liu.seSearch for publications in DiVA
Change search
Refine search result
1234567 151 - 200 of 448
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 151.
    Hägglund, Martin
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Epidemiology and prevention of football injuries2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aims of this thesis were to study the incidence, severity and pattern of injury in male and female elite football players; to study time trends in injury risk; to identify risk factors for injury; and to test the effectiveness of an intervention programme aimed at preventing re-injury.

    All studies followed a prospective design using standardised definitions and data collection forms. Individual training and match exposure was registered for all players participating. Time loss injuries were documented by each team’s medical staff.

    The amount of training increased by 68% between the 1982 and 2001 Swedish top male division seasons, reflecting the shift from semi-professionalism to full professionalism. No difference in injury incidence or injury severity was found between seasons. The injury incidence was 4.6 vs. 5.2/1000 training hours and 20.6 vs. 25.9/1000 match hours. The incidence of severe injury (absence >4 weeks) was 0.8/1000 hours in both seasons.

    The Swedish and Danish top male divisions were followed during the spring season of 2001. A higher risk for training injury (11.8 vs. 6.0/1000 hours, p<0.01) and severe injury (1.8 vs. 0.7/1000 hours, p=0.002) was observed among the Danish players. Re-injury accounted for 30% and 24% of injuries in Denmark and Sweden respectively.

    The Swedish top male division was studied over two consecutive seasons, 2001 and 2002, and comparison of training and match injury incidences between seasons showed similar results. Players who were injured in the 2001 season were at greater risk for injury in the following season compared to non-injured players (relative risk 2.7; 95% CI 1.7-4.3). Players with a previous hamstring injury, groin injury and knee joint trauma were two to three times more likely to suffer an identical injury to the same limb in the following season, but no such relationship was found for ankle sprain. Age was not associated with an increased injury risk.

    The effectiveness of a coach-controlled rehabilitation programme on the rate of re-injury was studied in a randomised controlled trial at amateur male level. In the control group, 23 of 79 injured players suffered a recurrence during the season compared to 10 of 90 players in the intervention group. There was a 75% lower re-injury risk in the intervention group for lower limb injuries (relative risk 0.25; 95% CI 0.11-0.57). The preventive effect was greatest during the first weeks after return to play.

    Both the male and female Swedish top divisions were followed during the 2005 season. Male elite players had a higher risk for training injury (4.7 vs. 3.8/1000 hours, p<0.05) and match injury (28.1 vs. 16.1/1000 hours, p<0.001) than women. However, no difference was observed in the rate of severe injury (0.7/1000 hours in both groups). The thigh was the most common site of injury in both men and women, while injury to the hip/groin was more frequent in men and to the knee in women. Knee sprain accounted for 31% and 37% of the time lost from training and match play in men and women respectively.

    List of papers
    1. Exposure and injury risk in Swedish elite football: a comparison between seasons 1982 and 2001
    Open this publication in new window or tab >>Exposure and injury risk in Swedish elite football: a comparison between seasons 1982 and 2001
    2003 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, Vol. 13, no 6, p. 364-370Article in journal (Refereed) Published
    Abstract [en]

    The long-term development of injury risk in Swedish male elite football was studied. Two prospective cohort studies from seasons 1982 and 2001 were compared with respect to exposure to football, injury incidence and injury severity.

    The mean number of training sessions during the season had increased by 68% between 1982 and 2001 (142 vs. 238, P<0.001), whereas teams played more matches in 1982 (49 vs. 41, P=0.02). The total exposure to football had increased by 27%. Three out of four players incurred an injury in both seasons. In 2001, players suffered more training injuries due to an increased training exposure. Accounting for risk exposure, there was no difference in injury incidence or severity between the two seasons. The incidence was 8.3 injuries/ 1000 h of total exposure (4.6 in training and 20.6 in matches) in 1982, compared to 7.8 1000 h−1 (5.2 in training and 25.9 in matches) in 2001. Major injuries accounted for 9% of all injuries, corresponding to an incidence of 0.8 /1000 h of football, in both seasons.

    A trend from semi-professionalism to full professionalism in Swedish elite football was seen during the last two decades. The injury risk did not change over the same period.

    Keywords
    sports injuries, soccer injuries, incidence, epidemiology, prospective study
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14339 (URN)10.1046/j.1600-0838.2003.00327.x (DOI)
    Available from: 2007-03-14 Created: 2007-03-14 Last updated: 2014-02-11
    2. Injury incidence and distribution in elite football - a prospective study of the Danish and the Swedish top divisions
    Open this publication in new window or tab >>Injury incidence and distribution in elite football - a prospective study of the Danish and the Swedish top divisions
    2005 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, Vol. 15, no 1, p. 21-28Article in journal (Refereed) Published
    Abstract [en]

    The Danish and Swedish male top football divisions were studied prospectively from January to June 2001. Exposure to football and injury incidence, severity and distribution were compared between the countries.

    Swedish players had greater exposure to training (171 vs. 123 h per season, P<0.001), whereas exposure to matches did not differ between the countries. There was a higher risk for injury during training in Denmark than in Sweden (11.8 vs. 6.0 per 1000 h, P<0.01), whereas for match play there was no difference (28.2 vs. 26.2 per 1000 h). The risk for incurring a major injury (absence from football more than 4 weeks) was greater in Denmark (1.8 vs. 0.7 per 1000 h, P=0.002). The distribution of injuries according to type and location was similar in both countries. Of all injuries in Denmark and Sweden, overuse injury accounted for 39% and 38% (NS), and re-injury for 30% and 24% (P=0.032), respectively.

    The greater training exposure and the long pre-season period in Sweden may explain some of the reported differences.

    Keywords
    sports injuries, soccer, incidence, epidemiology, re-injury
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14340 (URN)10.1111/j.1600-0838.2004.00395.x (DOI)
    Available from: 2007-03-14 Created: 2007-03-14 Last updated: 2014-02-06
    3. Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons
    Open this publication in new window or tab >>Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons
    2006 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, Vol. 40, p. 767-772Article in journal (Refereed) Published
    Abstract [en]

    Background: Previous injury is often proposed to be a risk factorfor football injury, but most studies rely on players reportingtheir own medical history and are thus potentially subject torecall bias. Little is known about the natural variation ininjury pattern between seasons.

    Objectives: To study whether prospectively recorded injuriesduring one season are associated with injuries sustained duringthe following season, and to compare injury risk and injurypattern between consecutive seasons.

    Methods: The medical staffs of 12 elite Swedish male footballteams prospectively recorded individual exposure and time lossinjuries over two full consecutive seasons (2001 and 2002).A multivariate model was used to determine the relation betweenprevious injury, anthropometric data, and the risk of injury.

    Results: The training and match injury incidences were similarbetween seasons (5.1 v 5.3 injuries/1000 training hours and25.9 v 22.7/1000 match hours), but analysis of injury severityand injury patterns showed variations between seasons. Playerswho were injured in the 2001 season were at greater risk ofany injury in the following season compared with non-injuredplayers (hazard ratio 2.7; 95% confidence interval 1.7 to 4.3,p<0.0001). Players with a previous hamstring injury, groininjury, and knee joint trauma were two to three times more likelyto suffer an identical injury in the following season, whereasno such relation was found for ankle sprain. Age was not associatedwith an increased injury risk.

    Conclusions: This study confirmed previous results showing thatprevious injury is an important risk factor for football injury.Overall injury incidences were similar between consecutive seasons,indicating that an injury surveillance study covering one fullseason can provide a reasonable overview of the injury problemamong elite football players in a specific environment. However,a prolonged study period is recommended for analyses of specificinjury patterns.

    Keywords
    risk factor; injury; re-injury; football; soccer; multivariate model
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14341 (URN)10.1136/bjsm.2006.026609 (DOI)
    Available from: 2007-03-14 Created: 2007-03-14 Last updated: 2014-02-05
    4. Lower re-injury rate with a coach-controlled rehabilitation program in amateur male soccer: A randomized controlled trial
    Open this publication in new window or tab >>Lower re-injury rate with a coach-controlled rehabilitation program in amateur male soccer: A randomized controlled trial
    2007 (English)In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 35, no 9, p. 1433-1442Article in journal (Refereed) Published
    Abstract [en]

    Background: Soccer injuries are common, and athletes returning to play after injury are especially at risk. Few studies have investigated how to prevent reinjury.

    Hypothesis: The rate of reinjury is reduced using a coach-controlled rehabilitation program.

    Study Design: Randomized controlled trial; Level of evidence, 1.

    Methods: Twenty-four male amateur soccer teams were randomized into an intervention (n = 282) and control group (n = 300). The intervention was implemented by team coaches and consisted of information about risk factors for reinjury, rehabilitation principles, and a 10-step progressive rehabilitation program including return to play criteria. During the 2003 season, coaches reported individual exposure and all time loss injuries were evaluated by a doctor and a physiotherapist. Four teams (n = 100) withdrew from the study after randomization, leaving 10 teams with 241 players for analysis in both groups.

    Results: There were 90 injured players (132 injuries) in the intervention group, and 10 of these (11%) suffered 14 reinjuries during the season. In the control group, 23 of 79 injured players (29%) had 40 recurrences (134 injuries). A Cox regression analysis showed a 66% reinjury risk reduction in the intervention group for all injury locations (hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.16–0.72, P = .0047) and 75% for lower limb injuries (HR 0.25, 95% CI 0.11–0.57, P < .001). The preventive effect was greatest within the first week of return to play. Injured players in the intervention group complied with the intervention for 90 of 132 injuries (68%).

    Conclusion: The reinjury rate in amateur male soccer players was reduced after a controlled rehabilitation program implemented by coaches.

    Keywords
    soccer, football, recurrent injury, prevention, rehabilitation
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14342 (URN)10.1177/0363546507300063 (DOI)
    Available from: 2007-03-14 Created: 2007-03-14 Last updated: 2017-12-13
    5. Injuries among male and female elite football players
    Open this publication in new window or tab >>Injuries among male and female elite football players
    (English)Manuscript (Other (popular science, discussion, etc.))
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14343 (URN)
    Available from: 2007-03-14 Created: 2007-03-14 Last updated: 2013-09-04
  • 152.
    Ihlstrom, Jonas
    et al.
    Swedish National Rd and Transport Research Institute, Linkoping, Sweden.
    Kecklund, Goran
    Stockholm University, Sweden.
    Anund, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Swedish National Rd and Transport Research Institute, Linkoping, Sweden.
    Split-shift work in relation to stress, health and psychosocial work factors among bus drivers2017In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 56, no 4, p. 531-538Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Shift work has been associated with poor health, sleep and fatigue problems and low satisfaction with working hours. However, one type of shift working, namely split shifts, have received little attention. OBJECTIVE: This study examined stress, health and psychosocial aspects of split-shift schedules among bus drivers in urban transport. METHODS: A questionnaire was distributed to drivers working more than 70% of full time which 235 drivers in total answered. RESULTS: In general, drivers working split-shift schedules (n = 146) did not differ from drivers not working such shifts (n = 83) as regards any of the outcome variables that were studied. However, when individual perceptions towards split-shift schedules were taken into account, a different picture appeared. Bus drivers who reported problems working split shifts (36%) reported poorer health, higher perceived stress, working hours interfering with social life, lower sleep quality, more persistent fatigue and lower general work satisfaction than those who did not view split shifts as a problem. Moreover, drivers who reported problems with split shifts also perceived lower possibilities to influence working hours, indicating lower work time control. CONCLUSIONS: This study indicates that split shifts were not associated with increased stress, poorer health and adverse psychosocial work factors for the entire study sample. However, the results showed that individual differences were important and approximately one third of the drivers reported problems with split shifts, which in turn was associated with stress, poor health and negative psychosocial work conditions. More research is needed to understand the individual and organizational determinants of tolerance to split shifts.

  • 153.
    Israelsson, Johan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Kalmar County Hospital, Sweden; Linnaeus University, Sweden.
    Bremer, Anders
    University of Borås, Sweden; Kalmar County Hospital, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Axelsson, Åsa B.
    University of Gothenburg, Sweden.
    Cronberg, Tobias
    Lund University, Sweden.
    Djärv, Therese
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Kristofferzon, Marja-Leena
    University of Gävle, Sweden; Uppsala University, Sweden.
    Larsson, Ing-Marie
    Uppsala University, Sweden.
    Lilja, Gisela
    Lund University, Sweden.
    Sunnerhagen, Katharina S.
    University of Gothenburg, Sweden.
    Wallin, Ewa
    Uppsala University, Sweden.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Åkerman, Eva
    Skåne University Hospital, Sweden; Karolinska Institute, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Sweden; Ersta Sköndal University of Coll, Sweden; Kalmar County Hospital, Sweden.
    Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender2017In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 114, p. 27-33Article in journal (Refereed)
    Abstract [en]

    Aim: To describe health status and psychological distress among in -hospital cardiac arrest (IHCA) survivors in relation to gender. Methods: This national register study consists of data from follow-up registration of IHCA survivors 3-6 months post cardiac arrest (CA) in Sweden. A questionnaire was sent to the survivors, including measurements of health status (EQ-5D-5L) and psychological distress (HADS). Results: Between 2013 and 2015, 594 IHCA survivors were included in the study. The median values for EQ-5D-5L index and EQVAS among survivors were 0.78 (ql-q3 = 0.67-0.86) and 70 (ql -q3 = 50-80) respectively. The values were significantly lower (p amp;lt; 0.001) in women compared to men. In addition, women reported more problems than men in all dimensions of EQ-5D-5L, except self -care. A majority of the respondents reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (p amp;lt; 0.001) and symptoms of depression (p amp;lt; 0.001) compared to men. Gender was significantly associated with poorer health status and more psychological distress. No interaction effects for gender and age were found. Conclusions: Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed. (C) 2017 Elsevier B.V. All rights reserved.

  • 154.
    Israelsson, Johan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Kalmar Cty Council, Sweden; Linnaeus Univ, Sweden.
    Thylén, Ingela
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Bremer, Anders
    Linnaeus Univ, Sweden; Kalmar Cty Council, Sweden.
    Arestedt, Kristofer
    Linnaeus Univ, Sweden; Kalmar Cty Council, Sweden.
    Factors associated with health-related quality of life among cardiac arrest survivors treated with an implantable cardioverter-defibrillator2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 132, p. 78-84Article in journal (Refereed)
    Abstract [en]

    Aim: To explore factors associated with health-related quality of life (HRQoL) among cardiac arrest (CA) survivors treated with an implantable cardioverter-defibrillator (ICD) in relation to gender, and to compare their HRQoL with a general population. Methods: This cross-sectional study included 990 adults treated with an ICD after suffering CA. All participants received a questionnaire including demographics, comorbidities and instruments to measure HRQoL (EQ-5D-3L and HADS), ICD-related concerns (ICDC), perceived control (CAS), and type D personally (DS-14). HRQoL (EQ-5D-3L) was compared to a general Swedish population, matched for age and gender. Linear regression analyses were used to explore factors associated with HRQoL. Results: The CA survivors reported better HRQoL in EQ index and less pain/discomfort compared to the general population (p amp;lt; 0.001). In contrast, they reported more problems in mobility and usual activities (p amp;lt; 0.01). Problems with anxiety and depression were reported by 15.5% and 7.4% respectively. The following factors were independently associated with all aspects of worse HRQoL: being unemployed, suffering more comorbidity, perceiving less control, and having a type D personally. Further, being female and suffering ICD-related concerns were independently associated with worse HRQoL in three of the four final regression models. Conclusions: This extensive population-based study showed that most CA survivors living with an ICD rate their HRQoL as acceptable. In addition, their HRQoL is similar to a general population. Women reported worse HRQoL compared to men. Several factors associated with HRQoL were identified, and might be used when screening patients for health problems and when developing health promoting interventions.

  • 155.
    Jackisch, Josephine
    Linköping University, Department of Medical and Health Sciences, Health and Society.
    Cultivating Well-Being: A study on Community Gardening and Health in Berlin and Paris2012Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

    This paper reports experiences of health and well-being common to actors in community gardens in Berlin and Paris. Community gardening has become an ever growing phenomenon since the 1990s, and to a larger extend since 2000 in western European cities. Despite the promising research from the US that has shown that community gardens have a potential for health promotion, there is a dearth of evidence from Europe. This study tries to fill this gap and maps the potential of community gardens for health and well-being as explained and experienced by the gardeners.

