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  • 101.
    Lindqvist, Kent
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Schelp, I
    Åhlgren, M
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Evaluation of a home injury prevention program in a WHO Safe community. 1999In: International journal for consumer and product safety, ISSN 1387-3059, Vol. 6, p. 25-32Article in journal (Refereed)
  • 102.
    Lindqvist, Kent
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Schelp, L
    Evaluation of an inter-organizational prevention program against injuries among the elderly in a WHO Safe Community2001In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 115, no 5, p. 308-316Article in journal (Refereed)
    Abstract [en]

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

  • 103.
    Lindqvist, Kent
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Schelp, L
    Evaluation of inter-organizational traffic injury prevention in a WHO safe community2001In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 33, no 5, p. 599-607Article in journal (Refereed)
    Abstract [en]

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

  • 104.
    Lindqvist, Kent
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Schelp, L.
    arolinska Institute, Department of Public Health Sciences, Division of Social Medicine, Norrbacka, Stockholm, and National Institute of Public Health, Stockholm, Sweden .
    Risto, Olof
    Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences.
    Evaluation of a child safety program based on the WHO Safe Community model2002In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 8, no 1, p. 23-26Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 105.
    Lindqvist, Kent
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Schelp, Å
    Schelp, L
    Åhlgren, M
    Åhlgren, M
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Evaluation of an inter-organizational program for prevention of work-related injuries in a WHO Safe Community.1999In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 13, p. 89-96Article in journal (Refereed)
  • 106.
    Medin, Jennie
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, National Centre for Work and Rehabilitation.
    Alexanderson, Kristina
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Begreppen Hälsa och Hälsofrämjande - en litteraturstudie.2001Book (Other academic)
    Abstract [sv]

    Begreppen hälsa och hälsofrämjande används alltmer i olika måldokument på lokal, nationell och internationell nivå. Det är dock sällan som begreppen definieras. Detta har inneburit en stor osäkerhet kring vad som egentligen avses med dessa begrepp och denna osäkerhet har ibland skapat irritation över vad som uppfattats som ”flummigt” och vagt kring hälsa.Denna bok är en litteraturgenomgång av olika teorier om och definitioner av hälsa och hälsofrämjande. Teorier och definitioner förklaras och klassificeras utifrån termer som holistisk, biostatistisk, teleologisk, strategi, handling o.s.v. Vi belyser frågor som: Är hälsa motsatsen till sjukdom? Är hälsa något annat än frånvaro av sjukdom? Går den att förklara med termer som handlingsförmåga, välbefinnande eller mening? Finns det någon skillnad mellan hälsofrämjande och prevention? Vad kan olika hälsosyner ha för inverkan på mötet med patienter, klienter etc.Målgruppen omfattar blivande och praktiserande läkare, sköterskor, folkhälsovetare, arbetsterapeuter, socionomer och andra yrkesgrupper som professionellt arbetar med hälsa och hälsofrämjande.

  • 107.
    Medin, Jennie
    et al.
    Linköping University, Department of Department of Health and Society, National Centre for Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Department of Health and Society, National Centre for Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Health promotion and rehabilitation: a case study2003In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 25, no 16, p. 908-915Article in journal (Refereed)
    Abstract [en]

    Background: Since the number of people in Sweden on long-term sick leave has rapidly increased since 1996, new non-biomedical models of occupational rehabilitation are at stake. A group of seven women who had finished medical treatment and rehabilitation but were still on sick leave or temporary disability pension for several years, worked in a problem-based rehabilitation group for 6 months. Focus for the group was on a process of change towards health and work ability.

    Purpose: The aim of this case study was to improve understanding of effects of a problem-based rehabilitation model (PBR) on health promoting processes amongst a group of women on long-term sick leave. Method: Data source was a focus group interview. The analysis follows the guidelines of qualitative analysis that emerges from grounded theory.

    Results: The pedagogical model of PBR enhanced the participant's internal resources such as self-confidence and ability to act in a social setting. External resources such as social support were improved. An individual follow-up was conducted 2 years after the rehabilitation process and four out of seven women had returned to work.

    Conclusion: Among this group of women PBR launched health-promoting processes. When the more medically oriented treatment is finished or is not able to contribute further to the individual's recovery, other aspects of the individuals abilities and health resources will be focused upon.

  • 108. Messing, K
    et al.
    Punett, L
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Pyle, J
    Zahm, S
    Wegman, D
    Stock, S
    Grosbois, S
    Be the fairest of them all: Challenges and recommendations for the treatment of gender in occupational health research2003In: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 43, no 6, p. 618-629Article in journal (Refereed)
    Abstract [en]

    Background Both women's and men's occupational health problems merit scientific attention. Researchers need to consider the effect of gender on how occupational health issues are experienced, expressed, defined, and addressed. More serious consideration of gender-related factors will help identify risk factors for both women and men. Methods The authors, who come from a number of disciplines (ergonomics, epidemiology, public health, social medicine, community psychology, economics, sociology) pooled their critiques in order to arrive at the most common and significant problems faced by occupational health researchers who wish to consider gender appropriately. Results This paper describes some ways that gender can be and has been handled in studies of occupational health, as well as some of the consequences. The paper also suggests specific research practices that avoid errors. Obstacles to gender-sensitive practices are considered. Conclusions Although gender-sensitive practices may be difficult to operationalize in some cases, they enrich the scientific quality of research and should lead to better data and ultimately to well-targeted prevention programs. ⌐ 2003 Wiley-Liss, Inc.

  • 109. Morin, Magnus
    et al.
    Eriksson, Henrik
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Jenvald, Johan
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Simulating Influenza Outbreaks in Local Communities2005In: BioMedSim,2005, 2005, p. 17-23Conference paper (Refereed)
  • 110.
    Moula, Alireza
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Population-based empowerment practice in immigrant communities: a socio-medical study of Iranian families in Sweden2005Doctoral thesis, monograph (Other academic)
    Abstract [en]

    The significant social problems that confront Iranian families that have immigrated to Western countries have been described in the literature, in particular regarding the difficulties between parents and their adolescent children. However, the investigations that have been performed have not focused on how the situations of these families can be improved. Therefore, I conducted an intervention study involving Iranian families in Sweden, one of the largest immigrant groups in this country. The objectives were as follows: (1) to describe how ideas about family pedagogy held by parents and adolescents are affected by move from a country with prevailing traditional family values to a Western society such as Sweden; and (2) to construct a family pedagogy based on the opinions/narratives of members of immigrant families (especially adolescents), and subsequently put this teaching into practice and then evaluate the results of that endeavor.

    The empirical data comprised 25 interviews with parents and adolescents, 10 letters written by adolescents, and some other evidence collected in Sweden and Iran. Symbolic interactionism was the main theoretical perspective that guided the entire research process, including the selection of methods. Therefore, it was natural to use methods from ethnography and grounded theory, as well as narrative analysis. Analysis of the data revealed three important dimensions in parent-adolescent relationships: power, communication, and intimacy. A model of visionary family pedagogy was constructed based on the analysis of the data, the UN:s Child Convention, and the application of symbolic interactionism done to gain an understanding of parent-adolescent relationships.

    Following the pragmatist circle of theory-practice-theory and in order to improve the situations of the Iranian families in Sweden, I initiated a two-year intervention program aimed at educating and supporting these people. This program was carried out within the Swedish Organization for the Rights of Children (BRIS) and used communication technology such as live local radio lectures and a telephone help-line to provide support. From 1998 to 2000, as many as 13,000 Iranians listened to a total of 83 live broadcasts, and 525 calls lasting a total of 22,507 minutes were made by Iranians for private family counseling. A pragmatist empowerment model for problem solving was developed and used both in the educative radio programs and especially in the help-line conversations.

