of participants in the dual intervention sample who, at baseline, had not reported equipping their homes with non-slip mats and removing loose rugs but who did report these changes in 1994. The increase in the reported use of shoe/cane spikes in the dual intervention sample was observed mainly for the period 1992-1994.

    CONCLUSIONS: A public health intervention model, including both population-based and individual interventions, can contribute to behavioral changes in the prevention of falls and changed physical activity patterns amongst elderly people.

    Keywords
    Environmental hazard, fall prevention, population-based
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13681 (URN)
    Available from: 2003-05-19 Created: 2003-05-19 Last updated: 2017-12-13
    5. Is calcaneal stiffness more sensitive to physical activity than forearm bone mineral density?: A population-based study of persons aged 20-79 years
    Open this publication in new window or tab >>Is calcaneal stiffness more sensitive to physical activity than forearm bone mineral density?: A population-based study of persons aged 20-79 years
    Show others...
    2004 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, Vol. 32, no 5, p. 333-339Article in journal (Refereed) Published
    Abstract [en]

    Aims: The aim of this study was to investigate the associations between forearm bone mineral density (BMD), calcaneal stiffness, and physical activity levels in a normal population using different non-invasive methods.

    Methods: The participants were invited to undergo bone measurements using single photon absorptiometry of the forearm and quantitative ultrasound (QUS) of the calcaneal bone, and also to complete a questionnaire. Physical activity levels were designated low, moderate, and high in the question on leisure-time activity.

    Results: There were 956 participants included in the present study. Forearm BMD in the eighth age decade was 0.40 g/cm2 (95% CI 0.33 - 0.46 g/cm2) lower than in the third decade among women and 0.28 g/cm2 (95% CI 0.18 - 0.37 g/cm2) lower among men. The differences in calcaneal stiffness between the same age decades were 22.4 (95% CI 17.5 - 27.4) among women and 15.8 (95% CI 8.0 - 23.5) among men. The correlation between forearm BMD and calcaneal stiffness was 0.58 (95% CI 0.52 - 0.64) in women and 0.34 (95% CI 0.25 - 0.42) in men. Reported moderate and high leisure-time activity levels in both genders were associated with higher calcaneal stiffness but not with forearm BMD.

    Conclusions: The QUS may be used to measure the effect of present physical activity levels on calcaneal bone at the population level. Further longitudinal studies are warranted in order to determine the most appropriate non-invasive method in population-based studies.

    Keywords
    community-based interventions, osteoporosis, prevention, quantitative ultrasound, questionnaire, reference values, single photon absorptiometry
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13682 (URN)10.1080/14034940410026273 (DOI)
    Available from: 2003-05-19 Created: 2003-05-19 Last updated: 2013-09-05
    6. Impact of a community-based osteoporosis and fall prevention program on fracture incidence
    Open this publication in new window or tab >>Impact of a community-based osteoporosis and fall prevention program on fracture incidence
    Show others...
    2005 (English)In: Osteoporosis international, ISSN 0937-941X, Vol. 16, no 6, p. 700-706Article in journal (Refereed) Published
    Abstract [en]

    Associations between a 10-year community-based osteoporosis and fall prevention program and fracture incidence amongst middle-aged and elderly residents in an intervention community are studied, and comparisons are made with a control community. A health-education program was provided to all residents in the intervention community, which addressed dietary intake, physical activity, smoking habits and environmental risk factors for osteoporosis and falls. Both communities are small, semi-rural and situated in Östergötland County in southern Sweden. The analysis is based on incidences of forearm fractures in the population 40 years of age or older, and hip fractures in the population 50 years of age or older. Data for three 5-year periods (pre-, early and late intervention) are accumulated and compared. In the intervention community, forearm fracture incidence decreased in women. There are also tendencies towards decreasing forearm fracture incidence in men, and towards decreasing trochanteric hip fracture incidences in women and in men in the late intervention period. No such changes in fracture incidences are found in the control community. Cervical hip fracture incidence did not change in the intervention and the control communities. Although the reported numbers of fractures are small (a total of 451 forearm and 357 hip fractures), the numbers are based on total community populations and thus represent a true difference. The decrease in forearm fracture incidence among women, and the tendency towards decreasing trochanteric hip fractures, in contrast to the absence of change in cervical hip fractures, might be mainly due to a more rapid effect of fall preventive measures than an increase in bone strength in the population. For the younger age groups an expected time lag between intervention and effect might invalidate the short follow-up period for outcome measurements. Thus, the effect of the 10-year intervention program on fracture incidence should be followed during an extended post-intervention period.