    The effect of community garden projects on human health and well-being cannot be reduced to the effect of nature on health alone. This study shows that there are at least two other major mechanisms at play, if we want to understand the phenomenon or evaluate its effects, namely the effects of community and 'free and open spaces'. Gardeners report health-related experiences with green space, such as stress relief and feeling of calm and vitality and increased well-being through sensual experiences and observing nature. Furthermore the garden projects open up a social space, which for many gardeners creates experiences of health through regular social contact, experiences of joy of sharing and having activities together. Furthermore, the community garden project was proposed to create a context and opportunities for flow, creativity and self-efficacy if it is a free and open space. However, not all experiences on well-being in CGPs are postive, and to all these spaces and their effects there are also certain limitations and conditions.

    Moreover, this study makes a theoretical contribution to the concept of health and well-being on the basis of the fuzziness around the concept of health encountered in the field. I propose that a holistic concept of health might be most suitable to describe health related to bottom-up community action like community gardens. To assess the effects of such projects in terms of well-being, this concepts should be dissentagled into the concept of health and happiness, whereas happiness in turn relates not only to life satisfaction but also to eudaimonian happiness related to meaning and doing good. Although this research project could not be comprehensive enough to provide all necessary evidence to evaluate health effects of community gardens, we believe that it provides viable paths for investigations into community driven health promotion and emerging healthy settings.

  • 156.
    Jacobsson, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Bergin, D.
    Swedish Athlet Assoc, Sweden.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Business support and Development, Department of Health and Care Development.
    Nyce, J. M.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Injuries in youth track and field are perceived to have multiple-level causes that call for ecological (holistic-developmental) interventions: A national sporting community perceptions and experiences2018In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 28, no 1, p. 348-355Article in journal (Refereed)
    Abstract [en]

    Engaging in competitive sports as a youth can have many health benefits, but recent studies also report a high risk for injury. The long-term purpose of this Swedish research program is to develop a framework for safe track and field training for young athletes (aged 12-15years). The aim of this study was to establish what is perceived to contribute and cause injuries in youth track and field by compiling the best available experiential knowledge about the underlying factors and use this knowledge to identify appropriate areas to handle these in practical ways. Nine focus group interviews with in total 74 participants and confirming interviews with five individuals were performed in seven Swedish regions. Qualitative research methods were used for data analysis. Injuries in youth athletes were not considered to be strictly the result of individual factors but rather the result of the interactions between factors at different levels. Three major factors emerged as follows: Insufficient knowledge for athletic development in daily practice; shortsighted communities of practice and sports policies not adjusted to youth; and societal health behaviors. The experiential knowledge in the national sporting community suggests that if effective and sustainable injury prevention processes are to be implemented for youth track and field, an ecological (holistic-developmental) approach to injury prevention is needed. Such an approach allows a longitudinal development-focused strategy for prevention that spans an athletes entire career.

  • 157.
    Jansson, S. P. O.
    et al.
    University of Örebro, Sweden.
    Fall, K.
    University of Örebro, Sweden; University of Örebro, Sweden.
    Brus, O.
    University of Örebro, Sweden.
    Magnuson, A.
    University of Örebro, Sweden.
    Wandell, P.
    Karolinska Institute, Sweden.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, "Primary Health Care in Motala".
    Rolandsson, O.
    Umeå University, Sweden.
    Prevalence and incidence of diabetes mellitus: a nationwide population-based pharmaco-epidemiological study in Sweden2015In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 32, no 10, p. 1319-1328Article in journal (Refereed)
    Abstract [en]

    Aim To investigate the changes in prevalence and incidence of pharmacologically and non-pharmacologically treated diabetes in Sweden during 2005 to 2013. Methods We obtained data on gender, date of birth and pharmacologically and non-pharmacologically treated diabetes from national registers for all Swedish residents. Results During the study period a total of 240 871 new cases of pharmacologically treated diabetes was found. The age-standardized incidence during the follow-up was 4.34 and 3.16 per 1000 individuals in men and women, respectively. A decreasing time trend in incidence for men of 0.6% per year (0.994, 95% CI 0.989-0.999) and for women of 0.7% per year (0.993, 95% CI 0.986-0.999) was observed. The age-standardized prevalence increased from 41.9 and 29.9 per 1000 in 2005/2006 to 50.8 and 34.6 in 2012/2013 in men and women, respectively. This corresponds to an annually increasing time trend for both men (1.024, 95% CI 1.022-1.027) and women (1.019, 95% CI 1.016-1.021). The total age-standardized prevalence of pharmacologically and non-pharmacologically treated diabetes (2012) was 46.9 per 1000 (55.6 for men and 38.8 for women). This corresponds to an annually increasing time trend (2010-2012) for both men (1.017, 95% CI 1.013-1.021) and women (1.012, 95% CI 1.008-1.016). Conclusions The prevalence of pharmacologically treated diabetes increased moderately during 8 years of follow-up, while the incidence decreased modestly. This is in contrast to the results reported by most other studies. The total prevalence of diabetes (both pharmacologically and non-pharmacologically treated) in Sweden is relatively low, from a global viewpoint.

  • 158.
    Johanna, Simmons
    et al.
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Katarina, Swahnberg
    Linnaeus University.
    Can nonresponse bias and known methodological differences explain the large discrepancies in the reported prevalence rate of violence found in Swedish studies?2019In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 5, p. 1-16, article id e0216451Article in journal (Refereed)
    Abstract [en]

    Introduction

    The reported prevalence rate of violence varies considerably between studies, even when conducted in similar populations. The reasons for this are largely unknown. This article considers the effects of nonresponse bias on the reported prevalence rate of interpersonal violence. We also single out violence perpetrated in intimate relationships and compare our results to previous Swedish studies. The aim was to explore the reasons for the large discrepancies in the prevalence rates found between studies.

    Material and method

    This is a cross sectional study of a random population sample. The NorVold Abuse Questionnaire (NorAQ), covering emotional, physical, and sexual violence, was answered by 754 men (response rate 35%) and 749 women (response rate 38%). Nonresponse bias was investigated in six ways, e.g., findings were replicated in two samples and we explored non-responders’ reasons for declining participation. Also, the prevalence rate of intimate partner violence was compared to four previous studies conducted in Sweden, considering the methodological differences.

    Results and discussion

    The only evidence of nonresponse bias found was for differences between the sample and the background population concerning the sociodemographic characteristics. However, the magnitude of that effect is bleak in comparison with the large discrepancies found in the prevalence rates between studies concerning intimate partner violence, e.g., emotional violence women: 11–41% and men: 4–37%; sexual and/or physical violence women: 12–27% and men: 2–21%. Some of the reasons behind these differences were obvious and pertained to differences in the definition and operationalization of violence. However, a considerable proportion of the difference could not easily be accounted for.

    Conclusion

    It is not reasonable that so little is known about the large discrepancies in the prevalence rate for what is supposedly the same concept, i.e., intimate partner violence. This study is a call for more empirical research on methods to investigate violence.

  • 159.
    Johansson Capusan, Andrea
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Environmental and Genetic Influences in Attention Deficit Hyperactivity Disorder (ADHD) and its Comorbidities2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Research in past decades has demonstrated the persistence of attention deficit hyperactivity disorder (ADHD) into adulthood, but many questions regarding prevalence, causes, and comorbidities of ADHD in adults remain to be investigated. Previous research focusing on childhood ADHD identified high heritability. Genetic and environmental influences on ADHD symptoms in adults and their association with comorbid conditions are not fully understood.

    The overall aim of this thesis was to study adult ADHD symptoms in the population and investigate associations with substance use disorders (SUD) and binge eating. In all four papers, we used population-based self-report data from twins aged 20–46 years from the Swedish Twin Registry. We used twin methods to explore the role of genetic and environmental factors underlying ADHD symptoms and their comorbidities.

    Study I examined the phenotypic association between ADHD and various forms of SUD. ADHD in adults was strongly associated with alcohol abuse and alcohol dependence, illicit drug use and regular nicotine use, with no differences between ADHD subtypes and no apparent substance preference. In Studies II and IV, we used bivariate twin models to examine the role of genetic and environmental factors in the association of adult ADHD symptoms with alcohol dependence (II) and with binge eating (IV). For ADHD symptoms and alcohol dependence, 64% of the overlap was explained by common genetic factors. The remaining variance was accounted for by environmental factors specific for each twin, with no sex differences for the overlap. Similarly, 91% of the association between ADHD symptoms and binge-eating behaviour was explained by common genetic factors. In Study III, using a within-twin pair analysis, we demonstrated that although most of the association between adult ADHD symptoms and self-reported childhood maltreatment (an environmental risk factor for ADHD) was explained by familial (genetic and environmental) confounding, our results were also consistent with a causal interpretation.

    In conclusion, adult ADHD symptoms are associated with SUD and binge-eating behaviour. We replicated findings from adolescent studies regarding shared genetic risk factors for alcohol dependence and ADHD symptoms in adults. For binge eating, we showed for the first time that shared genetic factors mainly explained the association with ADHD symptoms. Alterations in mesolimbic reward processing as well as the frontal, executive and inhibitory systems have been described for ADHD, alcohol dependence and binge-eating behaviour, possibly suggesting common genetic and neurobiological factors for all three conditions. Results that support a causal hypothesis regarding the association between childhood maltreatment and ADHD symptoms in adults need follow-up in longitudinal clinical samples that can examine neurobiological underpinnings of environmental effects. Clinically, the results of this thesis support that ADHD in adults be considered and addressed in adults with SUD or binge-eating behaviour. Given the common genetic risk factors and the role of the early childhood environment, family interventions should be considered for these populations.

    List of papers
    1. Comorbidity of Adult ADHD and Its Subtypes With Substance Use Disorder in a Large Population-Based Epidemiological Study.
    Open this publication in new window or tab >>Comorbidity of Adult ADHD and Its Subtypes With Substance Use Disorder in a Large Population-Based Epidemiological Study.
    2019 (English)In: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246, Vol. 23, no 12, p. 1416-1426Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: The objective of the study is to explore the role and possible substance preference in ADHD and subtypes in substance use disorder (SUD).

    METHOD: Using self-report data on ADHD Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) symptoms and SUD (alcohol, illicit drugs, and nicotine) in 18,167 Swedish twins, aged 20 to 45 years, we obtained odds ratios (OR) from mixed effect logistic regression, controlling for age, sex, education, and nonindependence of twin data.

    RESULTS: Increased ADHD symptoms were significantly associated with increased odds for all SUD. ORs ranged between 1.33 for regular nicotine (95% confidence interval [CI] = [1.12, 1.59]); 2.54 for multiple drug use (95% CI = [2.00, 3.23]), and 3.58 for alcohol dependence (95% CI = [2.86, 4.49]).

    CONCLUSION: ADHD symptoms and subtypes in the population are associated with increased risks for all SUD outcomes, with no difference between ADHD subtypes, no substance preference, and no sex differences for the comorbidity. Clinicians need to consider ADHD evaluation and treatment as part of management of SUD in adults.

    Place, publisher, year, edition, pages
    Sage Publications, 2019
    Keywords
    ADHD subtypes; adult ADHD; alcohol; comorbidity; substance-related disorders
    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:liu:diva-126285 (URN)10.1177/1087054715626511 (DOI)000484508800004 ()26838558 (PubMedID)
    Note

    Funding agencies: Swedish Research CouncilSwedish Research Council

    Available from: 2016-03-21 Created: 2016-03-21 Last updated: 2019-09-30
    2. Genetic and environmental contributions to the association between attention deficit hyperactivity disorder and alcohol dependence in adulthood: A large population-based twin study.
    Open this publication in new window or tab >>Genetic and environmental contributions to the association between attention deficit hyperactivity disorder and alcohol dependence in adulthood: A large population-based twin study.
    Show others...
    2015 (English)In: American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, ISSN 1552-4841, E-ISSN 1552-485X, Vol. 168, no 6, p. 414-422Article in journal (Refereed) Published
    Abstract [en]

    Previous research indicates that attention deficit hyperactivity disorder (ADHD) frequently co-occurs with alcohol dependence; however, the extent to which shared genetic risk factors underpin this association remains unclear. The aim of this study is to investigate the relative importance of genetic, shared, and nonshared environmental factors for the overlap between ADHD and alcohol dependence in adults. Almost 18,000 adult twins aged 20-45 years, from more than 12,000 twin pairs (5,420 complete pairs), from the population-representative Swedish Twin Registry, were included. Self-ratings were used to assess symptoms of ADHD and alcohol dependence. Twin analysis was used to determine the role of additive genetic (A), shared (C), and nonshared environmental (E) factors. As a result, we found a significant association between ADHD and alcohol dependence (odds ratio 3.58; 95% confidence interval, 2.85-4.49). Twin analysis suggested that shared genetic risk factors explained 64% of the overlap between ADHD and alcohol dependence. Nonshared environmental factors accounted for the remaining 36%, whereas the contribution of shared environmental factors was minimal. We found no support for statistically significant sex differences in the overlap between ADHD and alcohol dependence. In conclusion the overlap between ADHD and alcohol dependence in adulthood was largely explained by shared genetic risk factors. This is an important step toward understanding the underlying nature of the risk of alcohol dependence in patients with ADHD and suggests that individuals with ADHD and their family members are important targets for alcohol prevention and treatment.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2015
    National Category
    Substance Abuse
    Identifiers
    urn:nbn:se:liu:diva-116624 (URN)10.1002/ajmg.b.32300 (DOI)000360052200003 ()25711682 (PubMedID)
    Available from: 2015-03-27 Created: 2015-03-27 Last updated: 2017-12-04
    3. Childhood maltreatment and attention deficit hyperactivity disorder symptoms in adults: a large twin study
    Open this publication in new window or tab >>Childhood maltreatment and attention deficit hyperactivity disorder symptoms in adults: a large twin study
    Show others...
    2016 (English)In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, no 12, p. 2637-2646Article in journal (Refereed) Published
    Abstract [en]

    Background

    Childhood maltreatment (CM) has been associated with increased risk of attention deficit hyperactivity disorder (ADHD) in children and adults. It is, however, unclear whether this association is causal or due to familial confounding.

    Method

    Data from 18 168 adult twins, aged 20–46 years, were drawn from the population-based Swedish twin registry. Retrospective self-ratings of CM (emotional and physical neglect, physical and sexual abuse and witnessing family violence), and self-ratings for DSM-IV ADHD symptoms in adulthood were analysed. Possible familial confounding was investigated using a within twin-pair design based on monozygotic (MZ) and dizygotic (DZ) twins.

    esults

    CM was significantly associated with increased levels of ADHD symptom scores in adults [regression coefficient: 0.40 standard deviations, 95% confidence interval (CI) 0.37–0.43]. Within twin-pair analyses showed attenuated but significant estimates within DZ (0.29, 95% CI 0.21–0.36) and MZ (0.18, 95% CI 0.10–0.25) twin pairs. Similar results emerged for hyperactive/impulsive and inattentive ADHD symptom scores separately in association with CM. We conducted sensitivity analyses for early maltreatment, before age 7, and for abuse and neglect separately, and found similarly reduced estimates in DZ and MZ pairs. Re-traumatization after age 7 did not significantly influence results.

    Conclusions

    CM was significantly associated with increased ADHD symptoms in adults. Associations were partly due to familial confounding, but also consistent with a causal interpretation. Our findings support cognitive neuroscience studies investigating neural pathways through which exposure to CM may influence ADHD. Clinicians treating adults with ADHD should be aware of the association with maltreatment.