    The intervention program was evaluated together with a senior researcher. The problem-solving model has been taught to university students and to practicing social workers in Sweden since 2000. Experience from the intervention program has also been transferred to a child organization in Iran (the Society for Protecting the Rights of the Child, SPRC). As a result, the first telephone help-line for families has been started in Iran, and the problemsolving model has been taught to practicing social workers.

  • 111. Mörch, M
    et al.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Granérus, Ann-Kathrine
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Östergötlands Läns Landsting, MC - Medicincentrum, Geriatrik-LAH.
    Thirty year´s experience with cancer and non-cancer patients in palliative home care.1999In: Journal of Palliative Care, ISSN 0825-8597, Vol. 15, p. 43-48Article in journal (Refereed)
  • 112.
    Müssener, Ulrika
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Svensson, Tommy
    Linköping University, Department of Behavioural Sciences. Linköping University, Faculty of Health Sciences.
    Söderberg, Elsy
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Alexandersson, Kristina
    Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska lnstitutet, Stockholm, Sweden.
    Sickness absentees' experiences of positive encounters by healthcare and sickness insurance professionals: an interview studyManuscript (preprint) (Other academic)
    Abstract [en]

    We need more knowledge on factors that can promote retum to work (RTW) grounded on peoples' own views. One such factor of importance is the way absentees themselves experience their interactions with professionals. The purpose of the study was to identify and analyse sick-listed persons' experiences of positive encounters with professionals.

    An inductive and descriptive-qualitative approach was used to analyse transcripts from 11 semi-structured interviews with persons after or during long-term sickness absence. Being treated with respect, feeling supported, establishing a personal relationship, perceiving demands as well-balanced, and patiicipating in decisions regarding rehabilitation appeared as important qualities. Several interviewees believed that positive encounters might promote RTW.

    Further research is needed to elucidate the aspects of such interactions that enhance empowerment and self-confidence in persons on sick leave, in order to develop professional treatment strategies that facilitates for rehabilitation, and to favour collaborative work between and within group of professionals.

  • 113.
    Nalmpantis, Dimitrios
    et al.
    Grekland.
    Naniopoulos, Aristotelis
    Grekland.
    Bekiaris, Evangelos
    Grekland.
    Panou, Maria
    Grekland.
    Gregersen, Nils-Petter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Falkmer, Torbjörn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Paediatric Habilitation Community Service.
    Baten, Guido
    Belgien.
    Dols, Juan F
    Spanien.
    "Trainer" project: Pilot applications for the evaluation of new driver training technologies2005In: Traffic & Transport Psychology -: Theory and application: proceedings of the ICTTP 2004 / [ed] Geoffrey Underwood, Oxford: Elsevier , 2005, p. 141-156Chapter in book (Other academic)
    Abstract [en]

    Just as our transport systems become more and more important to our economic and social well-being, so they become more and more crowded and more at risk from congestion, disruption, and collapse. Technology and engineering can provide part of the solution, but the complete solution will need to take account of the behaviour of the users of the transport networks.

    The role of psychologists in this is to understand how people make decisions about the alternative modes of transport and about the alternative routes to their destinations, to understand how novice and other vulnerable users can develop safe and effective behaviours, how competent users can operate within the transport system optimally and within their perceptual and cognitive limitations.

    The contributions to this volume address these issues of how the use of our transport systems can be improved by taking into account knowledge of the behaviour of the people who use the systems. Topics discussed include driver training and licensing, driver impairment, road user attitudes and behaviour, enforcement and behaviour change, driver support systems, and the psychology of mobility and transport mode choice.

    This work will be of value not only to psychologists but to all transport professionals interested in the application of psychology to traffic

  • 114.
    Nettelbladt, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Mattisson, Cecilia
    Bogren, Mats
    Holmqvist, Marika
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Suicide Rates in the Lundby Cohort before and after the Introduction of Tricyclic Antidepressant Drugs2007In: Archives of Suicide Research, ISSN 1381-1118, E-ISSN 1573-8159, no 11, p. 57-67Article in journal (Refereed)
  • 115.
    Nijm, Johnny
    et al.
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Olsson, Anders G.
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
    Jonasson, Lena
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
    Impaired cortisol response to acute stressors in patients with coronary disease: Implications for inflammatory activity2007In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 262, no 3, p. 375-384Article in journal (Refereed)
    Abstract [en]

    Objectives: Inflammation is assumed to play a major role in the progress of atherosclerotic disease. We hypothesized that an altered hypothalamic-pituitary adrenal (HPA) axis activity was linked to a disinhibited inflammatory activity in patients with coronary artery disease (CAD).

    Methods: Thirty CAD patients were assessed 12-14 weeks after a first-time acute coronary syndrome. Serum samples were assayed for C-reactive protein (CRP) and interleukin-6. Free cortisol was measured in a 24-h urine sample and in repeated saliva samples 30 min after awakening and at bedtime. The levels of inflammatory markers and cortisol were also determined before and after standardized physical and psychological stress tests.

    Results: The CAD patients had a higher 24-h cortisol secretion and a flattened diurnal slope, resulting from significantly higher cortisol levels at bedtime, compared to clinically healthy controls. The levels of evening cortisol were strongly related to inflammatory markers in serum. When exposed to acute physical and psychological stressors, the CAD patients showed a significantly blunted cortisol response compared to controls. In addition, a stress-induced increase in CRP was only observed in the patient group.

    Conclusions: Patients with CAD exhibited a cortisol pattern that markedly differed from controls. The data indicate that a dysfunctional HPA axis response involves a failure to contain inflammatory activity in CAD patients, thus providing a possible link between stress and inflammation in disease.

  • 116.
    Nilsen, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Evaluation of community-based injury prevention programmes: methodological issues and challenges.2005In: International journal of injury control and safety promotion, ISSN 1745-7300, Vol. 12, no 3, p. 143-156Article in journal (Refereed)
    Abstract [en]

    The evaluation of comprehensive community-based injury prevention programmes is complex and poses many methodological challenges. There is little consensus in contemporary literature about the most appropriate methods of evaluating these programmes. This study employed a systematic literature review to examine evaluations of 16 community-based injury prevention programmes with regard to key methodological issues and challenges. Three aspects of the evaluated programmes were analysed: assessed elements (context, structure, process, impact, and outcome), study design, and methodological issues addressed. The results showed that context, structure and process assessments were the most neglected aspects of the evaluation studies. The programmes were typically described with minimal discussion of how the context may have influenced the effectiveness. The process (activities) was described rather than evaluated against appropriate standards of comparisons. Impact evaluations adhered more closely to documented guidelines, but half of the evaluations did not include impact variables. Outcome evaluations focused on injury incidence. Most evaluations employed some qualitative methods, but the vast majority of methods used were quantitative. This study indicated that the quasi-experimental study design has become an accepted norm for the evaluation of community-based injury prevention programmes. Most of the evaluations contained explicit details of the methodology used and of the choices related to the methodology. While threats to internal validity were identified in most studies, problems related to external validity and construct validity were largely overlooked by the evaluators.

  • 117.
    Nilsen, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Strategies for health: An anthology2007Collection (editor) (Other academic)
    Abstract [en]

    This anthology is comprised of six papers, introducing readers to at variety of topics relevant to the Strategies for Health arena. The papers are intended to reflect the breadth of research conducted in Strategies for Health. The aim is to contribute to a greater understanding of the concept of health and provide insight into some strategies for improvement of health and safety. The anthology was edited by Per Nilsen, in cooperation with Lennart Nordenfelt and Kerstin Ekberg, who served as an Editorial Committee.