    Keywords
    Fracture outcome, Fragility fractures, Prevention, Quasi-experimental
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13683 (URN)10.1007/s00198-004-1732-0 (DOI)
    Available from: 2003-05-19 Created: 2003-05-19 Last updated: 2013-09-05
  • 134.
    Grahn Kronhed, Ann-Charlotte
    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.
    Blomberg, Carina
    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.
    Löfman, Owe
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public 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.
    Möller, Margareta
    Research and Development Unit, Primary Health Care, Borås, Sweden.
    Impact of a community-based osteoporosis and fall prevention program on fracture incidence2005In: Osteoporosis international, ISSN 0937-941X, Vol. 16, no 6, p. 700-706Article in journal (Refereed)
    Abstract [en]

    Associations between a 10-year community-based osteoporosis and fall prevention program and fracture incidence amongst middle-aged and elderly residents in an intervention community are studied, and comparisons are made with a control community. A health-education program was provided to all residents in the intervention community, which addressed dietary intake, physical activity, smoking habits and environmental risk factors for osteoporosis and falls. Both communities are small, semi-rural and situated in Östergötland County in southern Sweden. The analysis is based on incidences of forearm fractures in the population 40 years of age or older, and hip fractures in the population 50 years of age or older. Data for three 5-year periods (pre-, early and late intervention) are accumulated and compared. In the intervention community, forearm fracture incidence decreased in women. There are also tendencies towards decreasing forearm fracture incidence in men, and towards decreasing trochanteric hip fracture incidences in women and in men in the late intervention period. No such changes in fracture incidences are found in the control community. Cervical hip fracture incidence did not change in the intervention and the control communities. Although the reported numbers of fractures are small (a total of 451 forearm and 357 hip fractures), the numbers are based on total community populations and thus represent a true difference. The decrease in forearm fracture incidence among women, and the tendency towards decreasing trochanteric hip fractures, in contrast to the absence of change in cervical hip fractures, might be mainly due to a more rapid effect of fall preventive measures than an increase in bone strength in the population. For the younger age groups an expected time lag between intervention and effect might invalidate the short follow-up period for outcome measurements. Thus, the effect of the 10-year intervention program on fracture incidence should be followed during an extended post-intervention period.

  • 135.
    Grahn Kronhed, Ann-Charlotte
    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.
    Blomberg, Carina
    Löfman, Owe
    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.
    Möller, Margareta
    Research and Development Unit, Primary Health Care, Borås, Sweden.
    Evaluation of an osteoporosis and fall risk intervention program for community-dwelling elderly.: a quasi-experimental study of behavioural modifications2006In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 18, no 3, p. 235-241Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Osteoporosis and fall fractures are increasing problems amongst the elderly. The aim of this study was to explore whether combined population-based and individual interventions directed at risk factors for osteoporosis and falls result in behavioral changes in an elderly population.

    METHODS: A quasi-experimental design was used for the study. Persons aged >or=65 years were randomly selected in the intervention and control community. An intervention program was managed from the primary health care center and delivered to the community. Health education was designed to increase awareness of risk factors for the development of osteoporosis and falling. Questionnaires about lifestyle, health, previous fractures, safety behavior and physical activity level were distributed at baseline in 1989 and at the follow-ups in 1992 and 1994 in both communities.

    RESULTS: There was a difference of 17.7% between the dual intervention (receiving both population-based and individual interventions) and the control samples regarding the self-reported use of shoe/cane spikes, and a difference of 20.5% regarding the reported "moderate level" of physical activity in 1994. There was an increase in the number of participants in the dual intervention sample who, at baseline, had not reported equipping their homes with non-slip mats and removing loose rugs but who did report these changes in 1994. The increase in the reported use of shoe/cane spikes in the dual intervention sample was observed mainly for the period 1992-1994.