    Place, publisher, year, edition, pages
    Cambridge: Cambridge University Press, 2016
    Keywords
    Adult ADHD; childhood maltreatment; environmental risk; familial confounding; twins
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology Psychiatry Occupational Health and Environmental Health Other Medical Sciences not elsewhere specified
    Identifiers
    urn:nbn:se:liu:diva-130714 (URN)10.1017/S0033291716001021 (DOI)000382567600016 ()27376862 (PubMedID)
    Note

    Funding agencies: Swedish Research Council [2014-3831, LIO-440851]

    Available from: 2016-08-22 Created: 2016-08-22 Last updated: 2018-01-10Bibliographically approved
  • 160.
    Johansson Capusan, Andrea
    et al.
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine.
    Kuja-Halkola, R.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Viding, E.
    Developmental Risk and Resilience Unit, University College, London UK.
    McCrory, E.
    Developmental Risk and Resilience Unit, University College, London UK.
    Marteinsdottir, Ina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Larsson, H.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden / Department of Medical Sciences, Örebro University, Örebro, Sweden.
    Childhood maltreatment and attention deficit hyperactivity disorder symptoms in adults: a large twin study2016In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, no 12, p. 2637-2646Article in journal (Refereed)
    Abstract [en]

    Background

    Childhood maltreatment (CM) has been associated with increased risk of attention deficit hyperactivity disorder (ADHD) in children and adults. It is, however, unclear whether this association is causal or due to familial confounding.

    Method

    Data from 18 168 adult twins, aged 20–46 years, were drawn from the population-based Swedish twin registry. Retrospective self-ratings of CM (emotional and physical neglect, physical and sexual abuse and witnessing family violence), and self-ratings for DSM-IV ADHD symptoms in adulthood were analysed. Possible familial confounding was investigated using a within twin-pair design based on monozygotic (MZ) and dizygotic (DZ) twins.

    esults

    CM was significantly associated with increased levels of ADHD symptom scores in adults [regression coefficient: 0.40 standard deviations, 95% confidence interval (CI) 0.37–0.43]. Within twin-pair analyses showed attenuated but significant estimates within DZ (0.29, 95% CI 0.21–0.36) and MZ (0.18, 95% CI 0.10–0.25) twin pairs. Similar results emerged for hyperactive/impulsive and inattentive ADHD symptom scores separately in association with CM. We conducted sensitivity analyses for early maltreatment, before age 7, and for abuse and neglect separately, and found similarly reduced estimates in DZ and MZ pairs. Re-traumatization after age 7 did not significantly influence results.

    Conclusions

    CM was significantly associated with increased ADHD symptoms in adults. Associations were partly due to familial confounding, but also consistent with a causal interpretation. Our findings support cognitive neuroscience studies investigating neural pathways through which exposure to CM may influence ADHD. Clinicians treating adults with ADHD should be aware of the association with maltreatment.

  • 161.
    Johansson, Lisbeth M.
    et al.
    Unit for Research and Development in Primary Health Care, Futurum - Academy for Health and Care, Region Jönköping County, Jönköping, Sweden.
    Lingfors, Hans
    Linköping University. Unit for Research and Development in Primary Health Care, Futurum - Academy for Health and Care, Region Jönköping County, Jönköping, Sweden.
    Golsäter, Marie
    Linköping University. Child Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden; Unit for Research and Development in Primary Health Care, Futurum - Academy for Health and Care, Region Jönköping County, Jönköping, Sweden.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Fransson, Eleonor I.
    Linköping University. Unit for Research and Development in Primary Health Care, Futurum - Academy for Health and Care, Region Jönköping County, Jönköping, Sweden; The A.D.U.L.T Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden; The A.D.U.L.T Research Group, Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Can physical activity compensate for low socioeconomic status with regard to poor self-rated health and low quality-of-life?2019In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 17, article id 33Article in journal (Refereed)
    Abstract [en]

    Background

    Both high socioeconomic status (SES) and high physical activity (PA) are associated with better self-rated health (SRH) and higher quality-of-life (QoL).

    Aim

    To investigate whether high levels of PA may compensate for the association between low SES and subjective health outcomes in terms of poorer SRH and lower QoL.

    Method

    Data from a cross-sectional, population-based study (n = 5326) was utilized. Multiple logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between indicators of SES (economic situation and educational level), SRH and QoL, as well as between the combination of SES and PA in relation to SRH and QoL.

    Result

    Participants with high PA and economic problems had approximately the same OR for good SRH as those with low PA and without economic problems (OR 1.75 [95% CI 1.20–2.54] and 1.81 [1.25–2.63] respectively). Participants with high PA and low education had higher odds for good SRH (OR 3.34 [2.96–5.34] compared to those with low PA and high education (OR 1.46 [0.89–2.39]).Those with high PA and economic problems had an OR of 2.09 [1.42–3.08], for high QoL, while the corresponding OR for those with low PA and without economic problems was 4.38 [2.89–6.63].

    Conclusion

    Physically active people with low SES, had the same or even better odds to report good SRH compared to those with low PA and high SES. For QoL the result was not as consistent. The findings highlight the potential for promotion of PA to reduce SES-based inequalities in SRH.

  • 162.
    Johansson, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
    Cognitive impairment and its consequences in everyday life2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim was to improve knowledge of the consequences of cognitive dysfunction in everyday life and of instruments to make these assessments. The thesis contains four studies each of different design using different populations.

    In study I, the relationship between cognitive function, ability to perform activities of daily living and perceived health-related quality of life were investigated in a population of 85-year-old individuals in the community of Linköping (n = 373). The study was part of the Elderly in Linköping Screening Assessment 85 (ELSA 85). Even mild cognitive dysfunction correlated with impaired ability to perform activities of daily living and lower health-related quality of life.

    In study II, the diagnostic accuracy and clinical utility of Cognistat, a cognitive screening instrument, were evaluated for identifying individuals with cognitive impairment in a primary care population. Cognistat has relatively good diagnostic accuracy with a sensitivity of 0.85, a specificity of 0.79 and a Clinical Utility Index (CUI) of 0.72. The corresponding values were 0.59, 0.91 and 0.53 for the Mini Mental State Examination (MMSE), and 0.26, 0.88 and 0.20 for the Clock Drawing Test (CDT).

    In study III, the aim was to develop an instrument measuring self-perceived or caregiver reported ability to perform everyday life activities in persons with suspected cognitive impairment or dementia and to perform psychometric testing of this instrument, named the Cognitive Impairment in Daily Life (CID). The CID was found to have good content validity.

    In study IV, experiences of cognitive impairment, its consequences in everyday life and the need for support in persons with mild cognitive impairment (MCI) or mild dementia and their relatives were explored. Interviews were performed with five people with MCI, eight people with mild dementia and their relatives (n = 13). The main finding was that persons with MCI and dementia experienced cognitive changes that could be burdensome and result in changed activity patterns.

    In conclusion, the findings support earlier research and show that cognitive dysfunction even at mild stages has an impact on everyday life and reduces perceived quality of life. To improve interventions for persons with cognitive impairment, it is important to assess not only cognitive function but also its consequences in everyday life activities.

    List of papers
    1. Cognition, daily living, and health-related quality of life in 85-year-olds in Sweden
    Open this publication in new window or tab >>Cognition, daily living, and health-related quality of life in 85-year-olds in Sweden
    2012 (English)In: Aging, Neuropsychology and Cognition, ISSN 1382-5585, E-ISSN 1744-4128, Vol. 19, no 3, p. 421-432Article in journal (Refereed) Published
    Abstract [en]

    This study investigates how cognition influences activities of daily living and health-related quality of life in 85-year-olds in Sweden (n = 373). Data collection included a postal questionnaire comprising demographics and health-related quality of life measured by the EQ-5D. The ability to perform personal activities of daily living (PADL) was assessed during a home visit that included administering the Mini Mental State Examination (MMSE). Cognitive impairment was shown in 108 individuals (29%). The majority were independent with respect to PADL. A larger number of participants with cognitive impairment reported that they needed assistance in instrumental activities of daily living (IADL) compared to the group without cognitive impairment. Impaired cognition was significantly related to problems with IADL. Significant but low correlations were found between cognition and health-related quality of life – higher ratings on perceived quality of life correlated with higher results on the MMSE.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2012
    Keywords
    Elderly; Cognitive impairment; Population study; Daily living; Quality
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-77575 (URN)10.1080/13825585.2011.629290 (DOI)000306171800005 ()
    Available from: 2012-05-23 Created: 2012-05-23 Last updated: 2017-12-07
    2. Clinical Utility of Cognistat in Multiprofessional Team Evalutations of Patients with Cognitive Impairment in Swedish Primary Care
    Open this publication in new window or tab >>Clinical Utility of Cognistat in Multiprofessional Team Evalutations of Patients with Cognitive Impairment in Swedish Primary Care
    2014 (English)In: International Journal of Family Medicine, ISSN 2090-2042, E-ISSN 2090-2050, Vol. 2014, p. 649253-Article in journal (Refereed) Published
    Abstract [en]

    Background. Diagnostic evaluations of dementia are often performed in primary health care (PHC). Cognitive evaluation requires validated instruments.

    Objective. To investigate the diagnostic accuracy and clinical utility of Cognistat in a primary care population.

    Methods. Participants were recruited from 4 PHC centres; 52 had cognitive symptoms and 29 were presumed cognitively healthy. Participants were tested using the Mini-Mental State Examination (MMSE), the Clock Drawing Test (CDT), and Cognistat. Clinical diagnoses, based on independent neuropsychological examination and a medical consensus discussion in secondary care, were used as criteria for diagnostic accuracy analyses.

    Results. The sensitivity, specificity, positive predictive value, and negative predictive value were 0.85, 0.79, 0.85, and 0.79, respectively, for Cognistat; 0.59, 0.91, 0.90, and 0.61 for MMSE; 0.26, 0.88, 0.75, and 0.46 for CDT; 0.70, 0.79, 0.82, and 0.65 for MMSE and CDT combined. The area under the receiver operating characteristic curve was 0.82 for Cognistat, 0.75 for MMSE, 0.57 for CDT, and 0.74 for MMSE and CDT combined.

    Conclusions. The diagnostic accuracy and clinical utility of Cognistat was better than the other tests alone or combined. Cognistat is well adapted for cognitive evaluations in PHC and can help the general practitioner to decide which patients should be referred to secondary care.

     

    Place, publisher, year, edition, pages
    Hindawi Publishing Corporation, 2014
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-107048 (URN)10.1155/2014/649253 (DOI)
    Available from: 2014-06-04 Created: 2014-06-04 Last updated: 2019-09-20Bibliographically approved
    3. Development of an instrument for measuring activities of daily living in persons with suspected cognitive impairment
    Open this publication in new window or tab >>Development of an instrument for measuring activities of daily living in persons with suspected cognitive impairment
    2016 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 23, no 3, p. 230-239Article in journal (Refereed) Published
    Abstract [en]

    Background: According to the Swedish National Board of Health and Welfare, structured assessment of function and activity has high priority when investigating for dementia.

    Aim/objectives: The aim was to develop and psychometrically test an instrument to measure self-reported and/or informant-reported ability to perform activities of daily living in persons with suspected cognitive impairment.

    Material and methods: The Cognitive Impairment in Daily Life (CID) instrument has been developed in several phases. Content validity was achieved through five expert panels using a Content Validity Index (CVI). The content was tested further in a pilot study of 51 patients and 49 relatives from primary care or a specialist memory clinic.

    Results: Content validity was good with a CVI index of 0.83. All patients considered that relevant activities were included. Most relatives considered that the activities included in the instrument were adequate and captured the patients’ difficulties in daily life. Some adjustments to the items and scale were suggested and these were done after each phase. In general, relatives indicated more difficulties than patients.

    Conclusion: The CID instrument seems promising in terms of content validity. Further testing of reliability and construct validity is ongoing.

    Keywords
    Cognition, dementia investigation, instrument development
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-115306 (URN)10.3109/11038128.2016.1139621 (DOI)000374634100006 ()
    Available from: 2015-03-13 Created: 2015-03-13 Last updated: 2017-12-04Bibliographically approved
    4. Cognitive impairment and its consequences in everyday life: experiences of people with mild cognitive impairment or mild dementia and their relatives
    Open this publication in new window or tab >>Cognitive impairment and its consequences in everyday life: experiences of people with mild cognitive impairment or mild dementia and their relatives
    2015 (English)In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 27, no 6, p. 949-958Article in journal (Refereed) Published
    Abstract [en]

    Background: The aim of this study was to explore experiences of cognitive impairment, its consequences in everyday life and need for support in people with mild cognitive impairment (MCI) or mild dementia and their relatives.

    Methods: A qualitative approach with an explorative design with interviews was chosen. The participants included five people with MCI and eight people with mild dementia and their relatives. All participants were recruited at a geriatric memory clinic in Sweden. The Grounded Theory method was used.

    Results: The following categories emerged: noticing cognitive changes; changed activity patterns; coping strategies; uncertainty about own ability and environmental reactions; support in everyday life; support from the healthcare system; consequences in everyday life for relatives; and support for relatives. The main findings were that people with MCI and dementia experienced cognitive changes that could be burdensome and changed activity patterns. Most of them, however, considered themselves capable of coping on their own. The relatives noticed cognitive changes and activity disruptions to a greater extent and tried to be supportive in everyday life. Degree of awareness varied and lack of awareness could lead to many problems in everyday life.

    Conclusions: Perceived cognitive impairment and its consequences in everyday life were individual and differed among people with MCI or dementia and their relatives. Thus, healthcare professionals must listen to both people with cognitive impairment and their relatives for optimal individual care planning. Support such as education groups and day care could be more tailored towards the early stages of dementia.

    Place, publisher, year, edition, pages
    Cambridge University Press, 2015
    Keywords
    Alzheimer’s disease; activities of daily living; qualitative research
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-115307 (URN)10.1017/S1041610215000058 (DOI)000354093800009 ()25644289 (PubMedID)
    Available from: 2015-03-13 Created: 2015-03-13 Last updated: 2017-12-04Bibliographically approved
  • 163.
    Johansson, Maria
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science.
    Marcusson, Jan
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science.
    Wressle, Ewa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
    Cognitive impairment and its consequences in everyday life: experiences of people with mild cognitive impairment or mild dementia and their relatives2015In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 27, no 6, p. 949-958Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to explore experiences of cognitive impairment, its consequences in everyday life and need for support in people with mild cognitive impairment (MCI) or mild dementia and their relatives.

    Methods: A qualitative approach with an explorative design with interviews was chosen. The participants included five people with MCI and eight people with mild dementia and their relatives. All participants were recruited at a geriatric memory clinic in Sweden. The Grounded Theory method was used.

    Results: The following categories emerged: noticing cognitive changes; changed activity patterns; coping strategies; uncertainty about own ability and environmental reactions; support in everyday life; support from the healthcare system; consequences in everyday life for relatives; and support for relatives. The main findings were that people with MCI and dementia experienced cognitive changes that could be burdensome and changed activity patterns. Most of them, however, considered themselves capable of coping on their own. The relatives noticed cognitive changes and activity disruptions to a greater extent and tried to be supportive in everyday life. Degree of awareness varied and lack of awareness could lead to many problems in everyday life.

    Conclusions: Perceived cognitive impairment and its consequences in everyday life were individual and differed among people with MCI or dementia and their relatives. Thus, healthcare professionals must listen to both people with cognitive impairment and their relatives for optimal individual care planning. Support such as education groups and day care could be more tailored towards the early stages of dementia.

  • 164.
    Johansson, Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Marcusson, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Wressle, Ewa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Development of an instrument for measuring activities of daily living in persons with suspected cognitive impairment2016In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 23, no 3, p. 230-239Article in journal (Refereed)
    Abstract [en]

    Background: According to the Swedish National Board of Health and Welfare, structured assessment of function and activity has high priority when investigating for dementia.

    Aim/objectives: The aim was to develop and psychometrically test an instrument to measure self-reported and/or informant-reported ability to perform activities of daily living in persons with suspected cognitive impairment.

    Material and methods: The Cognitive Impairment in Daily Life (CID) instrument has been developed in several phases. Content validity was achieved through five expert panels using a Content Validity Index (CVI). The content was tested further in a pilot study of 51 patients and 49 relatives from primary care or a specialist memory clinic.

    Results: Content validity was good with a CVI index of 0.83. All patients considered that relevant activities were included. Most relatives considered that the activities included in the instrument were adequate and captured the patients’ difficulties in daily life. Some adjustments to the items and scale were suggested and these were done after each phase. In general, relatives indicated more difficulties than patients.

    Conclusion: The CID instrument seems promising in terms of content validity. Further testing of reliability and construct validity is ongoing.