  • 118.
    Nilsen, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    The how and why of community-based injury prevention A conceptual and evaluation model2007In: Safety Science, ISSN 0925-7535, E-ISSN 1879-1042, Vol. 45, p. 501-521Article in journal (Refereed)
  • 119.
    Nilsen, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Aalto, Mauri
    National Health Institute, Finland.
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Seppä, Kaija
    Tampere University Hospital, Finland.
    Effectivness of strategies to implement brief alcohol intervention in primary healthcare2006In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, no 24Article in journal (Refereed)
  • 120.
    Nilsen, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Holmqvist, Marika
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Nordqvist, Cecilia
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Frequency of heavy episodic drinking among nonfatal injury patients attending an emergency room.2007In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 39, p. 757-766Article in journal (Refereed)
  • 121.
    Nilsen, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Holmqvist, Marika
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Nordqvist, Cecilia
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Linking drinking to injury--causal attribution of injury to alcohol intake among patients in a Swedish emergency room.2007In: International journal of injury control and safety promotion, ISSN 1745-7300, Vol. 14, no 2, p. 93-102Article in journal (Refereed)
    Abstract [en]

    This study analysed the drinking patterns and motivation to change drinking behaviours among injury patients who acknowledged alcohol as a factor in their injuries. A cross-sectional study was conducted over 18 months at a Swedish emergency department. A total of 1930 injury patients aged 18 - 70 years were enrolled in the study (76.8% completion rate). Of those who reported drinking, 10% acknowledged alcohol as a factor in their injury. A patient was more likely to report a causal attribution of the injury to alcohol the higher the weekly intake and the higher the frequency of heavy episodic drinking. The motivation to change variables showed a similar pattern of increased likelihood of attributing a causal link of alcohol and injury with increasing discontent with drinking behaviours and increasing desire to change drinking behaviours. The findings suggest that the ability to measure causal attribution of alcohol to injuries could be a promising tool to help patients explore the association between their injuries and alcohol use and motivate patients to modify drinking behaviours in order to avoid future injuries.

  • 122.
    Nilsen, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Hudson, D S
    Socialmedicin Karolinska institutet.
    Kullberg, Agneta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Ekman, R
    Socialmedicin Karolinska institutet.
    Lindqvist, Kent
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Making sense of safety2004In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 10, p. 71-73Article in journal (Refereed)
  • 123.
    Nilsen, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Hudson, Diana
    Lindqvist, Kent
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Economic analysis of injury prevention - applying results and methodologies from cost- of- injury studies2006In: International journal of injury control and safety promotion, ISSN 1745-7300, Vol. 13, no 1Article in journal (Refereed)
  • 124.
    Nilsen, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Yorkston, Emily
    University of Queensland.
    Uncovering evidence on community-based injury prevention: A review of programme effectiveness and factors influencing effectiveness.2007In: International journal of injury control and safety promotion, ISSN 1745-7300, Vol. 14, no 4, p. 241-250Article in journal (Refereed)
    Abstract [en]

      

  • 125.
    Nilsson, Evalill
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV), Biomedicine.
    Raak, Ragnhild
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV), Biomedicine.
    Wahren, Lis Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV), Biomedicine.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Hälsorelaterad livskvalitet i relation till psykologiska förklaringsvariabler2004In: Svenska Läkarsällskapets Riksstämma,2004, 2004, p. 82-82Conference paper (Other academic)
  • 126.
    Nilsson, Evalill
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies, Natural Science - Medicine - Esthetics - Communication .
    Wenemark, Marika
    IMH Hälsouniversitetet, Linköpings Universitet.
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Respondent satisfaction regarding SF-36 and EQ-5D, and patients' perspectives concerning health outcome assessment within routine health care2007In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 16, no 10, p. 1647-1654Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate respondent satisfaction regarding SF-36 and EQ-5D and patients' perspectives concerning health outcome assessment within routine health care. Methods: Eighteen Swedish hospitals participated in the study which included 30 patient intervention groups (e.g. education groups for patients with ischemic heart disease or chronic obstructive pulmonary disease). Patients responded to SF-36 and EQ-5D before and after ordinary interventions (n = 463), and then completed an evaluation form. Results: Regarding respondent satisfaction, most patients found both questionnaires easy to understand (70% vs. 75% for SF-36 and EQ-5D respectively), easy to respond to (54% vs. 60%), and that they gave the ability of describing their health in a comprehensive way (68% for both). Health outcome assessment in routine health care was perceived as valuable by 57% of the patients, while 4% disapproved. Most patients (68%) considered both questionnaires equally suitable, 25% preferred SF-36 and 8% EQ-5D. Among those who were more satisfied with a short questionnaire (EQ-5D), several still preferred a longer and more comprehensive questionnaire (SF-36). Conclusion: Health outcome assessment within routine health care seems to be acceptable, and even appreciated, by patients. Questionnaire length and ease of response were not found to be crucial arguments in choosing between SF-36 and EQ-5D. © 2007 Springer Science+Business Media B.V.

  • 127.
    Nolén, Sixten
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Increased bicycle helmet use in Sweden: needs and possibilities2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: From the perspective of what is called "vision zero" in Sweden, fatalities and injuries among bicyclists are unacceptable. Despite that, bicyclists constitutes approximately one third of all road user inpatients in Swedish hospitals, which is about the same proportion seen for drivers and passengers of motor vehicles. There are too many bicycle-related head injuries, but the risk of such traumas could be reduced considerably by the use of helmets. Bicycle helmet wearing can be increased by voluntary means, for instance by long-term community-based helmet promotion programs. However, the best effect has been achieved by combining promotion with a compulsory helmet law for all bicyclists, as has been done in Australia, New Zealand, and North America

    Aim: The general aim of the research underlying this dissertation was to provide further information about the need for increased bicycle helmet use in Sweden, and to determine what measures can lead to more widespread helmet wearing. The four papers included addressed two main questions: (1) What is the need for increased helmet wearing among different categories of bicyclists in Sweden? (2) Is a non-compulsory local bicycle helmet law a realistic alternative to a mandatory helmet law for all bicyclists?

    Materials and methods: Observational studies of helmet use by bicyclists in Sweden were conducted once a year (average n = 37,031/year) during the period 1988-2002 (paper I). The general trend in observed helmet wearing in different categories of bicyclists was analyzed by linear regression, and the results were used to predict future trends in helmet wearing. Three studies (papers II-IV) were also performed to evaluate a non-compulsory local bicycle helmet "law" in Motala municipality during the study period 1995 to 1998 (papers II-IV). This law was introduced in 1996 and applies specifically to school children (ages 6-12 years), although the intention is to increase helmet use among all bicyclists. Adoption of the law was accompanied by helmet promotion activities. In one of the studies in the evaluation, written material and in-depth interviews (n=8) were analyzed qualitatively to describe the process and structure of development of the Motala helmet law. The other two studies used a quasi-experimental design to assess the impact of the helmet law: one comprised annual observations of helmet wearing among bicyclists in Motala (average n=2,458/year) and control areas (average n=17,818/year); and the other included questionnaire data on attitudes, beliefs, and self-reported behavior of school children in Motala (n=1,277) and control areas (n=2,198). The average response rate was 72.8%.