    CONCLUSIONS: A public health intervention model, including both population-based and individual interventions, can contribute to behavioral changes in the prevention of falls and changed physical activity patterns amongst elderly people.

  • 136.
    Grahn Kronhed, Ann-Charlotte
    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.
    Hallberg, Inger
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ödkvist, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Möller, Margareta
    Centre for Health Care Sciences, Örebro University Hospital.
    Effect of training on health-related quality of life, pain and falls in osteoporotic women2009In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 11, no 3, p. 154-165Article in journal (Refereed)
    Abstract [en]

    Physical inactivity is a risk factor for osteoporosis and fractures. The aim of the study was to see if supervised training would improve health-related quality of life (HRQL), reduce pain and falls in osteoporotic women. Women with established osteoporosis (n=124) were invited to a 1-year, follow-up study. Seventy-three women aged 60-81 years met the inclusion criteria and were randomized to an exercise (E) or control (C) group. A 4-month, supervised group training programme was designed. Participants were studied using HRQL questionnaires, clinical tests and dynamic posturography. Thirty-one women in the E-group and 34 women in the C-group completed the study. The E-group improved in six SF-36 domains and mental component summary (MCsum) index and also in worst pain intensity (p<0.01) after the supervised exercise training. Differences were found between the groups when comparing changes in four SF-36 domains, MCsum and worst pain (p=0.001). Physical activity level decreased in the E-group after the supervised period. Mean time to first fall occurred earlier in the C-group than in the E-group for the first 4 months but the trend did not last for the 1-year follow-up. The study suggests that supervised group training is beneficial for women with established osteoporosis.

  • 137.
    Grahn Kronhed, Ann-Charlotte
    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.
    Knutsson, Inger
    Primary Health Care Laboratory, Vadstena, Sweden.
    Löfman, Ove
    Linköping University, Department of Department of Health and Society. 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.
    Toss, Göran
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences.
    Möller, Margareta
    Research and Development Unit, Primary Health Care, BorÅs, Sweden.
    Is calcaneal stiffness more sensitive to physical activity than forearm bone mineral density?: A population-based study of persons aged 20-79 years2004In: Scandinavian Journal of Public Health, ISSN 1403-4948, Vol. 32, no 5, p. 333-339Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of this study was to investigate the associations between forearm bone mineral density (BMD), calcaneal stiffness, and physical activity levels in a normal population using different non-invasive methods.

    Methods: The participants were invited to undergo bone measurements using single photon absorptiometry of the forearm and quantitative ultrasound (QUS) of the calcaneal bone, and also to complete a questionnaire. Physical activity levels were designated low, moderate, and high in the question on leisure-time activity.

    Results: There were 956 participants included in the present study. Forearm BMD in the eighth age decade was 0.40 g/cm2 (95% CI 0.33 - 0.46 g/cm2) lower than in the third decade among women and 0.28 g/cm2 (95% CI 0.18 - 0.37 g/cm2) lower among men. The differences in calcaneal stiffness between the same age decades were 22.4 (95% CI 17.5 - 27.4) among women and 15.8 (95% CI 8.0 - 23.5) among men. The correlation between forearm BMD and calcaneal stiffness was 0.58 (95% CI 0.52 - 0.64) in women and 0.34 (95% CI 0.25 - 0.42) in men. Reported moderate and high leisure-time activity levels in both genders were associated with higher calcaneal stiffness but not with forearm BMD.

    Conclusions: The QUS may be used to measure the effect of present physical activity levels on calcaneal bone at the population level. Further longitudinal studies are warranted in order to determine the most appropriate non-invasive method in population-based studies.