  • 165.
    Johansson Stark, Åsa
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Empowering knowledge and Quality of Recovery after hip or knee replacement2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

    Arthroplasty is commonly used for an increasing population of patients with osteoarthritis, and the recovery process starts directly after surgery. Today’s shorter hospital stay may be a challenge for the patients and their spouses. Patient education is linked to and promotes the recovery process and can improve the outcome after elective hip or knee replacement. Fulfilment of knowledge expectations is essential for enabling people to become empowered during the period of recovery.

    Aim

    The overall aim was to explore the association between empowering knowledge and patients’ quality of recovery after elective hip or knee replacement.

    Methods

    The design of the four papers was descriptive, prospective and comparative. Consecutively included patients and their spouses from Cyprus, Finland, Greece, Iceland and Sweden answered questionnaires before surgery and at discharge from hospital. Data was collected during the years 2009-2012. Relationships and associations between a number of factors and fulfilment of knowledge expectations, and patients’ quality of recovery were investigated. Comparisons between patients undergoing hip or knee replacement and between patients and their spouses were made.

    Results

    Patients and their spouses had similar knowledge expectations, and these were not fulfilled during the hospital stay. Spouses had less fulfilled knowledge expectations compared with the patients. Swedish patients and spouses had less fulfilled knowledge expectations compared with the Icelandic and Finnish ones. Patients who experienced the hospital stay as meeting their general expectations had more fulfilled knowledge expectations compared with those who did not.

    Access to knowledge was the main predictor of the variance in fulfilment of knowledge expectations. Negative emotions, such as depressive state and impatience, were associated with less fulfilled knowledge expectations. For patients undergoing hip replacement, a higher level of professional education was associated with less fulfilled knowledge expectations. For patients undergoing knee replacement, a history of employment in social services or healthcare was associated with less fulfilled knowledge expectations.

    Patients’ experience of greater satisfaction with care was associated with better quality of recovery for both kinds of arthroplasty. Patients with fulfilled knowledge expectations experienced better quality of recovery. The spouserelated factors, namely uncertainty and depressive state, were associated with lower quality of recovery. Factors associated with greater quality of recovery among the patients were spouses with a history of employment in social services or health care, and nurses explaining matters concerning the care and treatment for the spouses.

    Conclusion

    Patients and their spouses had high knowledge expectations that were not fulfilled during the hospital stay. Patients’ emotional state and their access to knowledge were important for their fulfilment of knowledge expectations. Patients’ and spouses’ emotional state also played an important role in determining the patients’ quality of recovery, and greater satisfaction with care among the patients was associated with better quality of recovery.

    These results emphasise the need to detect patients and their spouses in need of support in their preparation and recovery process. It is therefore important to assess patients’ and spouses’ personal knowledge expectations, and adapt to their emotional state while fulfilling them.

    The content of patient education should be personalised in future care, and informal caregivers should be seriously taken into account during the period of early recovery. The results of this thesis can be used in the development and testing of person-centred educational interventions for patients undergoing elective hip or knee replacements.

    List of papers
    1. Fulfilment of knowledge expectations and emotional state among people undergoing hip replacement: A multi-national survey
    Open this publication in new window or tab >>Fulfilment of knowledge expectations and emotional state among people undergoing hip replacement: A multi-national survey
    Show others...
    2014 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 51, no 11, p. 1491-1499Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND:

    Patient education in connection with hip replacement is intended to prepare patients for surgery, discharge and postoperative recovery. Patients experience symptoms and emotions due to disease or upcoming surgery which can affect how their knowledge expectations are fulfilled.

    OBJECTIVES:

    To describe the differences between received and expected knowledge in patients undergoing elective hip replacement in three Nordic countries, and to analyse how these differences are related to patients' characteristics, preoperative symptoms and emotions.

    DESIGN:

    A descriptive, prospective survey with two data collection points; before admission and at hospital discharge after surgery.

    SETTINGS:

    Two Finnish, three Icelandic and two Swedish hospitals.

    PARTICIPANTS:

    The population consisted of patients on a waiting list for hip replacement. Of the consecutively included patients, 320 answered questionnaires both before admission and at discharge and were included in the study. The mean age of the patients was 64 years, and 55% were women.

    METHODS:

    Structured questionnaires were used; the knowledge expectations of hospital patients scale and self-reported scales for symptoms and emotions before admission and received knowledge of hospital patients scale at discharge. Fulfilment of knowledge expectation was assessed by calculating the difference between received and expected knowledge with a paired sample t-test. A multiple stepwise regression model was used to explain the variance of fulfilled knowledge expectations.

    RESULTS:

    Patients expected more knowledge than they received (p<0.001) and 77% of them had unfulfilled knowledge expectations. Patients with a higher level of education were more likely to have unfulfilled knowledge expectations. A higher level of education was also related to a greater difference between received and expected knowledge. The difference was more correlated with patients' emotions than their symptoms. A depressive state was the major predictor of the variance in the difference between received and expected knowledge.

    CONCLUSIONS:

    In order to better support patients by education it is necessary to assess their emotional state, educational level and knowledge expectations before surgery.

    Place, publisher, year, edition, pages
    Elsevier, 2014
    Keywords
    Emotions, Empowering knowledge, Hip replacement, Knowledge expectations, Orthopaedic nursing, Patient education, Symptoms
    National Category
    Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-109769 (URN)10.1016/j.ijnurstu.2014.03.006 (DOI)000343351900009 ()24751503 (PubMedID)
    Projects
    Empowering Patient Education
    Available from: 2014-08-27 Created: 2014-08-27 Last updated: 2017-12-05Bibliographically approved
    2. The fulfilment of knowledge expectations during the perioperative period of patients undergoing knee arthroplasty - a Nordic perspective
    Open this publication in new window or tab >>The fulfilment of knowledge expectations during the perioperative period of patients undergoing knee arthroplasty - a Nordic perspective
    Show others...
    2014 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 19-20, p. 2896-2908Article in journal (Refereed) Published
    Abstract [en]

    AIMS AND OBJECTIVES: To describe the possible differences between knowledge expectations and received knowledge of patients undergoing elective knee arthroplasty in Iceland, Sweden and Finland and also to determine the relationship between such a difference and both background factors and patient satisfaction with care.

    BACKGROUND: Knee arthroplasty is a fast-growing and a successful treatment for patients with osteoarthritis. Patient education can improve surgery outcomes, but it remains unknown what knowledge patients expect to receive and actually acquire during the perioperative period and what factors are related to that experience.

    DESIGN: Descriptive, prospective survey.

    METHODS: In total, 290 patients answered questionnaires about their expectations (Knowledge Expectations of hospital patients - scale) before surgery and about received knowledge (Received Knowledge of hospital patients - scale) and satisfaction with hospital care (Patient Satisfaction Scale) at discharge. Sociodemographics, clinical information, accessibility to knowledge from healthcare providers (Access to Knowledge Scale), and preferences for information and behavioural control (Krantz Health Opinion Survey) were collected as background data.

    RESULTS: Patients` knowledge expectations were higher (mean 3·6, SD 0·4) than their perception of received knowledge (mean 3·0, SD 0·7). Multiple linear regression analysis showed that access to knowledge, information preferences and work experience within health- or social care explained 33% (R²) of the variation in the difference between received and expected knowledge. Patients reported high satisfaction with their care except regarding how their family was involved.

    CONCLUSION: Patients undergoing knee arthroplasty receive less knowledge than they expect, and individual factors and communication with healthcare providers during hospitalisation are related to their experience. The content of patient education and family involvement should be considered in future care.

    RELEVANCE TO CLINICAL PRACTICE: The results strengthen the knowledge base on the educational needs of knee arthroplasty patients and can be used to develop and test new interventions.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2014
    Keywords
    Knee arthroplasty, osteoarthritis, patient education, patient expectations, patient satisfaction, surgery
    National Category
    Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-105225 (URN)10.1111/jocn.12552 (DOI)000343857700020 ()24476393 (PubMedID)
    Projects
    EEPO
    Available from: 2014-03-13 Created: 2014-03-13 Last updated: 2017-12-05Bibliographically approved
    3. The quality of recovery on discharge from hospital, a comparison between patients undergoing hip and knee replacement: a European study
    Open this publication in new window or tab >>The quality of recovery on discharge from hospital, a comparison between patients undergoing hip and knee replacement: a European study
    Show others...
    2016 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 17-18, p. 2489-2501Article in journal (Refereed) Published
    Abstract [en]

    Aims and objectives. To describe and compare the quality of recovery (QoR) on discharge from hospital between patients undergoing elective hip or knee replacement. The study will also attempt to identify any predicting factors.

    Background. Arthroplasty is commonly used for an increasing population of patients with osteoarthritis, and the recovery process starts directly after surgery. Today’s shorter hospital stay may be a challenge for the patients during the early period of recovery. It is therefore important to identify factors associated with QoR at discharge from hospital.

    Design. A descriptive, comparative study including 12 hospitals in five European countries; Cyprus, Finland, Greece, Iceland and Sweden.

    Methods. Consecutively included patients responded on: Health-Related Quality of Life, and emotions before surgery and at hospital discharge; Quality of Recovery, Patient Satisfaction and fulfilment of knowledge expectations. Related factors and associations were analysed separately for each kind of arthroplasty. In total 865 patients were included (hip n=413, knee n=452).

    Results. In the dimension of pain, patients undergoing hip replacement had significantly better QoR compared to those undergoing knee replacement. Both patient groups experienced negative emotions before surgery that were related to poorer QoR. Fulfilment of knowledge expectations has a limited effect on QoR. Greater satisfaction with care predicted better QoR.

    Conclusions. Negative preoperative emotions were related to poorer QoR. For both kinds of arthroplasty, greater satisfaction with care was associated with better QoR.

    Relevance to clinical practice. The result emphasises the need to detect patients in need of support in their preparation and recovery process, taking into account the perspective of their emotional state.

    Place, publisher, year, edition, pages
    Wiley-Blackwell Publishing Inc., 2016
    Keywords
    Fulfilment of knowledge expectations, health-related quality of life, hip replacement, knee replacement, preoperative emotional state, quality of recovery, satisfaction with care
    National Category
    Nursing Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-125235 (URN)10.1111/jocn.13278 (DOI)
    Note

    At the time of thesis presentation publication was in status: Manuscript

    Available from: 2016-02-17 Created: 2016-02-17 Last updated: 2017-04-21Bibliographically approved
    4. Spouse-related factors associated with Quality of Recovery of patients after hip or knee replacement: a Nordic perspective
    Open this publication in new window or tab >>Spouse-related factors associated with Quality of Recovery of patients after hip or knee replacement: a Nordic perspective
    Show others...
    2016 (English)In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 23, p. 32-46Article in journal (Refereed) Published
    Abstract [en]

    Background: Today’s shorter hospital stays means that patients may need support from informal caregivers during their recovery period. The responsibility for providing this support shifts from the health care staff to their family members fairly early in the recovery process. Spousal caregivers are considered to be primary caregivers as their relationship with the patient is more interdependent than other family members or caregivers.

    Objectives: The aim was to describe spouse-related factors that were associated with patients’ quality of recovery on discharge from hospital after elective hip or knee replacement.

    Design: The design was prospective, descriptive and comparative with two measurements; before arthroplasty and on discharge.

    Settings: Two Finnish, three Icelandic and two Swedish university or community hospitals.

    Participants: The sample consisted of spouses and patients. The inclusion criteria were: age ≥ 18 years, able to complete the questionnaires, and able to understand Finnish/Icelandic/Swedish. The patients were asked to identify one family member. Spouses were those defining themselves as; wife, husband or cohabiting partner. Out of 463 spouses, 306 (66%) were included. The mean age of the included spouses was 64 years, and 54% of them were females.

    Methods: Self-reported instruments on; expected and received knowledge, access to knowledge, emotional state and quality of recovery were used.

    Results: If the spouses were or had been employed in the social services or healthcare their partner had greater quality of recovery (p=0.006). Spouses experiencing negative emotions had partners who experienced lower quality of recovery (p<0.001). Spouses who experienced that nurses had enough time and explained matters concerning their family members’ care and treatment had partners who experienced greater quality of recovery (p=0.011, 0.044).

    Conclusions: Spouses’ emotional state played an important role in the patients’ quality of recovery, with uncertainty and depressive state as the main predictors. The importance of nurses explaining matters sufficiently to spouses was emphasized, while spouses’ fulfilment of knowledge expectations was not associated with patients’ recovery.

    Place, publisher, year, edition, pages
    Elsevier, 2016
    Keywords
    Access to knowledge, empowering knowledge, emotional state, fulfilment of knowledge expectations, hip replacement, knee replacement, recovery, spousal caregivers
    National Category
    Nursing Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-125236 (URN)10.1016/j.ijotn.2016.03.001 (DOI)
    Note

    At the time for thesis presentation publication was in status: Manuscript

    Available from: 2016-02-17 Created: 2016-02-17 Last updated: 2017-04-21Bibliographically approved
  • 166.
    Johansson Stark, Åsa
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Charalambous, Andreas
    Cyprus University of Technology, Limassol, Cyprus; Department of Nursing Science, Turku University Hospital, University of Turku, Turku, Finland.
    Istomina, Natalja
    Department of Nursing, Klaipeda University, Lithuania.
    Salanterä, Sanna
    University of Turku, Department of Nursing Science, Turku University Hospital, Turku, Finland.
    Sigurdardottir, Arun K
    School of Health Sciences, University of Akureyri, Iceland .
    Sourtzi, Panayota
    University of Athens, Faculty of Nursing, Athens, Greece.
    Valkeapää, Kirsi
    University of Turku, Department of nursing Science, Turku, Finland and Dean Lahti University of Applied Sciences, Lahti Finland.
    Zabalegui, Adelaida
    Nursing, Hospital Clinic of Barcelona, Spain.
    Bachrach-Lindström, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    The quality of recovery on discharge from hospital, a comparison between patients undergoing hip and knee replacement: a European study2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 17-18, p. 2489-2501Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To describe and compare the quality of recovery (QoR) on discharge from hospital between patients undergoing elective hip or knee replacement. The study will also attempt to identify any predicting factors.

    Background. Arthroplasty is commonly used for an increasing population of patients with osteoarthritis, and the recovery process starts directly after surgery. Today’s shorter hospital stay may be a challenge for the patients during the early period of recovery. It is therefore important to identify factors associated with QoR at discharge from hospital.

    Design. A descriptive, comparative study including 12 hospitals in five European countries; Cyprus, Finland, Greece, Iceland and Sweden.

    Methods. Consecutively included patients responded on: Health-Related Quality of Life, and emotions before surgery and at hospital discharge; Quality of Recovery, Patient Satisfaction and fulfilment of knowledge expectations. Related factors and associations were analysed separately for each kind of arthroplasty. In total 865 patients were included (hip n=413, knee n=452).

    Results. In the dimension of pain, patients undergoing hip replacement had significantly better QoR compared to those undergoing knee replacement. Both patient groups experienced negative emotions before surgery that were related to poorer QoR. Fulfilment of knowledge expectations has a limited effect on QoR. Greater satisfaction with care predicted better QoR.

    Conclusions. Negative preoperative emotions were related to poorer QoR. For both kinds of arthroplasty, greater satisfaction with care was associated with better QoR.

    Relevance to clinical practice. The result emphasises the need to detect patients in need of support in their preparation and recovery process, taking into account the perspective of their emotional state.

  • 167.
    Johansson Stark, Åsa
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Salanterä, Sanna
    University of Turku, Department of Nursing Science, Turku University Hospital, Turku, Finland.
    Sigurdardottir, Arun K
    School of Health Sciences, University of Akureyri, Iceland .
    Valkeapää, Kirsi
    University of Turku, Department of nursing Science, Turku, Finland and Dean Lahti University of Applied Sciences, Lahti Finland.
    Bachrach-Lindström, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Spouse-related factors associated with Quality of Recovery of patients after hip or knee replacement: a Nordic perspective2016In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 23, p. 32-46Article in journal (Refereed)
    Abstract [en]

    Background: Today’s shorter hospital stays means that patients may need support from informal caregivers during their recovery period. The responsibility for providing this support shifts from the health care staff to their family members fairly early in the recovery process. Spousal caregivers are considered to be primary caregivers as their relationship with the patient is more interdependent than other family members or caregivers.