    Results and discussion: There was a significant upward trend in helmet use in all categories of bicyclists from 1988 to 2002. Helmet wearing increased from 20% to 35% among children(≤ 10 years) riding bikes in their leisure time, from 5% to 33% among school children, and from 2% to 14% in adults. Total average helmet use rose from 4% to 17%. However, during the last five years of the study period (1998-2002), there was no upward trend in helmet wearing for any of the categories of bicyclists. If the historic trend in helmet use continues, the average wearing rate will be about 30% by the year 2010. The Motala helmet law was dogged by several problems, mainly during the initiation phase, and some of them led to poor rooting of the law in the schools and indistinct roles and responsibilities of the municipal actors. Despite that, the law initially led to a significant increase in helmet wearing among the primary target group (school children), from a pre-law level of 65% to about 76% six months post-law, whereas thereafter the wearing rate gradually decreased and was at the pre-law level 2 ½ years after the law was adopted. Nonetheless, a weak but significant effect on adult bicyclists remained: the pre-law level of about 2% rose to about 8% at the end of the study period. Only about 10% of bicyclists on bike paths in Motala wore helmets 2 ½ years post-law. The questionnaire study showed one significant effect on school children in Motala two years post-law, namely, a stronger intention to ride bicycles if a national compulsory helmet law was introduced. There was, however, no significant long-term influence on children's attitudes or beliefs about helmet wearing, which agrees with the results of the observational study.

    General conclusions: It is indeed necessary to increase bicycle helmet wearing in Sweden. Both the current average rate of helmet use and the rate predicted for the near future are far from the goal of 80% that was officially proposed by several years ago. Previous research has shown that, to achieve substantial and sustained bicycle helmet use, it is necessary to use helmet promotion in combination with a national helmet law that is compulsory and applies to all bicyclists. The present evaluation of the non-compulsory local helmet law in Motala indicated that this type of initiative is not a powerful alternative to a mandatory national helmet law. Nevertheless, much has been learned from the initiation and implementation of this local action.

    List of papers
    1. Bicycle helmet use in Sweden during the 1990s and in the future
    Open this publication in new window or tab >>Bicycle helmet use in Sweden during the 1990s and in the future
    2005 (English)In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 20, no 1, p. 33-40Article in journal (Refereed) Published
    Abstract [en]

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

    Keywords
    bicycle helmet, observational study, safety promotion
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-29696 (URN)10.1093/heapro/dah505 (DOI)15086 (Local ID)15086 (Archive number)15086 (OAI)
    Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13
    2. A local bicycle helmet ‘law’ in a Swedish municipality: the structure and process of initiation and implementation
    Open this publication in new window or tab >>A local bicycle helmet ‘law’ in a Swedish municipality: the structure and process of initiation and implementation
    2002 (English)In: Injury control and safety promotion, ISSN 1566-0974, E-ISSN 1744-4985, Vol. 9, no 2, p. 89-98Article in journal (Refereed) Published
    Abstract [en]

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

    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-26283 (URN)10.1076/icsp.9.2.89.8695 (DOI)10799 (Local ID)10799 (Archive number)10799 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13
    3. A local bicycle helmet ‘law’ in a Swedish municipality: the effects on helmet use
    Open this publication in new window or tab >>A local bicycle helmet ‘law’ in a Swedish municipality: the effects on helmet use
    2004 (English)In: Injury control and safety promotion, ISSN 1566-0974, E-ISSN 1744-4985, Vol. 11, no 1, p. 39-46Article in journal (Refereed) Published
    Abstract [en]

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

    Keywords
    Bicycle helmet;injury prevention
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-22266 (URN)10.1076/icsp.11.1.39.26314 (DOI)1440 (Local ID)1440 (Archive number)1440 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
    4. A local bicycle helmet ‘law’ in a Swedish municipality: effects on children's attitudes, beliefs and self-reported behavior
    Open this publication in new window or tab >>A local bicycle helmet ‘law’ in a Swedish municipality: effects on children's attitudes, beliefs and self-reported behavior
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

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

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

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

    Keywords
    bicycle helmets, legislation, safety promotion
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-85041 (URN)
    Available from: 2012-10-31 Created: 2012-10-31 Last updated: 2012-10-31
  • 128.
    Nolén, Sixten
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekman, Robert
    Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, Stockholm, Sweden and Swedish Rescue Services Agency, National Centre for Learning from Accidents (NCO), Karlskoga, Sweden .
    Lindqvist, Kent
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bicycle helmet use in Sweden during the 1990s and in the future2005In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 20, no 1, p. 33-40Article in journal (Refereed)
    Abstract [en]

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

  • 129.
    Nolén, Sixten
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    A local bicycle helmet ‘law’ in a Swedish municipality: effects on children's attitudes, beliefs and self-reported behaviorManuscript (preprint) (Other academic)
    Abstract [en]

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

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

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

  • 130.
    Nolén, Sixten
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    A local bicycle helmet ‘law’ in a Swedish municipality: the effects on helmet use2004In: Injury control and safety promotion, ISSN 1566-0974, E-ISSN 1744-4985, Vol. 11, no 1, p. 39-46Article in journal (Refereed)
    Abstract [en]

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

  • 131.
    Nolén, Sixten
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    A local bicycle helmet ‘law’ in a Swedish municipality: the structure and process of initiation and implementation2002In: Injury control and safety promotion, ISSN 1566-0974, E-ISSN 1744-4985, Vol. 9, no 2, p. 89-98Article in journal (Refereed)
    Abstract [en]

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

  • 132.
    Nordlund, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, National Centre for Work and Rehabilitation.
    Ekberg, Kerstin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, National Centre for Work and Rehabilitation.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Group: med:, Linquest
    Ståhlbom, Bengt
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Östergötlands Läns Landsting, Pain and Occupational Centre, Occupational and Environmental Medicine Centre.
    Tondel, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Östergötlands Läns Landsting, Pain and Occupational Centre, Occupational and Environmental Medicine Centre.
    EQ-5D in a general population survey - A description of the most commonly reported EQ-5D health states using the SF-362005In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 14, no 4, p. 1099-1109Article in journal (Refereed)
    Abstract [en]

    The importance of studying health-related quality of life in the general population has increasingly been emphasized. From a public health perspective, this benefits the identification of population inequalities in health status. One of the currently most popular instruments is the EQ-5D. Evaluations of the EQ-5D generally focus on the overall preference-based index. As this index has a built-in value, exploration of the information from the underlying health states is also important. In this study, the ten most commonly reported EQ-5D health states are described using the SF-36. Data collected in 1999 by questionnaires mailed to a random sample aged 20-74 in south-eastern Sweden were used (n = 9489). Almost 43% reported the best possible EQ-5D health state and 78% were accounted for by three EQ-5D health states. The EQ-5D health state classification was largely reflected by the SF-36, with the EQ-5D items mobility, usual activities, pain/discomfort and anxiety/depression tapping most clearly on the SF-36 scales physical functioning, role limitations due to physical health problems, bodily pain, and mental health, respectively. However, within the same level of EQ-5D (i.e., moderate problems) there was a rather large variation of SF-36 scale scores, particularly regarding the EQ-5D item pain/discomfort and the SF-36 scale BP. © Springer 2005.