  • 138.
    Grahn Kronhed, Ann-Charlotte
    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.
    Möller, C.
    Olsson, B.
    Möller, Margareta
    Research and Development Unit, Primary Health Care, BorÅs, Sweden.
    The effect of short-term balance training on community-dwelling older adults2001In: Journal of Aging & Physical Activity, ISSN 1063-8652, Vol. 9, no 1, p. 19-31Article in journal (Refereed)
    Abstract [en]

    This study evaluated a balance-training program's influence in healthy older adults. Fifteen community-dwelling participants aged 70Ð75 years were randomized to an exercise group, and 15 gender- and age-matched participants, to a control group. The 9-week training program comprised ordinary-life balance, vestibular-habituation, and ball exercises and station training. Clinical balance tests were conducted before and after training. Tests that showed significant improvement in the exercise group after the intervention included standing on the right leg with eyes closed, standing on the right leg and the left leg while turning the head and walking 30 m. Significant between-group differences were found at posttest. A significant decrease was seen in the control group in the walking-forward test, and this change was significantly different between groups. The study indicates that balance performance in healthy older adults might be improved by balance training including exercises that stimulate multiple sensory systems and their central integration.

  • 139.
    Gregersen, Nils. P.
    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.
    Berg, Hans-Yngve
    Linköping University, Department of health and environment.
    Lifestyle and accidents among young drivers1994In: Accident Analysis & Prevention, ISSN 0001-4575, Vol. 26, no 3, p. 297-303Article in journal (Refereed)
    Abstract [en]

    This study covers the lifestyle component of the problems related to young drivers' accident risk. The purpose of the study is to measure the relationship between lifestyle and accident risk, and to identify specific high-risk and low-risk groups. Lifestyle is measured through a questionnaire, where 20-year-olds describe themselves and how often they deal with a large number of different activities, like sports, music, movies, reading, cars and driving, political engagement, etc. They also report their involvement in traffic accidents. With a principal component analysis followed by a cluster analysis, lifestyle profiles are defined. These profiles are finally correlated to accidents, which makes it possible to define high-risk and low-risk groups. The cluster analysis defined 15 clusters including four high-risk groups with an average overrisk of 150% and two low-risk groups with an average underrisk of 75%. The results are discussed from two perspectives. The first is the importance of theoretical understanding of the contribution of lifestyle factors to young drivers' high accident risk. The second is how the findings could be used in practical road safety measures, like education, campaigns, etc.

  • 140.
    Gregersen, Nils. P.
    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.
    Berg, Hans-Yngve
    Swedish National Road and Transport Research Institute (VTI), Linköping, Linköping, Sweden.
    Engström, Inger
    Swedish National Road and Transport Research Institute (VTI), Linköping, Linköping, Sweden.
    Nolén, Sixten
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nyberg, Anders
    Linköping University, Department of Department of Health and Society.
    Rimmö, Per-Arne
    Department of Psychology, University of Uppsala, Uppsala, Sweden.
    Sixteen years age limit for learner drivers in Sweden: an evaluation of safety effects2000In: Accident Analysis and Prevention, ISSN 0001-4575, Vol. 32, no 1, p. 25-35Article in journal (Refereed)
    Abstract [en]

    Through a reform implemented in Sweden, September 1993, the age limit for practising car driving was lowered from 17½ to 16 years while the licensing age remained 18. The purpose of lowering the age limit was to give the learner drivers an opportunity to acquire more experience as drivers before being allowed to drive on their own. The primary aim of this study was to evaluate the effect of the reform in terms of accident involvement and data were therefore obtained from the national register of police reported accidents. The results show that after the reform there was a general reduction in the accident risk (accidents per 10 million km) of novice drivers with approximately 15%. Additional analyses show that the reduction of accident risk in the group who utilised the new age limit was approximately 40%, whereas those who did not utilise the prolonged training period did not benefit at all. Between 45 and 50% of the age population were found to utilise the reform. The accident reduction does not seem to be just an initial first year effect since the results were similar over 3 years of novice drivers during their first 2 years with a licence. These results suggest that the reform has been beneficial for the safety of novice drivers in Sweden. The results also suggest a potential for additional safety improvements if more young learner drivers can be brought to utilise the low age limit.