    Objectives: The aim was to describe spouse-related factors that were associated with patients’ quality of recovery on discharge from hospital after elective hip or knee replacement.

    Design: The design was prospective, descriptive and comparative with two measurements; before arthroplasty and on discharge.

    Settings: Two Finnish, three Icelandic and two Swedish university or community hospitals.

    Participants: The sample consisted of spouses and patients. The inclusion criteria were: age ≥ 18 years, able to complete the questionnaires, and able to understand Finnish/Icelandic/Swedish. The patients were asked to identify one family member. Spouses were those defining themselves as; wife, husband or cohabiting partner. Out of 463 spouses, 306 (66%) were included. The mean age of the included spouses was 64 years, and 54% of them were females.

    Methods: Self-reported instruments on; expected and received knowledge, access to knowledge, emotional state and quality of recovery were used.

    Results: If the spouses were or had been employed in the social services or healthcare their partner had greater quality of recovery (p=0.006). Spouses experiencing negative emotions had partners who experienced lower quality of recovery (p<0.001). Spouses who experienced that nurses had enough time and explained matters concerning their family members’ care and treatment had partners who experienced greater quality of recovery (p=0.011, 0.044).

    Conclusions: Spouses’ emotional state played an important role in the patients’ quality of recovery, with uncertainty and depressive state as the main predictors. The importance of nurses explaining matters sufficiently to spouses was emphasized, while spouses’ fulfilment of knowledge expectations was not associated with patients’ recovery.

  • 168.
    Jonkma, Nini H.
    et al.
    University of Medical Centre Utrecht, Netherlands.
    Schuurmans, Marieke J.
    University of Medical Centre Utrecht, Netherlands.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Shortxidge-Baggett, Lillie M.
    Pace University, NY 10038 USA.
    Hoes, Arno W.
    University of Medical Centre Utrecht, Netherlands.
    Trappenburg, Jaap C. A.
    University of Medical Centre Utrecht, Netherlands.
    Self-management interventions: Proposal and validation of a new operational definition2016In: JOURNAL OF CLINICAL EPIDEMIOLOGY, ISSN 0895-4356, Vol. 80, p. 34-42Article in journal (Refereed)
    Abstract [en]

    Objectives: Systematic reviews on complex interventions like self-management interventions often do not explicitly state an operational definition of the intervention studied, which may impact the reviews conclusions. This study aimed to propose an operational definition of self-management interventions and determine its discriminative performance compared with other operational definitions. Study Design and Setting: Systematic review of definitions of self-management interventions and consensus meetings with self management research experts and practitioners. Results: Self-management interventions were defined as interventions that aim to equip patients with skills to actively participate and take responsibility in the management of their chronic condition in order to function optimally through at least knowledge acquisition and a combination of at least two of the following: stimulation of independent sign/symptom monitoring, medication management, enhancing problem-solving and decision-making skills for medical treatment management, and changing their physical activity, dietary, and/or smoking behavior. This definition substantially reduced the number of selected studies (255 of 750). In two preliminary expert meetings (n = 6), the proposed definition was identifiable for self-management research experts and practitioners (80% and 60% agreement, respectively). Conclusion: Future systematic reviews must carefully consider the operational definition of the intervention studied because the definition influences the selection of studies on which conclusions and recommendations for clinical practice are based. (C) 2016 Elsevier Inc. All rights reserved.

  • 169.
    Jonsson, Linda
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Fredlund, Cecilia
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Psykiatriska kliniken inkl beroendekliniken.
    Priebe, Gisela
    Lund Univ, Sweden.
    Wadsby, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Online sexual abuse of adolescents by a perpetrator met online: a cross-sectional study2019In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 13, no 1, article id 32Article in journal (Refereed)
    Abstract [en]

    Background

    The current study aimed at exploring adolescents’ experiences of online sexual contacts leading to online sexual abuse by a perpetrator whom the victim had first met online. Associations with socio demographic background, experience of abuse, relation to parents, health and risk behaviors were studied.

    Methods

    The participants were a representative national sample of 5175 students in the third year of the Swedish high school Swedish (M age = 17.97). Analyses included bivariate statistics and stepwise multiple logistic regression models.

    Results

    In total 330 (5.8%) adolescents had gotten to know someone during the preceding 12 months for the purpose of engaging in some kind of sexual activity online. Thirty-two (9.7%) of those, the index group, had felt that they had been persuaded, pressed or coerced on at least one occasion. Sexual interaction under pressure was seen as constituting sexual abuse. These adolescent victims of online sexual abuse, the index group, did not differ with respect to socio-demographic background from the adolescents without this experience, the reference group. The index group had significantly more prior experiences of different kind of abuse, indicating that they belong to a polyvictimized group. More frequent risk behavior, poorer psychological health, poorer relationships with parents and lower self-esteem also characterized the index group. Online sexual abuse, without experiences of offline abuse, was associated with a poorer psychological health, at least at the same level as offline sexual abuse only.

    Conclusions

    The study made clear the importance of viewing online sexual abuse as a serious form of sexual abuse. Professionals meeting these children need to focus not only on their psychological health such as symptoms of trauma and depression but also need to screen them for online behavior, online abuse and other forms of previous abuse.

  • 170.
    Jonsson, Linda
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Barn utsatta för sexuella övergrepp på nätet2017Report (Other academic)
    Abstract [sv]

    Denna fördjupningsrapport fokuserar på barns erfarenheter av sexuella övergrepp på nätet. Rapporten baseras på den tredje epidemiologiska undersökningen om ungdomars sexuella beteenden och erfarenheter på Internet. Unga sex och Internet – i en föränderlig värld är en enkätstudie från 2014 där 5 839 elever i gymnasiets tredje år deltog. Deltagarna tillfrågades om erfarenheter av olika övergrepp av sexuell karaktär på nätet såsom nätgrooming, sexuella övergrepp och sexuella övergreppsbilder.

    Resultaten i denna rapport är nya och unika. De ska tolkas med försiktighet då det behövs mer studier inom området. Dock visar resultaten tydliga mönster, som vi till viss del känner igen från både nationell och internationell forskning samt kliniska erfarenheter vi fått ta del av.

    Såväl de ungdomar som blivit nätgroomade (23,2 %) som de som blivit utsatta för sexuella övergrepp över nätet senaste året (32 ungdomar av de 330 ungdomar som hade haft sex på nätet) uppvisade en tämligen likartad bild av utsatthet för andra sexuella övergrepp, känslomässig och fysisk misshandel, känslomässig och fysisk mobbning samt olika former av självskadebeteenden. Till detta kommer att de rapporterade en sämre känslomässig relation till sina föräldrar under uppväxten även om de sociodemografiskt inte skiljde sig från andra ungdomar med få undantag.

    Ett viktigt resultat från studien är att vi har kunnat konstatera att dokumentation i form av fotografering och filmning av sexuella övergrepp påverkar den psykiska hälsan negativt. Även osäkerheten om det skett eller inte är förknippad med en ytterligare försämrad psykisk ohälsa jämfört med när övergrepp inte dokumenterats. För de barn/ungdomar vars bilder spritts ökar den psykiska ohälsan ytterligare.

    Bilden som målas upp är att denna grupp av ungdomar har en komplex bild av traumatiska erfarenheter och ohälsa och närmast är att betrakta som polytraumatiserade.

    Forskningens uppgift är att på ett vetenskapligt sätt belysa olika fenomen i samhället och att utifrån genererade data dra slutsatser och ge rekommendationer för att som i detta fall bidra till en bättre hjälp som i detta fall till en utsatt och belastad grupp barn- och ungdomar.

    Vi kan se att dessa ungdomar behöver såväl förebyggande som rehabiliterande insatser.

    På det förebyggande planet behövs bättre kunskap om våld och andra former av övergrepp bland alla som arbetar med barn. Utan denna kunskap och professionell utveckling kommer de barn som riskerar att utsättas eller redan blivit utsatta riskera att inte upptäckas i tid, och att inte heller kunna erbjudas adekvata insatser. Detta gäller sannolikt än mer de mest utsatta, bl.a. de grupper som denna fördjupningsrapport fokuserat på.

    Barn och unga måste tidigt få kunskap om vad ett sexuellt övergrepp är, vilka rättigheter man har och vad man kan göra om man blir drabbad. Skolan är en utmärkt plats att genomföra denna typ av utbildning. Vi kan se ett behov av en förändrad, moderniserad, sexualundervisning med fokus på relationer, ömsesidighet och respekt för att stärka barn och ungdomars sexuella integritet.

    Kunskap om våld och andra övergrepp mot barn behöver integreras i samtliga utbildningar som riktar sig till personer som kommer att arbeta med barn och ungdomar. Detta sker lämpligast genom att ämnet införs i respektive examinationsordningar. Det är också angeläget att fortbilda redan anställd personal inom rättsväsende, socialt arbete, hälso- och sjukvård och skola om våld och sexuella övergrepp mot barn.

    Utsatta barn/och ungdomar vänder sig oftast till kompisar och andra jämnåriga för att prata om övergreppen och för att få ett initialt stöd (Svedin et al., 2015; Landberg et al., 2015). Därför måste det till stora satsningar vad gäller kunskap om kompisstöd, vad man t.ex. ska göra om en kompis utsatts. Redan idag finns bra framtaget material (se www.dagsattprataom.se) som behöver spridas vidare till bland annat ungdomsmottagningar och skolan.

    Erfarenheterna från intervjuer med ungdomar i EU-projektet SPIRTO (Jonsson et al, 2015c) visar att främsta anledningen till att unga undviker att prata med sina föräldrar om vad de gör på nätet är för att de upplever att föräldrarna kan för lite. Unga efterlyser kunskapsspridning till föräldrar och lärare och andra som arbetar med barn om nätet. Hur nätet fungerar som källa till information och glädje såväl som till de risker som finns på nätet.

    Förövarna behöver hjälp och behandling för att minska risken att de utsätter nya barn. Därför är det ytterst viktigt med behandlingsenheter spridda i landet som alla har möjlighet att kontakta.

    Resultaten gällande det markant allvarliga hälsoläget för de barn som drabbats av övergrepp på nätet av sexuell karaktär ställer krav på skola, hälso- och sjukvård samt rättsväsende. De drabbade barnen måste prioriteras genom att få snabba utredningar från både polis och socialtjänst följt av möjlighet till bra stöd och behandling. Precis som i huvudrapporten från 2015 (Svedin et al., 2015), finns det anledning att understryka att om barn och ungdomars psykosociala ohälsa är så nedsatt som här framkommer, måste samhället säkerställa att de erbjuds professionellt stöd och hjälp. Många kan behöva högspecialiserad vård. Detta gäller en stor del av de barn och unga som utsatts för våld eller andra övergrepp och är extra angeläget för en polyviktimiserad grupp som den som denna rapport fokuserar på.

    I framtiden behövs fler studier med olika metodik för att få en bättre bild och en djupare förståelse för hur övergrepp på nätet av sexuell karaktär påverkar de drabbade barnen.

  • 171.
    Jonsson, Åsa
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    How to create and analyze a Heart Failure Registry with emphasis on Anemia and Quality of Life2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and aims

    Heart failure (HF) is a major cause of serious morbidity and death in the population and one of the leading medical causes of hospitalization among people older than 60 years. The aim of this thesis was to describe how to create and how to analyze a Heart Failure Registry with emphasis on Anemia and Quality of Life. (Paper I) We described the creation of the Swedish Heart Failure Registry (SwedeHF) as an instrument, which may help to optimize the handling of HF patients and show how the registry can be used to improve the management of patients with HF. (Paper II) In order to show how to analyze a HF registry we investigated the prevalence of anemia, its predictors, and its association with mortality and morbidity in a large cohort of unselected patients with HFrEF included in the SwedeHF, and to explore if there are subgroups of HF patients identifying high--‐risk patients in need of treatment. (Paper III) In order to show another way of analyzing a HF registry we assessed the prevalence of, associations with, and prognostic impact of anemia in patients with HFmrEF and HFpEF. (Paper IV) Finally we examined the usefulness of EQ--‐ 5D as a measure of patient--‐reported outcomes among HF patients using different analytical models and data from the SwedeHF, and comparing results about HRQoL for patients with HFpEF and HFrEF.

    Methods

    An observational study based on the SwedeHF database, consisting of about 70 variables, was undertaken to describe how a registry is created and can be used (Paper I). One comorbidity (anemia) was applied to different types of HF patients, HFrEF (EF <40%) (II) and HFmrEF (EF 40--‐49% ) or HFpEF (> 50%) (III) analyzing the data with different statistical methods. The usefulness of EQ--‐5D as measure of patient--‐ reported outcomes was studied and the results about HRQoL were compared for patients with HFpEF and HFrEF (IV).

    Results

    In the first paper (Paper I) we showed how to create a HF registry and presented some characteristics of the patients included, however not adjusted since this was not the purpose of the study. In the second paper (Paper II) we studied anemia in patients with HFrEF and found that the prevalence of anemia in HFrEF were 34 % and the most important independent predictors were higher age, male gender and renal dysfunction. One--‐year survival was 75 % with anemia vs. 81 % without (p<0,001). In the matched cohort after propensity score the hazard ratio associated with anemia was for all--‐cause death 1.34. Anemia was associated with greater risk with lower age, male gender, EF 30--‐39%, and NYHA--‐class I--‐II. In the third paper (Paper III) we studied anemia in other types of HF patients and found that the prevalence in the overall cohort in patients with EF > 40% was 42 %, in HFmrEF 38 % and in HFpEF (45%). Independent associations with anemia were HFpEF, male sex, higher age, worse New York Heart Association class and renal function, systolic blood pressure <100 mmHg, heart rate ≥70 bpm, diabetes, and absence of atrial fibrillation. One--‐year survival with vs. without anemia was 74% vs. 89% in HFmrEF and 71% vs. 84% in HFpEF (p<0.001 for all). Thus very similar results in paper II and III but in different types of HF patients. In the fourth paper (Paper IV) we studied the usefulness of EQ--‐5D in two groups of patients with HF (HFpEF and HFrEF)) and found that the mean EQ--‐5D index showed small reductions in both groups at follow--‐up. The patients in the HFpEF group reported worsening in all five dimensions, while those in the HFrEF group reported worsening in only three. The Paretian classification showed that 24% of the patients in the HFpEF group and 34% of those in the HFrEF group reported overall improvement while 43% and 39% reported overall worsening. Multiple logistic regressions showed that treatment in a cardiology clinic affected outcome in the HFrEF group but not in the HFpEF group (Paper IV).

    Conclusions

    The SwedeHF is a valuable tool for improving the management of patients with HF, since it enables participating centers to focus on their own potential for improving diagnoses and medical treatment, through the online reports (Paper I). Anemia is associated with higher age, male gender and renal dysfunction and increased risk of mortality and morbidity (II, III). The influence of anemia on mortality was significantly greater in younger patients in men and in those with more stable HF (Paper II, III). The usefulness of EQ--‐5D is dependent on the analytical method used. While the index showed minor differences between groups, analyses of specific dimensions showed different patterns of change in the two groups of patients (HFpEF and HFrEF). The Paretian classification identified subgroups that improved or worsened, and can therefore help to identify needs for improvement in health services (Paper IV).

    List of papers
    1. Heart failure registry: a valuable tool for improving the management of patients with heart failure
    Open this publication in new window or tab >>Heart failure registry: a valuable tool for improving the management of patients with heart failure
    2010 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 12, no 1, p. 25-31Article in journal (Refereed) Published
    Abstract [en]

    Guidelines on how to diagnose and treat patients with heart failure (HF) are published regularly. However, many patients do not fulfil the diagnostic criteria and are not treated with recommended drugs. The Swedish Heart Failure Registry (S-HFR) is an instrument which may help to optimize the handling of HF patients. The S-HFR is an Internet-based registry in which participating centres (units) can record details of their HF patients directly online and transfer data from standardized forms or from computerized patient documentation. Up to December 2007, 16 117 patients from 78 units had been included in the S-HFR. Of these, 10 229 patients had been followed for at least 1 year, and 2133 deaths were recorded. Online reports from the registry showed that electrocardiograms were available for 97% of the patients. Sinus rhythm was found in 51% of patients and atrial fibrillation in 38%. Echocardiography was performed in 83% of the patients. Overall, 77% of patients were treated with angiotensin converting enzyme inhibitors or angiotensin II receptor blockers, 80% were on beta-blockers, 34% on aldosterone antagonists, and 83% on diuretics. The S-HFR is a valuable tool for improving the management of patients with HF, since it enables participating centres to focus on their own potential for improving diagnoses and medical treatment, through the online reports provided.