  • 133. Nordqvist, C
    et al.
    Holmqvist, C
    Cedersund, E
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Att arbeta med ryggont: en pilotstudie med fokusgrupper.1999In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 76, p. 347-356Article in journal (Other (popular science, discussion, etc.))
  • 134.
    Nordqvist, Cecilia
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Holmqvist, C
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Arbetsgivarens betydelse vid sjukskrivning - om att återgå i arbete.2000In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 5, p. 429-437Article in journal (Other (popular science, discussion, etc.))
  • 135.
    Nordqvist, Cecilia
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Beroendekliniken IHS. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Dependency.
    Johansson, Kjell
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Lindqvist, Kent
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Sekundärprevention av alkoholproblem på Motala lasaretts akutmottagning2002In: Riksstämman 2002,2002, 2002Conference paper (Refereed)
  • 136.
    Nordqvist, Cecilia
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Cedersund, Elisabet
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment.
    Holmqvist, C
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Att komma igen. Om att återgå i arbete efter sjukskrivning för rygg-, nack- eller skulderbesvär, en pilotstudie med fokusgrupper.2000In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 4, p. 347-356Article in journal (Other (popular science, discussion, etc.))
  • 137.
    Nordqvist, Cecilia
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Holmqvist, Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Views of laypersons on the role employers play in return to work when sick-listed2003In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 13, no 1, p. 11-20Article in journal (Refereed)
    Abstract [en]

    Sickness absenteeism is an increasing public health problem, but few studies have examined the views of laypersons regarding factors that promote return to work. The present investigation concerns the opinions of such individuals on the role employers play in this context. Data from five focus-group interviews of laypersons with experience of long-term sickness absence were subjected to grounded theory analysis. When asked about factors that hinder or promote return to work, the laypersons spontaneously emphasized the importance of the employer. Specifically, they stressed the need for a structured back-to-work program at each workplace, which should include contacting absent employees and informing fellow workers of possible changes in task assignments upon return of the absent person. Reported hindering factors included lack of such information, leading to envy and harassment. Respondents also asserted the importance of work supervisors in creating a positive emotional atmosphere.

  • 138.
    Nordqvist, Cecilia
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Lindqvist, Kent
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Wilhelm, Elisabeth
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Olycksfall och alkoholvanor2004In: Svenska läkarsällskapets riksstämma,2004, Katrineholm: Sörmlands grafiska Quebecor AB , 2004, p. 46-46Conference paper (Other academic)
  • 139.
    Nyberg, Anders
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Gregersen, Nils Petter
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Practicing for and performance on driver’s license tests in relation to gender differences in crash involvement among novice drivers2007In: Journal of Safety Research, ISSN 0022-4375, E-ISSN 1879-1247, Vol. 38, no 1, p. 71-80Article in journal (Refereed)
    Abstract [en]

    Background: Young male novice drivers are overrepresented in injury motor-vehicle crashes compared to females in the same category. This difference in crash involvement is often assumed to include factors such as overestimation, risk acceptance, and sensation seeking, but it can also be related to acquisition of knowledge, skills, insight, and driving experience. Therefore, this study explored possible gender differences among 18–24-year-olds in Sweden regarding practicing as learners, outcome of the driver's tests, and crash involvement during the first year after licensure.

    Method: Data for 2005 from different sources (e.g., questionnaires, license test, and crash statistics) were examined. It was not possible to follow individual subjects through all stages or in all analyses. Nevertheless, the study design did enable scrutinization and discussion of gender differences between younger inexperienced drivers with respect to education and training, license test results, and initial period of licensure.

    Results: Males and females assimilated tuition in different ways. Females studied more theory, pursued training in a more structured manner, practiced more elements of driving in several different environments, and participated more extensively in driving school instruction. National statistics showed that females did better on the written test but not on the driving test. Males were involved in 1.9 more injury crashes per 1,000 drivers than females during their first year of licensed driving. The proportional distribution of crash types was the same for both sexes during the first period as novice drivers, but the circumstances surrounding the accidents varied (e.g., males were involved in more night crashes).

    Impact on traffic safety: More structured training while learning appears to be one of the reasons why females initially do better than males as novice drivers. Therefore, in the future, driver education should focus not only on matters such as the amount of time spent on training and preconditioning, but also on the importance of the organization and content of the learning process.

  • 140.
    Nyberg, Anders
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Gregersen, Nils Petter
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Wiklund, Mats
    Swedish National Road and Transport Research Institute (VTI), SE-581 95 Linköping, Sweden.
    Practicing in relation to the outcome of the driving test2007In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 39, no 1, p. 159-168Article in journal (Refereed)
    Abstract [en]

    In Sweden, a written and a driving test must be passed for licensure, and these two examinations are the only means of verifying that learner drivers have acquired the competencies stipulated in the national curriculum. The present study investigated 18–24-year olds regarding the effects of personal background and mode of driver education instruction on the outcome of the driving test. This was done by analysing the following for individual subjects: data on practicing obtained using a questionnaire, and test results of license tests. The results suggest that among the candidates under study, there are equal opportunities in the context of obtaining a driver's license independent of a person's background. The rate of passing was higher for those who started behind-the-wheel training at 16 and applied to take the driving test via a driving school, than for those who started the training at an older age and applied to take the test in person. It was also found that the probability of passing the test was greater if there is successful cooperation between learner and driving school instructor, and if a large proportion of the training been devoted to the task speed adaptation.

  • 141.
    Ockander, Marlene
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    A female lay perspective on health, disease, and sickness absence2001Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Knowledge about a female perspective on health and disease is important to understand what happens in e.g. the medical meeting. A deeper understanding for the phenomenon of health also has social and economic importance. In Sweden women account for about 60% of the long-term cases of sickness absence.

    Aim: To explore and describe women's perceptions of health and disease and their accounts of sickness absence.

    Methods: The chronic diseases mentioned by elderly women in an interview study are compared with those documented in their respective medical records (n=199). The prevalence of positive diagnoses, overall agreement, and the kappa-coefficient were calculated for each group of diagnoses. Semi-stmctnred interviews were conducted with 82 women who had been on sick leave (60 days or more) or who had disability pension. Sixty of these middle-aged women also carried out a Q-sort.

    Results: The lowest overall agreement between the elderly women report during interviews and their medical records was observed for psychiatric diseases, followed by diseases of the gastrointestinal system. Poor chance-adjusted agreement was found concerning diseases of the gastrointestinal system and diseases of the skin (Paper I). Long-term sickness absence can be said to arise in three distinguishable "spaces": the workspace, the medical-legal space, and the mental space. In the beginning, the women were positive about sick leave as such, which they saw as an opportunity for physical rest. But as time went on, they came to regard sick leave as creating a vicious circle of new problems related to inactivity and isolation. Apart from this vicious circle and chronic physical impairments, certain conditions at the workplace, at the hospital, and the social insurance office transformed seemingly trivial sick leaves into long-term and irreversible sickness absences (Paper II). The women's accounts of being sickness absent contained interpretations of what had happened to them, how things were for the moment, and what they thought the future would bring. Three different accounts could be distinguished: the crisis, the breakpoint, and the migration. The perceptions of their own situation and especially what they thought about their future were associated with their feelings of power to initiative and well-being. The descriptions of life on sick leave are connected to a theory of "loss of work" (Paper III). For these women, to be able to get back to work was found to be equivalent to breaking away from the prospect of isolation and loneliness. Five actors were identified along with suggestions for their actions: the woman who is on sick leave herself, the employer, the health care provider, the social insurance official, and the shop-steward. It was found important to take oneself seriously and also to be taken seriously by others. The results are related to a theory of enduring and suffering (Paper IV). Six accounts representing different conceptions of health, illness, and medicine were identified and described (Paper V).

    Conclusions: The results point to the importance of doing research from different perspectives, using different methods and different sources of information to obtain a deeper understanding of a complex phenomenon like health. Above all, the results presented in this thesis point to a large variation at the individual level in perceptions, which implies the need for care in, for example, the planning of rehabilitation programs. The results also highlight the point that sick leave without follow-up from work, health care, and the social insurance office might have negative consequences on health. Implications for practice are suggested along with proposals for future research.