  • 141.
    Gregersen, Nils. P.
    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.
    Nyberg, Anders
    Linköping University, Department of Department of Health and Society.
    Berg, Hans-Yngve
    Accident involvement among learner drivers: an analysis of the consequences of supervised practice2003In: Accident Analysis and Prevention, ISSN 0001-4575, Vol. 35, no 5, p. 725-730Article in journal (Refereed)
    Abstract [en]

    It is a well-known fact that experience is important for safe driving. Previously, this presented a problem since experience was mostly gained during the most dangerous period of driving—the first years with a licence. In many countries, this “experience paradox” has been addressed by providing increased opportunities to gain experience through supervised practice. One question, however, which still needs to be answered is what has been lost and what has been gained through supervised practice. Does this method lead to fewer accidents after licensing and/or has the number of accidents in driving practice increased? There were three aims in the study. The first was to calculate the size of the accident problem in terms of the number of accidents, health risk and accident risk during practising. The second aim was to evaluate the solution of the “experience paradox” that supervised practice suggests by calculating the costs in terms of accidents during driving practice and the benefits in terms of reduced accident involvement after obtaining a licence. The third aim was to analyse conflict types that occur during driving practice. National register data on licence holders and police-reported injury accidents and self-reported exposure were used. The results show that during the period 1994–2000, 444 driving practice injury accidents were registered, compared to 13,657 accidents during the first 2 years with a licence. The health risk during the period after licensing was 33 times higher and the accident risk 10 times higher than the corresponding risk during practice. The cost-benefit analysis showed that the benefits in terms of accident reduction after licensing were 30 times higher than the costs in terms of driving practice accidents. It is recommended that measures to reduce such accidents should focus on better education of the lay instructor, but not on introducing measures to reduce the amount of lay-instructed practice.

  • 142.
    Grodzinsky, Ewa
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Hallert, Claes
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Bergfors, Elisabet
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Olsen Faresjö, Åshild
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Could gastrointestinal disorders differ in two close but divergent social environments?2012In: International Journal of Health Geographics, ISSN 1476-072X, E-ISSN 1476-072X, Vol. 11, no 5Article in journal (Refereed)
    Abstract [en]

    Background: Many public health problems in modern society affect the gastrointestinal area. Knowledge of the disease occurrence in populations is better understood if viewed in a psychosocial context including indicators of the social environment where people spend their lives. The general aim of this study was to estimate the occurrence in the population and between sexes of common gastrointestinal conditions in two neighborhood cities representing two different social environments defined as a "white-collar" and a "blue-collar" city. less thanbrgreater than less thanbrgreater thanMethods: We conducted a retrospective register study using data of diagnosed gastrointestinal disorders (cumulative incidence rates) derived from an administrative health care register based on medical records assigned by the physicians at hospitals and primary care. less thanbrgreater than less thanbrgreater thanResults: Functional gastrointestinal diseases and peptic ulcers were more frequent in the white-collar city, while diagnoses in the gallbladder area were significantly more frequent in the blue-collar city. Functional dyspepsia, irritable bowel syndrome, and unspecified functional bowel diseases, and celiac disease, were more frequent among women while esophageal reflux, peptic ulcers, gastric and rectal cancers were more frequent among men regardless of social environment. less thanbrgreater than less thanbrgreater thanConclusions: Knowledge of the occurrence of gastrointestinal problems in populations is better understood if viewed in a context were the social environment is included. Indicators of the social environment should therefore also be considered in future studies of the occurrence of gastrointestinal problems.

  • 143.
    Gustafsson, Klas
    et al.
    Karolinska Institute.
    Backenroth-Ohsako, Gunnel
    Karolinska Institute.
    Rosenhall, Ulf
    Karolinska Institute.
    Ternevall-Kjerulf, Elisabeth
    Karolinska Institute.
    Ulfendahl, Mats
    Karolinska Institute.
    Alexanderson, Kristina
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Future risk for disability pension among people with sickness absence due to otoaudiological diagnoses: a population-based cohort study with a 12-year follow-up2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 5, p. 501-507Article in journal (Refereed)
    Abstract [en]