    Keywords
    Heart failure; Registry; Diagnostics; Medical treatment
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-52877 (URN)10.1093/eurjhf/hfp175 (DOI)
    Available from: 2010-01-13 Created: 2010-01-12 Last updated: 2017-12-12
    2. A comprehensive assessment of the association between anemia, clinical covariates and outcomes in a population-wide heart failure registry
    Open this publication in new window or tab >>A comprehensive assessment of the association between anemia, clinical covariates and outcomes in a population-wide heart failure registry
    Show others...
    2016 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 211, p. 124-131Article in journal (Refereed) Published
    Abstract [en]

    Background: The aim was to investigate the prevalence of, predictors of, and association with mortality and morbidity of anemia in a large unselected cohort of patients with heart failure (HF) and reduced ejection fraction (HFrEF) and to explore if there were specific subgroups of high risk. Methods: In patients with HFrEF in the Swedish Heart Failure Registry, we assessed hemoglobin levels and associations between baseline characteristics and anemia with logistic regression. Using propensity scores for anemia, we assessed the association between anemia and outcomes with Cox regression, and performed interaction and sub-group analyses. Results: There were 24 511 patients with HFrEF (8303 with anemia). Most important independent predictors of anemia were higher age, male gender and renal dysfunction. One-year survival was 75% with anemia vs. 81% without (p &lt; 0.001). In the matched cohort after propensity score the hazard ratio associated with anemia was for all-cause death 1.34 (1.28-1.40; p &lt; 0.0001), CV mortality 1.28 (1.20-1.36; p &lt; 0.0001), and combined CV mortality or HF hospitalization 1.24 (1.18-1.30; p &lt; 0.0001). In interaction analyses, anemia was associated with greater risk with lower age, male gender, EF 30-39%, and NYHA-class I-II. Conclusion: In HFrEF, anemia is associated with higher age, male gender and renal dysfunction and increased risk of mortality and morbidity. The influence of anemia on mortality was significantly greater in younger patients, in men, and in those with more stable HF. The clinical implication of these findings might be in the future to perform targeted treatment studies. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

    Place, publisher, year, edition, pages
    ELSEVIER IRELAND LTD, 2016
    Keywords
    Heart failure; Reduced ejection fraction; Anemia; Outcomes; Observational study
    National Category
    Mathematics Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-127741 (URN)10.1016/j.ijcard.2016.02.144 (DOI)000373918100029 ()26999301 (PubMedID)
    Note

    Funding Agencies|Swedish National Board of Health and Welfare; Swedish Association of Local Authorities and Regions; Swedish Society of Cardiology; Linkoping University; Swedish HF Registry foundation

    Available from: 2016-05-12 Created: 2016-05-12 Last updated: 2017-11-30
  • 172.
    Juelson, Kristin
    Linköping University, Department of Medicine and Health Sciences, Health and Society.
    The Struggles of Youth in a Time of HIV/AIDS Awareness and Prevention Programs: A discussion of the personal, interpersonal, and social challenges youth face against the backdrop of media-oriented campaign discourses in South Africa 2008Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    This thesis examines the different discourses on sexuality put forth by two prominent media-oriented HIV/AIDS awareness and prevention campaigns, Soul City and Love Life, in South Africa, and the ways in which they resonate with youth as they struggle to negotiate their own sexual identities in a rapidly changing society. It uses qualitative methods to consider the struggles of individuals in the personal, interpersonal, and larger social realms and how campaigns speak to them in different ways and, in turn, how youth negotiate their own identities. On the personal level, this thesis considers individual negotiations of knowledge and awareness of HIV/AIDS in the face of campaigns, particularly as they work within certain frameworks of morals and values. Then, on the interpersonal level, struggles concerning conflicting ideals and realities in love and relationships are considered, as are gender issues and the realities of exchange values and notions of responsibility in relationships. Building on personal and interpersonal struggles, larger social challenges involving the influence of traditional and modern values on sexual expression, as well as the influences of popular culture are discussed. In many ways this paper is a commentary on some of the major challenges of being young, but because of this it inherently lends itself to discussions of the challenges that campaigns face as they attempt to speak to youth about HIV/AIDS and where their good intentions might be failing. Furthermore, it also helps to understand the ways that the risk of HIV/AIDS has come to inform discourses on youth sexuality.

  • 173.
    Järemo, Pirjo
    et al.
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska University, Huddinge, Sweden.
    Arman, M.
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska University, Huddinge, Sweden.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gottberg, K.
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska University, Huddinge, Sweden.
    Illness beliefs among patients with chronic widespread pain - associations with self-reported health status, anxiety and depressive symptoms and impact of pain2017In: BMC Psychology, E-ISSN 2050-7283, Vol. 5, no 24Article in journal (Refereed)
    Abstract [en]

    Chronic widespread pain (CWP) is a disabling condition associated with a decrease in health. Illness beliefs are individual and are acquired during life. Constraining beliefs may prevent patients from regaining health. Understanding these patients’ illness beliefs may be a way to improve the health care they are offered. The aim of this study was to describe illness beliefs among patients with CWP and associations with self-reported health, anxiety and depressive symptoms, and impact of pain.

  • 174.
    Jönsson, B
    et al.
    Department of Economics, Stockholm School of Economics, Sweden.
    Christiansen, C
    Center for Clinical and Basic Research, Ballerup, Denmark.
    Johnell, O
    Department of Orthopedics, Malmö General Hospital, Malmö, Sweden.
    Hedbrant, Johan
    Linköping University.
    Cost-effectiveness of fracture prevention in established osteoporosis.1995In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 5, no 2, p. 136-142Article in journal (Refereed)
    Abstract [en]

    This study presents the results of a computer simulation model for calculating the cost-effectiveness and cost-utility of treating patients with established osteoporosis in order to reduce the risk of fractures. The results are based on Swedish data for risk of fracture and costs. The treatment intervention modelled is based on treatment of a 62-year-old woman with established osteoporosis. The cost per hip fracture avoided is 350,000 SEK, assuming a 50% reduction in the risk of fracture due to 5 years of treatment. A sensitivity analysis for changes in the cost and effectiveness of treatment, the risk of fracture and the discount rate is performed. The cost per life-year gained and the cost per quality-adjusted life-year (QALY) gained is presented to enable comparison of the cost-effectiveness of treating osteoporosis with that of other health care interventions. A comparison between treating the same woman for osteoporosis and mild hypertension shows a cost per life-year gained of 220,000 SEK and 128,000 SEK respectively. Cost per QALY gained is very similar for the two interventions: 105,000 SEK and 103,000 SEK respectively. This model provides a tool to enable clinicians, administrators and health policy makers to analyze and understand the economic aspects of a major health policy issue.

  • 175.
    Kaboru, Berthollet Bwira
    et al.
    Institutionen för hälsovetenskaper, Örebro universitet.
    Andersson, Gunnel
    Institutionen för hälsovetenskaper, Örebro universitet.
    Borneskog, Catrin
    Institutionen för hälsovetenskaper, Örebro universitet.
    Adolfsson, Annsofie
    Institutionen för hälsovetenskaper, Örebro universitet.
    Namegabe, Edmond Ntabe
    Faculté de Santé et Développement Communautaires, Université Libre des Pays des Grands Lacs (ULPGL), Goma, DRC.
    Knowledge and attitudes towards sexual violence in conflicted-affected rural communities in the Walikale District, DR Congo: Implications for rural health services2014In: Annals of public health and research, E-ISSN 2378-9328, Vol. 1, no 2, p. 1009-Article in journal (Refereed)
    Abstract [en]

    Sexual violence has become endemic in the Democratic Republic of Congo (DRC), but the perspectives of rural communities of the scourge remain poorly researched. This study aims to describe the attitudes and knowledge of rural communities in regard to sexual violence, its occurrence and associated problems in rural communities in the Itebero/Walikale district in the DRC. A descriptive cross-sectional design was adopted, and a structured questionnaire used. Four hundred respondents participated, representing a group of ten villages populated by a total of 10,000 inhabitants. The respondents stated that perpetrators were often men from their own village. The fields were cited as being the place where most of the assaults occurred. A substantial proportion of the respondents lacked sufficient knowledge of the health outcomes of sexual violence. HIV infection and unwanted pregnancies were the most feared consequences. The victims of violence either experienced compassion or suffered rejection, depending on the community groups. Victims were mostly supported by women from their community, followed by husbands, relatives and authorities. Health facilities were the primary sources of support for victims. Rural health facilities need to revolutionise their health education strategies to improve the current situation.

  • 176.
    Kaijser Alin, Christina
    et al.
    Karolinska Inst, Sweden.
    Uzunel, Elin
    Karolinska Inst, Sweden.
    Grahn Kronhed, Ann-Charlotte
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Rehabilitation in Motala.
    Alinaghizadeh, Hassan
    Karolinska Inst, Sweden; Acad Primary Hlth Care Ctr Stockholm, Sweden.
    Salminen, Helena
    Karolinska Inst, Sweden; Acad Primary Hlth Care Ctr Stockholm, Sweden.
    Effect of treatment on back pain and back extensor strength with a spinal orthosis in older women with osteoporosis: a randomized controlled trial2019In: ARCHIVES OF OSTEOPOROSIS, ISSN 1862-3522, Vol. 14, no 1, article id 5Article in journal (Refereed)
    Abstract [en]

    The treatment effect of an activating spinal orthosis on back pain and back extensor strength was compared to a training group and to a control group. Between the groups, there was no significant difference in back pain, back extensor strength, or kyphosis index after the 6months of treatment.PurposeThe aim of this study was to study the effect of treatment with an activating spinal orthosis on back pain, back extensor strength, and kyphotic index. Our hypothesis was that an activating spinal orthosis may be an alternative treatment to decrease back pain and increase back extensor strength.MethodsA total of 113 women aged 60years with back pain and osteoporosis, with or without vertebral fractures, were randomized to three groups: a spinal orthosis group, an equipment training group, and a control group. All three groups were examined at baseline and followed up after 3 and 6months. Statistical analyses were performed with a mixed model for repeated measures according to intention to treat (ITT) and per protocol (PP).ResultsA total of 96 women completed the study. Between the groups, there was no significant difference in baseline characteristics. Comparison between groups showed no significant difference in back pain, back extensor strength, or kyphosis index at the follow-up after 6months according to ITT and PP analyses. Analysis in each group showed that the back extensor strength had increased by 26.9% in the spinal orthosis group, by 22.1% in the exercise training group and by 9.9% in the control group.ConclusionsSix months treatment by an activating spinal orthosis showed no significant difference in back pain, back extensor strength, or kyphosis index between the three groups. In the spinal orthosis group, present back pain decreased slightly and back extensor strength increased by 26.9% which indicates that the spinal orthosis may become an alternative training method.Clinicaltrials.com ID: NCT03263585

  • 177.
    Kaijser Alin, Kristina
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden.
    Grahn Kronhed, Ann-Charlotte
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Rehabilitation in Motala.
    Salminen, Helena
    Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden.
    The association between spinal curvature and balance in elderly women at high risk of osteoporotic fractures in primary health care2016In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, Vol. 18, no 4, p. 226-232Article in journal (Refereed)
    Abstract [en]

    The main aim was to study the relationship between spinal curvature and balance in elderly women at high risk of osteoporotic fractures. Ninety-four women were included in this cross-sectional study. Static timed standing and dynamic balance tests were performed; spinal curvature was measured by using the Flexicurve ruler; and radiological data on vertebral fractures were gathered. The women in the hyperkyphosis subgroup had a 5.6 s longer tandem standing time eyes open (p<0.05), tandem gait forwards (p<0.05) and tandem gait backwards (p<0.01) than those without hyperkyphosis. Logistic regression with the ability to tandem walk as a dichotomous outcome (cut-off 4 steps) showed that women with a hyperkyphosis had an age-adjusted Odds ratio of 4.5 (95% CI 1.7–12.1) to perform4 tandem steps backwards and their Odds ratio to perform4 tandem steps forwards was also significantly higher with an age-adjusted Odds ratio of 2.8 (95% CI 1.1–7.4). Lordotic Index was positively correlated to one-leg standing with eyes open (p<0.05). The present study suggests an association between hyperkyphosis and a better tandem standing and tandem gait forwards and backwards.

  • 178.
    Kang, Gagandeep
    et al.
    Christian Medical Coll and Hospital, India.
    Thuppal, Sowmyanarayanan V.
    Christian Medical Coll and Hospital, India.
    Srinivasan, Rajan
    Christian Medical Coll and Hospital, India.
    Sarkar, Rajiv
    Christian Medical Coll and Hospital, India.
    Subashini, Beula
    Christian Medical Coll and Hospital, India.
    Venugopal, Srinivasan
    Christian Medical Coll and Hospital, India.
    Sindhu, Kulandaipalayam
    Christian Medical Coll and Hospital, India.
    Anbu, Dhivya
    Christian Medical Coll and Hospital, India.
    Parez, Nathalie
    Hop Enfants Armand Trousseau, France.
    Svensson, Lennart
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Bose, Anuradha
    Christian Medical Coll and Hospital, India.
    Racecadotril in the management of rotavirus and non-rotavirus diarrhea in under-five children: Two randomized, double-blind, placebo-controlled trials2016In: Indian Pediatrics, ISSN 0019-6061, E-ISSN 0974-7559, Vol. 53, no 7, p. 595-600Article in journal (Refereed)
    Abstract [en]

    To study the effect of racecadotril on reduction in the duration of acute rotavirus and non-rotavirus diarrhea. Two randomized double-blind placebo-controlled trials Community-based trial in an urban area in Vellore, hospital-based trial at a secondary hospital in Vellore 199 and 130 3-59 month old children in the community- and hospital-based trials, respectively. Racecadotril (1.5 mg/kg/dose, thrice a day for three days) or placebo were given to manage acute diarrhea in both trials. Median duration of diarrhea. Among 124 children completing the hospital trial, the median duration of diarrhea was 25 h in both arms (P=0.5); median total stool weight was 74 g/kg and 53.5 g/kg in racecadotril group and placebo group, respectively (P=0.4); and average fluid intake per day was 3.6 mL/kg/h and 3mL/kg/h in racecadotril and placebo arms, respectively (P=0.3). Among rotavirus-positive children, median duration of diarrhea was 26.9 h and 30.2 h in racecadotril and placebo arms, respectively (P=0.7). In the community, 196 completed the trial, the median duration of diarrhea was 2 days for both arms (P=0.8) and rotavirus positive children had similar outcomes with median diarrheal duration of 3 d in both arms (P=0.4). Treatment with racecadotril did not reduce diarrheal duration, stool volume or the requirement for fluid replacement in children with acute gastroenteritis, both with and without rotavirus infection.

  • 179.
    Karlsson, Elin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Sandqvist, Jan
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences.
    Seing, Ida
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Ståhl, Christian
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, HELIX Competence Centre. Linköping University, Faculty of Medicine and Health Sciences.
    Social validitet för försäkringsmedicinska utredningar och påföljande myndighetsbeslut inom sjukförsäkringen2019Report (Other academic)
    Abstract [sv]

    Bakgrund: I det svenska sjukförsäkringssystemet utförs försäkringsmedicinska utredningar av särskilda enheter inom hälso- och sjukvården på uppdrag av Försäkringskassan. Dessa utredningar ligger sedan till grund för handläggares beslut om sjukskrivnas rätt till sjukpenning. Studier av social validitet är ännu ovanliga inom försäkringsmedicin och folkhälsa men kan bidra med kunskap om vad som främjar eller hindrar att metoder uppfattas som godtagbara, begripliga och betydelsefulla.

    Syfte: Att utforska sjukskrivna personers upplevelse av social validitet för försäkringsmedicinska utredningar och påföljande myndighetsbeslut avseende sjukpenning inom sjukförsäkringen.