    List of papers
    1. Patient-doctor Concordance in Elderly Women’s Self-reported Health and Medical Records
    Open this publication in new window or tab >>Patient-doctor Concordance in Elderly Women’s Self-reported Health and Medical Records
    2002 (English)In: Methods of Information in Medicine, ISSN 0026-1270, Vol. 41, no 2, p. 119-124Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVES: To compare the chronic diseases mentioned by elderly women in an interview study with those documented in their respective medical records.

    METHODS: The prevalence of positive diagnoses, overall agreement, and the kappa-coefficient were calculated for each group of diagnoses.

    RESULTS: The lowest overall agreement was observed for psychiatric diseases, followed by diseases of the gastrointestinal system. Poor chance-adjusted agreement was found concerning diseases of the gastrointestinal system and diseases of the skin.

    CONCLUSIONS: The results suggest that a main reason for discordance was that the elderly women feared "losing face" by reporting some diseases.

    Keywords
    diagnosis, women, medical records, patients, medical decision making
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-26291 (URN)12061118 (PubMedID)10807 (Local ID)10807 (Archive number)10807 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    2. A female lay perspective on the establishment of long-term sickness absence
    Open this publication in new window or tab >>A female lay perspective on the establishment of long-term sickness absence
    2001 (English)In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 10, no 1, p. 74-79Article in journal (Refereed) Published
    Abstract [en]

    In Sweden women account for about 60% of the long-term cases of sickness absence. The aim of this study was to describe women's explanations as to how long-term sickness absence arises and becomes permanent, with reference to their personal experience. Semi-structured interviews were performed with 82 middle-aged women who have personal experience of long-term sickness absence. Long-term sickness absence can be said to arise in three distinguishable “spaces”: the work space, the medico-legal space and the mental space. In the beginning, the women were positive about sick-leave as such, which they saw as an opportunity for physical rest. But as time went on, they came to regard sick-leave as creating a vicious circle of new problems related to inactivity and isolation. Apart from this vicious circle and chronic physical impairments, certain conditions at the workplace, at the hospital and the social insurance office transformed seemingly trivial sick-leaves into long-term and irreversible sickness absences

    Keywords
    sickness absence, lay explanation models, women, phenomenology, interview
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-26067 (URN)10.1111/1468-2397.00154 (DOI)10526 (Local ID)10526 (Archive number)10526 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    3. Women's experiences of long term sickness absence: Is there a "loss of work syndrome"?
    Open this publication in new window or tab >>Women's experiences of long term sickness absence: Is there a "loss of work syndrome"?
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: In most European countries, long-term sickness absence contribute the greatest number of days that are reimbursed due to sickness absence. This group is growing and it is constituted mainly of women.

    Aim: The present study seeks further knowledge about what happens then and there, i.e., how long-term sickness absent women handle and explain, for themselves and others, this interruption in their daily life.

    Methods: Semi-structured interviews were performed with 82 middle-aged women with personal experience from long-term sickness absence.

    Results: The women's accounts of being sickness absent contained interpretations of what had happen to them, how things were for the moment, and what they thought the future would bring. Three different accounts could be distinguished: the crisis, the breakpoint, and the migration. The perception of their own situation and especially what they thought about their future was associated with their feeling of power to initiative and well-being.

    Conclusion: From our study we have found implications for central topics of importance: time elapse, sense of coherence, reorientation/adaptation, and vital goals.

    Keywords
    Vital goal, life plan, sense of coherence, phenomenology, women, sickness absence
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-80264 (URN)
    Available from: 2012-08-23 Created: 2012-08-23 Last updated: 2013-09-05Bibliographically approved
    4. How to avoid the frightening scenario of long-term sickness absence: The advice from women with personal experience
    Open this publication in new window or tab >>How to avoid the frightening scenario of long-term sickness absence: The advice from women with personal experience
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Aims: The aim of this study was to describe women's perceptions of what can be done to avoid long-term sickness absence.

    Methods: Interviews were conducted with 82 women who had been on sickness absence ( 60 days or more) or had disability pensions.

    Results: For these women, to be able to get back to work was found to be equivalent to breaking away from the prospect of isolation and loneliness. Five actors were identified along with suggestions for their actions: the woman who is on sick leave herself, the employer, the healthcare provider, the social insurance official, and the shop-steward.

    Conclusions: It is important to take oneself seriously and also to be taken seriously by others. Thus, it is important to not wait too long to take action which concerns both the individual herself and all those who get involved in her case at work, at hospital or at the social insurance office. Practical advice to reach recovery and avoid sickness absence is presented.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-80265 (URN)
    Available from: 2012-08-23 Created: 2012-08-23 Last updated: 2013-09-05Bibliographically approved
    5. Accounts of health, illness and medicine in women on long-term sickness absence
    Open this publication in new window or tab >>Accounts of health, illness and medicine in women on long-term sickness absence
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Long-term sickness absence has grown to an important social and economic question and it affects women more than men. The specific aim of the study was to identify patterns of association between ideas of health endorsed by groups of women having a close firsthand experience of long-term sickness absence. Using the Q-methodology, in a group of 60 middle-aged women, six accounts representing different conceptions of health, illness, and medicine were identified. Future studies should be implemented to investigate the prospective value of the categorisation identified in this study e.g. to see whether, and in that case how, these conceptions affect sick leave and rehabilitation.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-80266 (URN)
    Available from: 2012-08-23 Created: 2012-08-23 Last updated: 2013-09-05Bibliographically approved
  • 142.
    Ockander, Marlene
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hjerppe, M.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Patient-doctor Concordance in Elderly Women’s Self-reported Health and Medical Records2002In: Methods of Information in Medicine, ISSN 0026-1270, Vol. 41, no 2, p. 119-124Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To compare the chronic diseases mentioned by elderly women in an interview study with those documented in their respective medical records.

    METHODS: The prevalence of positive diagnoses, overall agreement, and the kappa-coefficient were calculated for each group of diagnoses.

    RESULTS: The lowest overall agreement was observed for psychiatric diseases, followed by diseases of the gastrointestinal system. Poor chance-adjusted agreement was found concerning diseases of the gastrointestinal system and diseases of the skin.

    CONCLUSIONS: The results suggest that a main reason for discordance was that the elderly women feared "losing face" by reporting some diseases.

  • 143.
    Ockander, Marlene K.
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Accounts of health, illness and medicine in women on long-term sickness absenceManuscript (preprint) (Other academic)
    Abstract [en]

    Long-term sickness absence has grown to an important social and economic question and it affects women more than men. The specific aim of the study was to identify patterns of association between ideas of health endorsed by groups of women having a close firsthand experience of long-term sickness absence. Using the Q-methodology, in a group of 60 middle-aged women, six accounts representing different conceptions of health, illness, and medicine were identified. Future studies should be implemented to investigate the prospective value of the categorisation identified in this study e.g. to see whether, and in that case how, these conceptions affect sick leave and rehabilitation.

  • 144.
    Ockander, Marlene K.
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Women's experiences of long term sickness absence: Is there a "loss of work syndrome"?Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: In most European countries, long-term sickness absence contribute the greatest number of days that are reimbursed due to sickness absence. This group is growing and it is constituted mainly of women.

    Aim: The present study seeks further knowledge about what happens then and there, i.e., how long-term sickness absent women handle and explain, for themselves and others, this interruption in their daily life.

    Methods: Semi-structured interviews were performed with 82 middle-aged women with personal experience from long-term sickness absence.