    Hearing difficulties is a growing public health problem and more knowledge of consequences of those difficulties in working life is warranted. Aims: To study the future risk of being granted a disability pension (DP) among people with sickness absence with an otoaudiological diagnoses (OAD) compared to other sickness absentees. Methods: A population-based prospective cohort study of all 40,786 people in a Swedish county who in 1985 were aged 16-64 and had a new sick-leave spell greater than 7 days. Those were followed for 12 years with regard to DP. Hazard ratios (HR) + 95% confidence intervals (CI) of being granted DP was calculated among those with sick leave due to OAD compared to people with sickness absence with other diagnoses. Results: In 1985, 515 people had a new sick-leave spell with an OAD. Twelve years later, 36% of those had been granted DP, compared to 24% of all other sickness absentees. Their HR for DP was 1.42 (95% CI 1.23-1.64) adjusting for gender and age. Compared to men, women with an OAD had a HR of DP of 1.24 (95% CI 0.90-1.71), when adjusted for age. The HR for DP regarding those aged greater than 45 years and sickness absent with OAD was 2.63 (95% CI 1.95-3.55) compared to the sickness absentees with OAD below 45 years of age, adjusted for gender. Conclusions: The risk for future DP was more than 40% higher among those initially on sickness absence due to OAD than among other sickness absentees.

  • 144.
    Gyllensvärd, Harald
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Cost-effectiveness of injury prevention - a systematic review of municipality based interventions.2010In: Cost effectiveness and resource allocation : C/E, ISSN 1478-7547, Vol. 8, p. 17-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Injuries are a major cause of mortality and morbidity which together result in avoidable societal costs. Due to limited resources, injury prevention interventions need to demonstrate cost-effectiveness to justify their implementation. However, the existing knowledge in this area is limited. Consequently, a systematic review is needed to support decision-making and to assist in the targeting of future research. The aim of this review is to critically appraise the published economic evidence of injury prevention interventions at the municipal level. METHODS: A search strategy was developed to focus a literature search in PubMed, Embase, Cochrane and NHS EED. Studies were eligible for inclusion if they were economic evaluations of injury prevention interventions that could be implemented by municipalities; had a relevant comparison group; did not include any form of medication or drug use; and were assessed as having at least an acceptable quality from an economic point of view. Articles were screened in three steps. In the final step, studies were critically appraised using a check-list based on Drummond's check-list for assessing economic evaluations. RESULTS: Of 791 potential articles 20 were accepted for inclusion. Seven studies showed net savings; four showed a cost per health score gained; six showed both savings and a cost per health score gained but for different time horizons and populations; and three showed no effect. The interventions targeted a range of areas such as traffic safety, fire safety, hip fractures, and sport injuries. One studied a multi-targeted community-based program. Only six articles used effectiveness data generated within the study. CONCLUSIONS: The results indicate that there are injury prevention interventions that offer good use of societal resources. However, there is a lack of economic evidence surrounding injury prevention interventions. This lack of evidence needs to be met by further research about the economic aspects of injury prevention interventions to improve the information available for decision-making.

  • 145.
    Hagberg, Jan
    et al.
    Karolinska Institute.
    Vaez, Marjan
    Karolinska Institute.
    Alexanderson, Kristina
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Methods for analysing individual changes in sick-leave diagnoses over time2010In: WORK-A JOURNAL OF PREVENTION ASSESSMENT and REHABILITATION, ISSN 1051-9815, Vol. 36, no 3, p. 283-293Article in journal (Refereed)
    Abstract [en]

    Several methodological challenges arise when attempting to analyse individual data on changes of sick-leave diagnoses over several years. Sick-leave spells for a person can recur, have different sick-leave diagnoses, and both these aspects are dependent of previous episodes, the numbers of repeated periods vary across subjects, and standard statistical methods are not valid for variables on nominal scales, e. g. sick-leave diagnoses. Objective: Our aim was to ascertain whether the number and pattern of changes in sick-leave diagnoses are associated with future disability pension (DP) and to test methods for analysis of repeated measurements on nominal data. Participants: Data from a 12-year prospective cohort study of the 8000 sick-leave periods of the 213 persons aged 25-34 who, in 1985, had a new sick-leave spell andgt;= 28 days with back diagnoses were used. Methods: We used entropies, uncertainty coefficients adjusted for repeated measurements, and transition matrices to examine the changes in sick-leave diagnoses that occurred during follow up. Results: In the 12 years 22% were granted DP and they had changed sick-leave diagnosis less frequently and more often had new sick-leave periods with musculoskeletal diagnoses than the others. The variation in diagnoses and the degree of dependence between consecutive diagnoses were associated with DP. Conclusions: Many tools in statistics are based on linear methods that require numerical variables, but such methods are not valid for repeated measurements on discrete variables on nominal scales, as for sick-leave diagnosis. In such cases, it can be beneficial to use tools that are applied in statistical information theory.