    Metod: Detta var en kvalitativ longitudinell studie baserad på telefonintervjuer med 30 sjukskrivna som varit på en försäkringsmedicinsk utredning, samt delvis deras akter från Försäkringskassan. En deduktiv innehållsanalys användes.

    Resultat: Sjukskrivnas förståelse för utredningen var beroende av huruvida de specifika testerna var tydligt relaterade till personernas svårigheter eller ej och vilken information de hade fått. De anser att den standardiserade strukturen inte är relevant för alla och att bristen på individanpassning förvårar möjligheten att få en rättvis bild av deras arbetsförmåga. 

    Diskussion: Social validitet utforskades för försäkringsmedicinska utredningar och myndighetsbeslut i termer av godtagbarhet, begriplighet och betydelse. Utredningarna indikerar en låg social validitet i termer av godtagbarhet på grund av bristen på individanpassning, även om vissa delar är mer socialt valida än andra. Vidare varierade utredningarnas begriplighet beroende på deras applicerbarhet och den erhållna informationen, medan dimensionen betydelse indikerar en högre grad av social validitet. Handläggarens påföljande myndighetsbeslut ansågs däremot orelaterat till utredningens resultat, sakna konkreta argument och ibland motsägande andra aktörers rekommendationer, vilket indikerar en låg social validitet i termer av både godtagbarhet, begriplighet och betydelse. 

    Slutsats: Social validitet finns för delar av utredningarna men är låg för det påföljande myndighetsbeslutet.

  • 180.
    Karlsson, Elin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Seing, Ida
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Sandqvist, Jan
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Communication characteristics between clients and stakeholders within the Swedish sickness insurance system: a document analysis of granted and withdrawn sickness benefit claims2019In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this study was to investigate how communication within the Swedish sickness insurance system differs between cases of sick leave and how this may affect clients’ cases.

    Materials and methods: This was a document study using 30 client files from the Swedish Social Insurance Agency (SIA). The clients included had been on a work ability evaluation during their sick leave spell and were aged 32–64 years. The material was analyzed using qualitative document analysis.

    Results: The results show different approaches to communication, characterized by emotional argumentation, matter-of-fact driven argumentation and information exchange, which have diverse success in affecting official decisions. Arguments characterized by emotions such as frustration or desperation are to a larger extent neglected by the authorities compared to those characterized by a matter-of-fact driven approach and referring to regulations and medical certificates.

    Conclusion: There are differences regarding how clients and stakeholders communicate the clients’ needs and pre-requisites, and how this affects official decisions. Further research must be carried out in order to establish social insurance literacy, initially for individuals on sick leave within the sickness insurance system, and whether there are differences between diverse groups that could lead to injustices.

    • Implications for rehabilitation
    • Within a social insurance context, professionals need to provide clients with adequate and individually adapted information in order for procedures to be perceived as comprehensible and manageable by the clients.

    • The support from stakeholders such as the treating physician and/or employer can affect clients’ sick-leave process.

    • Clients’ treating medical professionals can contribute to ensuring that clients rights are met by communicating the clients’ needs to other stakeholders in a formal way.

  • 181.
    Karlsson, Linda
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Zetterlund, Martin
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Behandlas barn olika?: Smärtskattning på barn efter skoliosoperation2010Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Despite improved guidelines and treatment of children, postoperative pain is still a problem. Painassessment in children and specially children with cognitive disibilities demands knowledge in existing pain measurement tools for nurses. Then all children have the opportunity to express their pain.

    Aim: To find out if there is a difference in the frequency of assessment in postoperative pain in children after surgery for scoliosis.

    Design: A retrospective study.

    Methods: The study was performed in Linköping University hospital. Children admitted 2008-2009 for Idiopatic scoliosis or Neuromuscular scoliosis surgery, in age 0-18 years and available via the data journal were included in the study.

    Results: Children with Idiopatic scoliosis had a higher freqvence of painassessment compared with Neuromuscular scoliosis. Children who didn´t understood verbal information had less frequence of painassesment compered with those who understood verbal information. Girls were assessed for pain significant more often as compared to boys in the group who understood verbal information.

    Conclusion: There was differences between children who were able to express themselves and those who weren´t in painassessment, but also gender matters and to ensure all children’s right to similar care it´s of importance to access different pain measurement tools.

  • 182.
    Karlsson, Linn
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Takala, Esa-Pekka
    Work-Related Diseases, Finnish Institute of Occupational Health,.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Associations between psychological factors and the effect of home-based physical exercise in women with chronic neck and shoulder pain.2016In: SAGE open medicine, E-ISSN 2050-3121, Vol. 4, article id 2050312116668933Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Exercise is often used in the treatment of chronic neck and shoulder muscle pain. It is likely that psychological aspects have an impact on the results of exercise-based treatments.

    OBJECTIVES: (1) To examine the associations between psychological factors and the effect of a home-based physical exercise intervention. (2) To examine differences in psychological factors at baseline between (a) subjects who continued in the trial and those who did not and (b) subjects who completed the intervention and those who did not.

    METHOD: A total of 57 women with chronic neck and shoulder pain were included in a home-based exercise intervention trial. Pain intensity, disability, and psychological factors (anxiety and depression symptoms, catastrophizing, fear-avoidance beliefs, self-efficacy, and pain acceptance) were measured at baseline, after 4-6 months, and after 1 year of exercise. Associations between the psychological factors and changes in pain intensity and disability were analysed, as well as differences in psychological factors at baseline between subjects who continued in and completed the intervention, and those who did not.

    RESULTS: Associations between positive changes in pain intensity and disability were found for low fear-avoidance beliefs and low-pain self-efficacy at baseline. In addition, fear-avoidance beliefs at baseline were higher in the subjects who dropped out of the intervention than in those who continued. Pain acceptance at baseline was higher in the subjects who completed the intervention at the end of the trial.

    CONCLUSION: Particularly, fear-avoidance beliefs and pain self-efficacy should be taken into consideration when implementing home-based physical exercise as treatment for chronic neck pain. In addition, high pain acceptance might improve the adherence to prescribed exercise.

  • 183.
    Karlsson, Nadine
    et al.
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Skargren, Elisabeth
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Kristenson, Margareta
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Emotional support predicts more sickness absence and poorer self assessed work ability: a two-year prospective cohort study2010In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, no 1, p. 648-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: While back pain and stressful work environment are shown to be important causes of sickness absence the effect of psychosocial resources on sickness absence, and on self assessed work ability, is less commonly investigated. The aim of this study was to assess these associations in a two-year follow-up study.

    METHODS: 341 working people aged 45 to 64, randomly drawn from the population, responded to a questionnaire at baseline and at a two-year follow-up. Poisson regression was used to analyse the association of psychosocial factors (psychosocial instruments on work environment, emotional support and psychological resources) and previous back pain (low back and/or neck) at baseline with sickness absence (spells and days) at follow-up, controlling for effects of age, sex, BMI, smoking, alcohol, occupation, disease and previous sickness absence. Logistic regression was used to study the associations of psychosocial factors and previous back pain at baseline with self assessed prognosis of poor work ability six months from follow-up. Finally, a multivariate analysis tested the independent effects of previous back pain and 3 psychosocial factors derived in a factor analysis: 1. work environment; 2. emotional support; 3. psychological resources, on work ability and absence days and spells.

    RESULTS: 80% of the sickness absence spells within the last 12 months before follow-up were short-term (<= 14 days). In the final model, high emotional support predicted more sickness absence spells (RR 1.36; 1.11-1.67) and days (RR 1.68, 1.22-2.31). Previous back pain (OR 2.56; 1.13-5.81), high emotional support (OR 1.58; 1.02-2.46), and low psychological resources (OR 0.62; 0.44-0.89) were related to poorer self assessed prognosis of work ability at follow up.

    CONCLUSIONS: In a general middle aged working population high emotional support was related to more sickness absence and also poorer self assessed prognosis of work ability. Our findings suggest that both sickness absence and self assessed work ability are dependent of life outside work and can be affected by a person's close community.

  • 184.
    Karlén, Jerker
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Early stress, cortisol in hair and health among children in different psychosocial environments2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Psychosocial circumstances during early life are increasingly recognized as crucial, not only for the growing individual but also for health throughout life. A possible mechanism could be physiologic dysregulation due to stress. Cortisol in hair is a new biomarker that allows assessment of long-term activity of the hypothalamic-pituitary-adrenal axis.

    The objective of this thesis was to investigate the relationship between early stress, levels of cortisol in hair and health among children in different psycho-social environments.

    The ABIS-study is a prospective population-based cohort study of every child born in southeast Sweden between Oct 1 1997 and Oct 1 1999 (N=21,700) in which approximately 17,000 families (79%) participated. The studies presented in Papers I, III and IV were based on ABIS data on children aged 1, 3, 5 and 8 years concerning stress related psychosocial variables as well as hair samples and diabetes related autoantibodies. Papers I and IV compared a subsample (n=2,448) from two different social environments. Paper III consisted of a subsample of 100 children as well as their mothers. Paper II covered 99 university students.

    Paper I showed that the risk for diabetes-related autoantibodies, both against GADA and IAG2A (>95% cut off), was significantly higher (p<0.0001) among children from the blue-collar than from the white-collar city. This difference persisted still after adjustment for other previously documented risk factors. In paper II the method of measuring cortisol concentrations in hair was developed and mean cortisol levels were significantly related to serious life events (p=0.045) among the students. Paper III demonstrated that, in children from one to eight years of age, cortisol levels in hair decreased over time and correlated to each succeeding age, between years 1 and 3 (r=0.30,p=0.002), 3 and 5 (r=0.39, p=0.001), and 5 and 8 (r=0.44, p=0.001). Repeated measures gave a significant linear association over time (p=0.001). Maternal hair cortisol levels during the second and third trimester and child hair cortisol at year 1 and 3 was also significantly associated. Paper IV showed that children with prenatal psychosocial exposures had higher infant cortisol levels in hair (B=0.40, p<0.0001, adjusted for gender and size for gestational age) in a dose-response manner and were more often (p≤0.05) affected by 12 of the 14 most common childhood diagnoses with a general pattern of rising ORs.

    In conclusion, the findings in this thesis showed that children born into an environment fraught with adverse psychosocial exposures seem to have an increased hypothalamic-pituitary-adrenal axis activity. It appears to be persistent throughout early childhood and affect health negatively, as evidenced through common childhood diseases and levels of autoantibodies. A widespread and dose response-like effect of adverse psychosocial circumstances was seen on the different outcomes studied throughout this thesis. This supports the model of physiologic dysregulation as a plausible pathway in how the duration and number of early detrimental exposures act as a trajectory to health disparities. Knowledge of these relationships could be valuable in selecting preventive measures, not least in primary care. Moreover, given the prolonged nature of exposure to a stressful social environment, the novel biomarker of cortisol in hair appears to be a useful aid in studies on how long-term stress affects health and may be particularly relevant when applied to research on children.

    List of papers
    1. Could the social environment trigger the induction of diabetes related autoantibodies in young children?
    Open this publication in new window or tab >>Could the social environment trigger the induction of diabetes related autoantibodies in young children?
    2012 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no 2, p. 177-182Article in journal (Refereed) Published
    Abstract [en]

    Aims: The onset and progression of the autoimmune process leading to type 1 diabetes is partly dependent on genetic predisposition and partly on environmental factors. We have implemented a study design where 1-year-old children, from two equally sized, neighbouring but socioeconomically different cities, were compared for the induction of beta-cell autoantibodies. Methods: This study comprises 2448 newborn infants, all living in the urban parts of the twin cities, followed prospectively with regular biological samples and questionnaires in a major population-based study. Of these, a random sample of 1497 children were tested for tyrosine phosphatase (IA-2A) and 1409 children for glutamic acid decarboxylase (GADA). Other documented risk factors of beta-cell autoimmunity and type 1 diabetes, such as family characteristics, dietary factors, and psychosocial factors were also included in the analysis. Results: The risk for diabetes-related autoantibodies, both against GADA and IA-2A (andgt; 95% cut off), was significantly higher (p andlt; 0.0001) among children from the blue-collar than from the white-collar city. This difference persisted still after adjustment for other previously documented risk factors. Some of these previously known risk factors remained significant in the multivariate analysis as independent explanatory factors, in addition to living in a blue-collar city. Conclusions:Factors in the social environment could trigger the induction of diabetes-related autoantibodies in 1-year-old children. These results point out that our present knowledge of factors influencing the autoimmune process might be widen to also include factors in the social environment of the community.

    Place, publisher, year, edition, pages
    SAGE Publications (UK and US), 2012
    Keywords
    Autoantibodies, children, diabetes, glutamic acid decarboxylase, tyrosine phosphatase, public health, social environment
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-76189 (URN)10.1177/1403494811435491 (DOI)000301192100010 ()
    Available from: 2012-03-31 Created: 2012-03-30 Last updated: 2017-12-07
    2. Cortisol in hair measured in young adults - a biomarker of major life stressors?
    Open this publication in new window or tab >>Cortisol in hair measured in young adults - a biomarker of major life stressors?
    Show others...
    2011 (English)In: BMC Clinical Pathology, ISSN 1472-6890, E-ISSN 1472-6890, Vol. 11, no 1, p. 12-Article in journal (Refereed) Published
    Abstract [en]

    Background Stress as a cause of illness has been firmly established. In public health and stress research a retrospective biomarker of extended stress would be an indispensible aid. The objective of this pilot study was to investigate whether concentrations of cortisol in hair correlate with perceived stress, experiences of serious life events, and perceived health in young adults. Methods Hair samples were cut from the posterior vertex area of (n = 99) university students who also answered a questionnaire covering experiences of serious life events, perceived Stress Scale and perceived health during the last three months. Cortisol was measured using a competitive radioimmunoassay in methanol extracts of hair samples frozen in liquid nitrogen and mechanically pulverised. Results Mean cortisol levels were significantly related to serious life events (p = 0.045), weakly negatively correlated to perceived stress (p = 0.025, r = -0.061) but nor affected by sex, coloured/permed hair, intake of pharmaceuticals or self-reported health. In a multiple regression model, only the indicator of serious life events had an independent (p = 0.041) explanation of increased levels of cortisol in hair. Out of four outliers with extremely high cortisol levels two could be contacted, both reported serious psychological problems. Conclusions These findings suggest that measurement of cortisol in hair could serve as a retrospective biomarker of increased cortisol production reflecting exposure to major life stressors and possibly extended psychological illness with important implications for research, clinical practice and public health. Experience of serious life events seems to be more important in raising cortisol levels in hair than perceived stress.

    Place, publisher, year, edition, pages
    BioMed Central, 2011
    Keywords
    Biomarker; Coping; Cortisol; Hair; Serious life events; Stress
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-74866 (URN)10.1186/1472-6890-11-12 (DOI)22026917 (PubMedID)
    Available from: 2012-02-10 Created: 2012-02-10 Last updated: 2017-12-07Bibliographically approved
    3. Maternal Influence on Child HPA Axis: A Prospective Study of Cortisol Levels in Hair
    Open this publication in new window or tab >>Maternal Influence on Child HPA Axis: A Prospective Study of Cortisol Levels in Hair
    Show others...
    2013 (English)In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 132, no 5, p. E1333-E1340Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To investigate cortisol concentrations in hair as biomarker of prolonged stress in young children and their mothers and the relation to perinatal and sociodemographic factors. less thanbrgreater than less thanbrgreater thanMETHODS: Prospective cohort study of 100 All Babies In Southeast Sweden study participants with repeated measures at 1, 3, 5, and 8 years and their mothers during pregnancy. Prolonged stress levels were assessed through cortisol in hair. A questionnaire covered perinatal and sociodemographic factors during the childs first year of life. less thanbrgreater than less thanbrgreater thanRESULTS: Maternal hair cortisol during the second and third trimester and child hair cortisol at year 1 and 3 correlated. Child cortisol in hair levels decreased over time and correlated to each succeeding age, between years 1 and 3 (r = 0.30, P = .002), 3 and 5 (r = 0.39, P andlt; .001), and 5 and 8 (r = 0.44, P andlt; .001). Repeated measures gave a significant linear association over time (P andlt; .001). There was an association between high levels of hair cortisol and birth weight (beta = .224, P = .020), nonappropriate size for gestational age (beta = .231, P = .017), and living in an apartment compared with a house (beta = .200, P = .049). In addition, we found high levels of cortisol in hair related to other factors associated with psychosocial stress exposure. less thanbrgreater than less thanbrgreater thanCONCLUSIONS: Correlation between hair cortisol levels in mothers and their children suggests a heritable trait or maternal calibration of the childs hypothalamic-pituitary-adrenocortical axis. Cortisol output gradually stabilizes and seems to have a stable trait. Cortisol concentration in hair has the potential to become a biomarker of prolonged stress, especially applicable as a noninvasive method when studying how stress influences childrens health.