    Results: The women's accounts of being sickness absent contained interpretations of what had happen to them, how things were for the moment, and what they thought the future would bring. Three different accounts could be distinguished: the crisis, the breakpoint, and the migration. The perception of their own situation and especially what they thought about their future was associated with their feeling of power to initiative and well-being.

    Conclusion: From our study we have found implications for central topics of importance: time elapse, sense of coherence, reorientation/adaptation, and vital goals.

  • 145.
    Ockander, Marlene K.
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nyce, J. M.
    School of Library and Information Management, Emporia State, Emporia, KS, USA and Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA.
    How to avoid the frightening scenario of long-term sickness absence: The advice from women with personal experienceManuscript (preprint) (Other academic)
    Abstract [en]

    Aims: The aim of this study was to describe women's perceptions of what can be done to avoid long-term sickness absence.

    Methods: Interviews were conducted with 82 women who had been on sickness absence ( 60 days or more) or had disability pensions.

    Results: For these women, to be able to get back to work was found to be equivalent to breaking away from the prospect of isolation and loneliness. Five actors were identified along with suggestions for their actions: the woman who is on sick leave herself, the employer, the healthcare provider, the social insurance official, and the shop-steward.

    Conclusions: It is important to take oneself seriously and also to be taken seriously by others. Thus, it is important to not wait too long to take action which concerns both the individual herself and all those who get involved in her case at work, at hospital or at the social insurance office. Practical advice to reach recovery and avoid sickness absence is presented.

  • 146.
    Ockander, Marlene
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    A female lay perspective on the establishment of long-term sickness absence2001In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 10, no 1, p. 74-79Article in journal (Refereed)
    Abstract [en]

    In Sweden women account for about 60% of the long-term cases of sickness absence. The aim of this study was to describe women's explanations as to how long-term sickness absence arises and becomes permanent, with reference to their personal experience. Semi-structured interviews were performed with 82 middle-aged women who have personal experience of long-term sickness absence. Long-term sickness absence can be said to arise in three distinguishable “spaces”: the work space, the medico-legal space and the mental space. In the beginning, the women were positive about sick-leave as such, which they saw as an opportunity for physical rest. But as time went on, they came to regard sick-leave as creating a vicious circle of new problems related to inactivity and isolation. Apart from this vicious circle and chronic physical impairments, certain conditions at the workplace, at the hospital and the social insurance office transformed seemingly trivial sick-leaves into long-term and irreversible sickness absences

  • 147.
    Ockander, Marlene
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Women's experiences of long term sickness absence: implications for rehabilitation practice and theory2003In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 31, no 2, p. 143-148Article in journal (Refereed)
    Abstract [en]

    Background: In most European countries, spells of long-term absence contribute the largest number of days that are reimbursed as a result of sickness absence. This group is growing and it is constituted mainly of women.

    Aim: The present study seeks further knowledge about what happens then and there, i.e. how women on long-term sickness absence handle and explain, for themselves and others, this interruption in their daily life.

    Methods: Semi-structured interviews were performed with 82 middle-aged women with personal experience of long-term sickness absence.

    Results: The women's accounts of sickness absence contained interpretations of what had happened to them, how things were at present, and what they thought the future would bring. Three different accounts could be distinguished: crisis, breakpoint, and migration. The perception of their own situation and especially what they thought about their future was associated with their feeling of power to take the initiative, and their well-being.

    Conclusion: From this study the authors have found implications for central topics of importance: time elapse, sense of coherence, reorientation/adaptation, vital goals, and gender.

  • 148.
    Pilemalm, Sofie
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces.
    Timpka, Toomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Third generation participatory design: making participation applicable to large-scale system development projects.2004In: PDC 2004,2004, Palo Alto: PDC , 2004, p. 127-Conference paper (Refereed)
  • 149.
    Reigo, Tomas
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    The nature of back pain in a general adult population: A longitudal study2000Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The purpose of this thesis was to study in a general adult population the prevalence and incidence of back trouble, predictive factors for new episodes of back pain, new sick leave episodes, and factors important for recovery from back pain. The pain drawing method was used in an epidemiological survey to identify pain in the entire back area. The bias that knowledge of back pain history has on the interpretation of pain drawings was studied in a separate study.

    The cross-sectional main study population consisted of 2000 individuals aged 20-59 years. A prospective survey was conducted after one year on the study population of factors important for new sick leave, new back pain episodes and recovery and after five years on two age strata of factors important for retaining back health. After ten years the number of disability pensions granted for back pain during the time period was studied. The socio-demographic and work-related factors that predicted disability pension were studied.

    The prevalence of back pain was found to be 23%. Back pain with radiation was reported by 40%, according to the pain drawings. Only 4% reported localised neck pain. Sick leave was reported by 12% of those with back pain. The more generalised pain pattern suggested that back pain is more than a local back pain problem.

    The one-year incidence of new back pain was 24%. Seventy-nine percent of the episodes lasted less than 2 months. A history of previous back pain predicted new back pain episodes, while stress at work and low work satisfaction was associated factors. Low age, more qualified work tasks and residence predicted recovery from back pain. New sick leave periods were predicted by unqualified work tasks, pain debut at work, previous back pain history and pain at the primary survey.

    The clinical findings in the group with pain at the primary survey showed that the absence of tenderness in the trapezium muscle was the strongest predictor of recovery. It was also found that straighter lordosis and restricted mobility in the cervical spine were associated with new sick leaves in the prospective year.

    The pain drawing study showed that knowledge of the pain history affected the interpretation and reliability of the pain drawing evaluation.

    The five-year survey showed that absence of physical load in the old age group and absence of psychological stress at work in the younger age group predicted retained back health.

    The study of disabilities granted on the grounds of back pain during ten prospective years has shown that age over 40, sick leave at the primary survey together with perceiving the work tasks as meaningless predicted disability pension.

    The results of this thesis suggest that back pain should be seen as arecurrent problem, where previous episodes strongly predict new episodes. The complex nature of back pain as a health problem suggests that the rehabilitation should be individualised and include both work-related factors as well as a wide range of factors not related to paid work.

    List of papers
    1. The epidemiology of back pain in vocational age groups
    Open this publication in new window or tab >>The epidemiology of back pain in vocational age groups
    1999 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 17, no 1, p. 17-21Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVES: To investigate the prevalence of back pain in a general population aged between 20 and 59 years.

    POPULATION: A representative sample of 2000 individuals from Ostergotland County, Sweden (population 400,000).

    STUDY DESIGN: Cross-sectional study using a questionnaire including the pain drawing.

    RESULTS: The observed point prevalence was 28% (95% confidence interval 26-31%). The adjusted prevalence taking into account the non-responders was 23% (21-25%). Lumbar pain with radiation was reported by 40%, while 4% had only cervical pain with radiation. Twelve per cent were on sick-leave due to back pain. Activity of daily life was affected mainly in the group of men aged 40-59 and only in household tasks. The back problems did not affect social activity.