  • 146.
    Hagdahl, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Development of IT-supported Inter-organisational Collaboration: A Case Study in the Swedish Public Sector2002Doctoral thesis, monograph (Other academic)
    Abstract [en]

    Collaboration across the organisational boundaries takes place for different reasons. One of them is to solve complex problems that cannot be dealt with by a single organisation. The area of vocational rehabilitation constitutes an example of inter-organisational collaboration motivated by a need for joint problem solving. Individuals are admitted to vocational rehabilitation with the aim of entering or re-entering the labour market. These individuals constitute a heterogeneous group with different kinds of problems, based on e.g. their social situation, long-term diseases and/or substance abuse. As a result, they are handled at more than one welfare state agency at the time, and the practitioners working at these agencies need to collaborate to find individual solutions for their clients. The expected positive effects of such collaboration are long-term planning, increased quality of the casee management, and reductions of invested time and money.

    In this thesis, an interpretive case study of inter-organisational teamwork within the vocational rehabilitation is presented. The aim of the study was to investigate how the collaboration could be supported by information technology.

    During a time period of two years, practitioners from three welfare state agencies took part in the research project, The activities included observations of the teamwork, individual interviews with the practitioners and design of information technology that should support the teamwork. An essential part of the design activities was the user representatives' direct participation in the design group, composed by practitioners and researchers. To stimulate the participation, methods with its origin in the participatory design approach were used.

    The design requirements that were defined included support for the team's communication and joint documentation of cases, and also information sharing about previous, present and future rehabilitation activities. The teamwork was characterised by an open, positive atmosphere where the practitioners were trying to find solutions for the clients within the frames of the current rules and regulations, limited by the resources allocated for vocational rehabilitation activities. However, the environment was also found to be dynamic with changing, and in some cases conflicting, enterprise objectives, Furthermore, the enterprise objectives were not broken down into tangible objectives on the operational level.

    The physical team meetings and the meetings with the clients constituted essential parts of the work practices and it is concluded that these meetings should not be substituted by technology. The case management could, however, be supported by a flexible tool that meets the users' needs of freedom of action.

  • 147.
    Hagglund, Martin
    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.
    Waldén, Marcus
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    UEFA injury study-an injury audit of European Championships 2006 to 20082009In: BRITISH JOURNAL OF SPORTS MEDICINE, ISSN 0306-3674, Vol. 43, no 7, p. 483-489Article in journal (Refereed)
    Abstract [en]

    Objective: To study the incidence and nature of injuries at European Championships, to compare training and match injury characteristics and to study differences in injury incidence between tournaments. Design: Team physicians prospectively recorded individual player exposure and time loss injuries during 12 European Championships (mens EURO n = 1, mens Under-21 n = 2, mens Under-19 n = 3, mens Under-17 n = 3, womens Under-19 n = 3) from 2006 to 2008. Setting: International football tournaments Participants: 1594 men and 433 women Main outcome measurement: Injury incidence Results: 224 injuries (45 training, 179 match play) were registered among 208 (10%) players. No differences in training injury incidence were seen between tournaments (range 1.3-3.9 injuries/1000 hours). The mens EURO had the highest match injury incidence (41.6 injuries/1000 hours) followed by the mens Under-21 tournaments (33.9). The lowest match injury incidence was seen in the womens Under-19 tournaments (20.5). Training injuries constituted 20% of all injuries and caused 26% of all match unavailability. A greater proportion of match injuries were due to trauma (83 vs 47%, p less than 0.001) and occurred from player contact (75 vs 48%, p = 0.018) compared to training injuries. A higher frequency of reinjury was found among training injuries than match injuries (20 vs 6%, p = 0.009). Conclusions: Match injury incidence increased with age, indicating greater risk with higher intensity of play. Training injury incidence was relatively low, but training injuries were responsible for a quarter of all match unavailability and may thus have a profound impact on team performance and should be the object of preventive measures.

  • 148.
    Hallberg, Niklas
    et al.
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Eriksson, Henrik
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    The medical software quality deployment method1999In: Methods of Information in Medicine, ISSN 0026-1270, Vol. 38, no 1, p. 66-73Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to develop a Quality Function Deployment (QFD) model for design of information systems in health-care environments. Consecutive blocked-subject case studies were conducted, based on action research methods. RESULTS: Starting with a QFD model for software development, a model for information system design, the Medical Software Quality Deployment (MSQD) model, was developed. The MSQD model was divided into the pre-study phase, in which the customer categories and their power to influence the design are determined; the data collection phase, in which the voice of customers (VoC) is identified by observations and interviews and quantified by Critical. Incident questionnaires; the need specification phase, where the VoC is specified into ranked customer needs; and the design phase where the customer needs are transformed stepwise to technical requirements and design attributes. QFD showed to be useful for integrating the values of different customer categories in software development for health-care settings. In the later design phases, other quality methods should be used for software implementation and testing.

  • 149.
    Hass, Ursula
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Brodin, Håkan
    Linköping University, Department of Management and Engineering, Engineering Materials. Linköping University, The Institute of Technology.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Assessment of computer-aided assistive technology: analysis of outcomes and costs1997In: Augmentative and Alternative Communication: AAC, ISSN 0743-4618, E-ISSN 1477-3848, Vol. 3, no 2, p. 125-135Article in journal (Refereed)
    Abstract [en]

    The objectives of this study were to identify and quantify outcomes related to implementation of computer-aided assistive technologies (CAAT) for individuals with communication disabilities and to analyze CAAT costs comprising the selected devices as well as the selection process. The study was designed as a pre/post, longitudinal study. Intermediate and global measures were used as outcome measures. Costs reflecting the resource consumption for the selected devices as well as the selection process were estimated. Individuals with communication disabilities who were referred to the regional CAAT centers were asked to participate in the study. Eighty-seven individuals were recruited. The study shows that usage of CAAT involves reasonable marginal costs for the selection process and equipment (on average SEK 14,800). Usage of CAAT diminishes disability and increases skills in handling computers. However, the outcomes are not entirely positive regarding handicap, health-related quality of life, and utility.

    Read More: http://informahealthcare.com/doi/abs/10.1080/07434619712331277928

  • 150. Hensing, G
    et al.
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    The association between sex segregation, working conditions, and sickness absence among employed women2004In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 61, no 2Article in journal (Refereed)
    Abstract [en]

    Aims: To analyse the association between sickness absence and sex segregation of occupation and of work site, respectively, and to analyse work environmental factors associated with high sickness absence. Methods: The study group consisted of 1075 women employed as nurses, assistant nurses, medical secretaries, or metal workers who answered a questionnaire comprising 218 questions on women's health and living conditions. Sickness absence was collected from employers' and social insurance registers. Results: Women working in the male dominated occupation had in general higher sickness absence compared to those working in female dominated occupations. However, metal workers at female dominated work sites had 2.98 (95% CI 2.17 to 3.79) sick-leave spells per woman and year compared to 1.70 (95% CI 1.29 to 2.10) among those working with almost only men. In spite of a better physical work environment, female metal workers at a female dominated work site had a higher sickness absence than other women, which probably could be explained by the worse psychosocial work environment. Working with more women also had a positive association to increased frequency of sick-leave spells in a multivariate analysis including several known indicators of increased sick-leave. Conclusions: There was an association between sickness absence and sex segregation, in different directions at the occupational and work site level. The mechanism behind this needs to be more closely understood regarding selection in and out of an occupation and a certain work site.

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