    CONCLUSIONS: The prevalence of back problems in the vocational ages was found to be 23%. Only small parts of a pain population are on sick-leave or have changed working tasks because of back problems. The distribution of pain in most cases is combined with radiation to extremities and not isolated to a single region. The combination of different localisations shows the pain problem to be more than just a "low back" problem.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-26127 (URN)10.1080/028134399750002836 (DOI)10586 (Local ID)10586 (Archive number)10586 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    2. Pain drawing evaluation–the problem with the clinically biased surgeon: Intra- and interobserver agreement in 50 cases related to clinical bias
    Open this publication in new window or tab >>Pain drawing evaluation–the problem with the clinically biased surgeon: Intra- and interobserver agreement in 50 cases related to clinical bias
    1998 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 69, no 4, p. 408-411Article in journal (Refereed) Published
    Abstract [en]

    To assess whether the clinical knowledge of the treating surgeon had any effect on the reliability of the pain-drawing evaluation, drawings from 50 low-back pain patients were evaluated by the treating surgeon and by three colleagues who had no clinical knowledge of the patient. The evaluation was repeated after 10 days. The treating surgeons were also blinded to clinical data. The kappa value in the evaluation when the surgeon had clinical knowledge of the patient was lower (0.29 (95% CI 0.13–0.45)) than the kappa value in the evaluations made without clinical knowledge (0.60 (CI 0.45–0.75)). The differences observed in interobserver reliability between open and blind evaluations suggest that clinical knowledge of a patient influences the evaluation of the pain drawings.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-79751 (URN)10.3109/17453679808999057 (DOI)
    Available from: 2012-08-13 Created: 2012-08-13 Last updated: 2017-12-07Bibliographically approved
    3. Back pain in an adult population: One year incidence, sick leave, and recovery from pain
    Open this publication in new window or tab >>Back pain in an adult population: One year incidence, sick leave, and recovery from pain
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Objective - To study the incidence of self-reported hack pain in a general population and to identify risk factors for sick leave and factors associated with recovery from back pain.

    Population - A cross-sectional sample (n=1344) of a general adult population.

    Setting - In a semi-urban Swedish county.

    Design - One-year prospective study of a single cohort.

    Main outcome measures - The incidence of back pain, risk factors for sick leave, factors predisposing for recovery.

    Results - The incidence of back pain was 24 % (95% C.I. 22% to 27%). 79% of the pain episodes lasted less than two months. History of previous back pain predisposed to developing new episodes of back pain, while stress at work combined with low work satisfaction were associated factors. Factors predisposing to recovery were young age, skilled work, and living in the countryside. Unskilled work, pain debut at work, previous history and back pain at the start of the study were factors predisposing to sick listing for back pain. Long-term sick leave was predisposed by previous history of back pain and ongoing back pain at the start of the study.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-79752 (URN)
    Available from: 2012-08-13 Created: 2012-08-13 Last updated: 2013-09-05Bibliographically approved
    4. Clinical findings in a population with back pain: Relation to one-year outcome and long-term sick leave
    Open this publication in new window or tab >>Clinical findings in a population with back pain: Relation to one-year outcome and long-term sick leave
    2000 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 18, no 4, p. 208-214Article in journal (Refereed) Published
    Abstract [en]

    Objective - To investigate whether physical examination findings can be used in predicting recovery from back pain and new episodes of sick leave.

    Design - One-year prospective study of a single cohort.

    Settings - Semi-rural Swedish county.

    Population - A cross-section of a general population with back pain (207 women, 176 men) between 20 and 59 years of age.

    Main outcome measures - Cumulative incidence of sick leave due to back pain, cumulative incidence of sick leave due to back pain > 30 days, incidence of recovery from back pain.

    Results - For recovery from pain, the absence of tenderness in the trapezius muscle (OR 0.33, CI 0.1-0.5) was predictive. New sick leave was predicted by tenderness in the trapezius muscle (OR 2.67, CI 1.5-4.9), and had a tendency to be associated with a flattened lumbar lordosis and a restricted cervical range of motion. For long-term sick leave, the same findings and also observation of scoliosis (OR 3.44, CI 1.1-10.5) were predictive.

    Conclusion - There are subgroups with back pain predisposed to development of more persistent symptoms and a higher risk for sick-listing.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-47518 (URN)10.1080/028134300448760 (DOI)
    Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
    5. Absence of back disorders in adults and work-related predictive factors in a 5-year perspective
    Open this publication in new window or tab >>Absence of back disorders in adults and work-related predictive factors in a 5-year perspective
    2001 (English)In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 10, no 3, p. 215-220Article in journal (Refereed) Published
    Abstract [en]

    Factors important for avoiding back disorders in different age-groups have seldom been compared and studied over time. We therefore set out to study age-related differences in socio-economic and work-related factors associated with the absence of back disorders in a 5-year comparative cohort study using a mailed questionnaire. Two subgroups (aged 25-34 and 54-59 years) derived from a representative sample of the Swedish population were followed at baseline, 1 year and 5 years. Questions were asked about the duration of back pain episodes, relapses, work changes and work satisfaction. A work adaptability, partnership, growth, affection, resolve (APGAR) score was included in the final questionnaire. Multivariate logistic regression was used to identify factors predicting the absence of back disorders. Absence of physically heavy work predicted an absence of back disorders [odds ratio (OR), 2.86, 95% confidence interval (CI), 1.3-6.3] in the older group. In the younger age-group, the absence of stressful work predicted absence of back disorders (OR, 2.0, 95% CI, 1.1-3.6). Thirty-seven per cent of the younger age-group and 43% of the older age-group did not experience any back pain episodes during the study period. The exploratory work APGAR scores indicated that back disorders were only associated with lower work satisfaction in the older group. The analyses point out the importance of avoiding perceived psychological stress in the young and avoiding perceived physically heavy work in the older age-group for avoiding back disorders. The results suggest a need for different programmes at workplaces to avoid back disorders depending on the age of the employees concerned.

    Keywords
    Absence of back disorders, Longitudinal study, Predictive factors
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-47314 (URN)10.1007/s005860100253 (DOI)
    Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
    6. Disability pension due to back pain: A ten-year prospective survey
    Open this publication in new window or tab >>Disability pension due to back pain: A ten-year prospective survey
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Back pain contributes to a large number of disability pensions. The process toward disability is not well understood. In a 10-year (1988-1998) prospective study of a single cohort (n=1902) representative of the general adult population in a semi-nrban Swedish county, the incidence of disability pensions based on back pain was studied. Socio-demographic and work-related risk factors for disability pension were analysed.

    Eigbt percent of respondents to a baseline survey (n=1344) and 10% of the non-respondents (n=558) were granted full-time disability pension on back pain diagnosis during the 10-year period. Age over 40, low professional status, primary sick leave because of back pain and the perception of work tasks as unsatisfying were found to predict disability.

    Disability pension granted due to back pain appears to have a variation over time and is affected by both social insurance and work-related factors.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-79778 (URN)
    Available from: 2012-08-14 Created: 2012-08-14 Last updated: 2013-09-05Bibliographically approved
  • 150.
    Reigo, Tomas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Tropp, Hans
    epartment of Orthopaedic Surgery, Norrköping Hospital, Sweden.
    Back pain in an adult population: One year incidence, sick leave, and recovery from painManuscript (preprint) (Other academic)
    Abstract [en]

    Objective - To study the incidence of self-reported hack pain in a general population and to identify risk factors for sick leave and factors associated with recovery from back pain.

    Population - A cross-sectional sample (n=1344) of a general adult population.

    Setting - In a semi-urban Swedish county.

    Design - One-year prospective study of a single cohort.

    Main outcome measures - The incidence of back pain, risk factors for sick leave, factors predisposing for recovery.

    Results - The incidence of back pain was 24 % (95% C.I. 22% to 27%). 79% of the pain episodes lasted less than two months. History of previous back pain predisposed to developing new episodes of back pain, while stress at work combined with low work satisfaction were associated factors. Factors predisposing to recovery were young age, skilled work, and living in the countryside. Unskilled work, pain debut at work, previous history and back pain at the start of the study were factors predisposing to sick listing for back pain. Long-term sick leave was predisposed by previous history of back pain and ongoing back pain at the start of the study.

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