    Place, publisher, year, edition, pages
    American Academy of Pediatrics, 2013
    Keywords
    stress, children, mother, cortisol, hair, health disparities
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-102501 (URN)10.1542/peds.2013-1178 (DOI)000326475000026 ()
    Note

    Funding Agencies|Swedish Child Diabetes Foundation (Barndiabetesfonden)||Research Council of Southeast Sweden|FORSS-87771FORSS-36321|Swedish Medical Research Council (MRF)|VR: K99-72X-11242-05A|JDRF Wallenberg Foundation|K 98-99D-12813-01A|County Council of Ostergotland, ALF project grant, Linkoping, Sweden||

    Available from: 2013-12-12 Created: 2013-12-12 Last updated: 2017-12-06Bibliographically approved
    4. Impact of prenatal psychosocial exposures on hair cortisol levels and child health: cohort study
    Open this publication in new window or tab >>Impact of prenatal psychosocial exposures on hair cortisol levels and child health: cohort study
    Show others...
    2014 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background Early psychosocial exposures are increasingly recognized as crucial for health throughout life. A possible mechanism could be physiologic dysregulation due to stress. Cortisol in hair is a new biomarker, assessing long-term HPA axis activity. The objective was to investigate whether prenatal adverse psychosocial circumstances influence infant cortisol levels in hair and health outcome in children prospectively until age 10.

    Methods True prospective cohort study in the general community with a questionnaire covering 11 psychosocial items in the family during pregnancy formed a composite scale of prenatal psychosocial vulnerability, and cumulative incidence of diseases through diagnoses until age 10 in n=1876 children. At age 1, cortisol levels in hair were measured using a competitive radioimmunoassay on a subsample of n=209.

    Results Children with added prenatal psychosocial exposures had higher infant cortisol levels in hair (B=0.40, p<0.0001, adjusted for gender and size for gestational age) in a cumulative manner and were more often (p≤0.05) affected by 12 of the 14 most common childhood diagnoses with a general pattern of rising ORs.

    Conclusions These findings support the model of physiologic dysregulation as a plausible mechanism in how the duration and number of early detrimental psychosocial exposures determine health outcome. It indicates that the multiplicity of adversities should be targeted in future interventions and could help to identify children who are at high risk of poor health. Furthermore, given the prolonged nature of exposure to a stressful social environment, the novel biomarker of cortisol in hair could be of major importance.

    Keywords
    Psychosocial stress, antenatal programming, child health and development, cortisol in hair, health disparities
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-111093 (URN)
    Available from: 2014-10-07 Created: 2014-10-07 Last updated: 2015-06-11Bibliographically approved
  • 185.
    Karlén, Jerker
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Frostell, Anneli
    Linköping University, Department of Behavioural Sciences and Learning, Cognition, Development and Disability. Linköping University, Faculty of Health Sciences.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Cortisol in hair measured in young adults - a biomarker of major life stressors?2011In: BMC Clinical Pathology, ISSN 1472-6890, E-ISSN 1472-6890, Vol. 11, no 1, p. 12-Article in journal (Refereed)
    Abstract [en]

    Background Stress as a cause of illness has been firmly established. In public health and stress research a retrospective biomarker of extended stress would be an indispensible aid. The objective of this pilot study was to investigate whether concentrations of cortisol in hair correlate with perceived stress, experiences of serious life events, and perceived health in young adults. Methods Hair samples were cut from the posterior vertex area of (n = 99) university students who also answered a questionnaire covering experiences of serious life events, perceived Stress Scale and perceived health during the last three months. Cortisol was measured using a competitive radioimmunoassay in methanol extracts of hair samples frozen in liquid nitrogen and mechanically pulverised. Results Mean cortisol levels were significantly related to serious life events (p = 0.045), weakly negatively correlated to perceived stress (p = 0.025, r = -0.061) but nor affected by sex, coloured/permed hair, intake of pharmaceuticals or self-reported health. In a multiple regression model, only the indicator of serious life events had an independent (p = 0.041) explanation of increased levels of cortisol in hair. Out of four outliers with extremely high cortisol levels two could be contacted, both reported serious psychological problems. Conclusions These findings suggest that measurement of cortisol in hair could serve as a retrospective biomarker of increased cortisol production reflecting exposure to major life stressors and possibly extended psychological illness with important implications for research, clinical practice and public health. Experience of serious life events seems to be more important in raising cortisol levels in hair than perceived stress.

  • 186.
    Karlén, Jerker
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care in Central County.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Hedmark, Max
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Olsen Faresjö, Åshild
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Impact of prenatal psychosocial exposures on hair cortisol levels and child health: cohort study2014Manuscript (preprint) (Other academic)
    Abstract [en]

    Background Early psychosocial exposures are increasingly recognized as crucial for health throughout life. A possible mechanism could be physiologic dysregulation due to stress. Cortisol in hair is a new biomarker, assessing long-term HPA axis activity. The objective was to investigate whether prenatal adverse psychosocial circumstances influence infant cortisol levels in hair and health outcome in children prospectively until age 10.

    Methods True prospective cohort study in the general community with a questionnaire covering 11 psychosocial items in the family during pregnancy formed a composite scale of prenatal psychosocial vulnerability, and cumulative incidence of diseases through diagnoses until age 10 in n=1876 children. At age 1, cortisol levels in hair were measured using a competitive radioimmunoassay on a subsample of n=209.

    Results Children with added prenatal psychosocial exposures had higher infant cortisol levels in hair (B=0.40, p<0.0001, adjusted for gender and size for gestational age) in a cumulative manner and were more often (p≤0.05) affected by 12 of the 14 most common childhood diagnoses with a general pattern of rising ORs.

    Conclusions These findings support the model of physiologic dysregulation as a plausible mechanism in how the duration and number of early detrimental psychosocial exposures determine health outcome. It indicates that the multiplicity of adversities should be targeted in future interventions and could help to identify children who are at high risk of poor health. Furthermore, given the prolonged nature of exposure to a stressful social environment, the novel biomarker of cortisol in hair could be of major importance.

  • 187.
    Kastbom, Åsa A.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Sexual behaviour, debut and identity among Swedish Schoolchildren2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Sexual behaviour among schoolchildren and adolescents is a sparsely researched area and there are delicate methodological obstacles and ethical concerns when conducting such research. Still it is a subject that engages both parents and professionals. A sexualized behaviour or an early sexual debut (younger than 14 years) can be a sign of sexual abuse. It is therefore of importance to describe what is common and what is uncommon sexual behaviour among children and what the consequences of an early or a late sexual debut may be for the individual upon reaching late adolescence. Adolescents who identify themselves as lesbian, gay or bisexual (LGB) are also a group that needs further attention and research since they are often described as having a lower quality of life and more often experience child abuse than heterosexual teens.

    Aims: The research leading to this thesis had four goals: 1) to elucidate the sexual behaviour of children between the ages of 7 and 13 as observed by their parents, 2) to investigate the relationship between an early sexual debut (before 14 years of age) and socio-demographic data, sexual experience, health, experience of child abuse and behaviour at 18-years-of-age, 3) to explore associations with no sexual debut (no oral, vaginal or anal sex) at the age of 18, and 4) to describe the relationship between sexual identification and socio-demographic background data, sexual behaviour, health and health behaviour, experiences of child sexual and/or physical abuse and present behaviour among Swedish adolescents.

    Methods: The parents of 418 children answered questionnaires about their child’s behaviour, both general and sexual, and a sample of 3432 Swedish high school students completed a survey about sexuality, health and abuse at the age of 18. In addition, 362 members of the Swedish Federation for Lesbian, Gay, Bisexual and Transgender Rights (RFSL) completed the same survey at a mean age of 21.4 years.

    Results: Most of the sexual behaviours among the schoolchildren were common, and in part related to, or varied with, age and gender. A small number of sexual behaviours often referred to as sexualised or problematic behaviours (for example, kissing adults with the tongue, imitating intercourse, masturbating in public, and touching other children’s genitals with the mouth) were found to be very unusual or not reported by any parent in this normative group of Swedish children. Among the adolescents, an early debut (younger than 14 years of age) correlated positively with number of partners, experience of oral and anal sex, smoking, drug and alcohol use and antisocial behaviour, such as being violent, lying, stealing and running away from home. Girls with an early sexual debut had significantly more experience of sexual abuse while boys with an early sexual debut were more likely to have a weak sense of coherence, low self-esteem and poor mental health, together with experience of sexual abuse, selling sex and physical abuse. A multiple logistic regression model showed that a number of antisocial acts and health behaviours remained significant, but early sexual debut did not increase the risk of psychiatric symptoms, low self-esteem or low sense of coherence at 18-years-of-age. Just under a quarter (24.6%) of the 3,380 adolescents had not had their sexual debut (no oral, anal or vaginal sex by the age of 18). There was a positive correlation between not debuting sexually at age 18 and a number of factors such as: being more likely to have caring fathers; parents born outside Europe; low sexual desire; lower pornography consumption; lower alcohol and tobacco consumption; less antisocial behavior and fewer experiences of sexual abuse than 18 year olds who had already made their sexua  debut. Adolescents with a minority sexual identity more often described their relationship with their parents as based on low care and high overprotection than did their heterosexual peers. The minority adolescents used alcohol and drugs to a significantly higher degree than the heterosexual adolescents. Multivariate analysis showed a positive correlation between a minority sexual identity and experience of anal sex, higher sexual lust, experience of sexual abuse, physical abuse and sexual exploitation. It was more than twice as common to have experience of penetrating sexual abuse and physical abuse with a sexual minority identity.

    Conclusions: Behaviours usually referred to as sexualised and problematic are uncommon among children at 7-13 years of age. Professionals and should give a child showing a sexualised behaviour special attention and investigate the reasons for the behaviour. Early sexual debut seems to be associated with problematic behaviours during later adolescence, indicating the fact that the early debut for some children is associated with an increased vulnerability, which has to be addressed. Family socio-demographics such as family stability and/or cultural status matter when it comes to time of sexual debut. Personality also seems to matter and further studies are needed to investigate if there is any correlation between personality traits and late sexual debut. Adolescents with no sexual debut at 18 years of age reported fewer antisocial acts, were less likely to smoke and drink alcohol, had less sexual desire and less experience of sexual abuse. Young people with a sexual minority identity (homo- and bisexual) could be seen to have a lower quality of life compared to heterosexual peers and studies need to be done to further explore possible reasons. They have a higher risk of having experience of sexual and physical abuse compared to heterosexual adolescents. Professionals need to be more aware of this group’s additional vulnerability including the increased risk of child abuse and offer different forms of support.

    List of papers
    1. Parents' reports on 7-12-years old childrens sexual behavior
    Open this publication in new window or tab >>Parents' reports on 7-12-years old childrens sexual behavior
    2011 (English)In: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 8, no Suppl. 3, p. 270-270Article in journal, Meeting abstract (Other academic) Published
    Abstract [en]

    Aim: To understand if a sexual behaviour in a child is a sign of sexual abuse or neglect we need to investigate sexual behaviours among chil-dren. In the present study we investigated Swedish children age 7–12 to determine what constitutes usual and unusual sexual behaviours.

    Methods: Parents of 418 children answered questionnaires about their child’s behaviour, both general and sexual, and about their own attitudes.

    Results: We found that most sexual behaviours we asked about are common, and are in part related to or vary with age and gender. A small number of sexual behaviours were found to be very unusual in this normative group of children.

    Conclusion: Behaviours usually referred to as sexualized and problematic and perhaps a sign of sexual abuse or neglect were very rare in this normative sample of children 7–12 years of age.

    Place, publisher, year, edition, pages
    Malden , MA, USA: Blackwell Publishing, 2011
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-69889 (URN)10.1111/j.1743-6109.2011.02325.x (DOI)000291345300747 ()
    Conference
    Proceedings from the 20th World Congress of Sexual Health, Glasgow, United Kingdom, June 12-16 2011
    Note

    Meeting Abstract: 746

    Available from: 2011-08-09 Created: 2011-08-08 Last updated: 2017-12-08Bibliographically approved
    2. Sexual debut before the age of 14 leads to poorer psychosocial health and risky behaviour in later life
    Open this publication in new window or tab >>Sexual debut before the age of 14 leads to poorer psychosocial health and risky behaviour in later life
    Show others...
    2015 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 1, p. 91-100Article in journal (Refereed) Published
    Abstract [en]

    Aim: This study investigated the relationship between sexual debut before 14 years of age and socio-demographics, sexual experience, health, experience of child abuse and behaviour at 18 years of age.

    Methods: A sample of 3432 Swedish high school seniors completed a survey about sexuality, health and abuse at the age of 18.

    Results: Early debut was positively correlated with risky behaviours, such as the number of partners, experience of oral and anal sex, health behaviours, such as smoking, drug and alcohol use, and antisocial behaviour, such as being violent, lying, stealing and running away from home. Girls with an early sexual debut had significantly more experience of sexual abuse. Boys with an early sexual debut were more likely to have a weak sense of coherence, low self-esteem and poor mental health, together with experience of sexual abuse, selling sex and physical abuse. A multiple logistic regression model showed that a number of antisocial acts and health behaviours remained significant, but early sexual debut did not increase the risk of psychiatric symptoms, low self-esteem or low sense of coherence at 18 years of age.

    Conclusion: Early sexual debut was associated with problematic behaviours during later adolescence, and this vulnerability requires attention from parents and healthcare providers.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2015
    Keywords
    Child abuse; Drug use; Risky behaviour; Sexual behaviour; Sexual debut
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-113719 (URN)10.1111/apa.12803 (DOI)000346987300025 ()25213099 (PubMedID)
    Available from: 2015-01-30 Created: 2015-01-29 Last updated: 2017-12-05
    3. Differences in sexual behavior, health, and history of child abuse among school students who had and had not engaged in sexual activity by the age of 18 years: a cross-sectional study
    Open this publication in new window or tab >>Differences in sexual behavior, health, and history of child abuse among school students who had and had not engaged in sexual activity by the age of 18 years: a cross-sectional study
    Show others...
    2016 (English)In: Adolescent Health, Medicine and Therapeutics, ISSN 1179-318X, Vol. 7, p. 1-11Article in journal (Refereed) Published
    Abstract [en]

    Background: Empirical research about late sexual debut and its consequences is limited, and further research is needed.

    Objective: To explore how students who had not had intercourse by the age of 18 years differed in terms of sociodemographic factors, physical and psychological health, sexual behavior, and history of sexual abuse from those who had.

    Materials and methods: This is a cross-sectional survey involving 3,380 Swedish 18-year-olds. Descriptive analyses were used to investigate different types of sexual behavior. Ordinal data concerning alcohol consumption, self-esteem, sexual and physical abuse, parental relationships, sense of coherence, and health were analyzed, and multiple regression was carried out to identify the most important factors associated with no sexual debut.

    Results: Just under a quarter of the adolescents had not had oral, anal, or vaginal sex by the age of 18 years, and they comprised the index group. They were characterized by being more likely to have caring fathers, parents born outside Europe, lower pornography consumption, lower alcohol and tobacco consumption, less antisocial behavior, and above all lower sexual desire (sometimes, adjusted odds ratio [aOR] 3.8; never/seldom, aOR 13.3) and fewer experiences of sexual abuse (aOR 25.5). Family structure and culture matters when it comes to the age of sexual debut.

    Conclusion: Adolescents with no sexual debut at 18 years of age seemed to live a more stable and cautious life than more sexual experienced peers, exemplified by fewer antisocial acts, less smoking and alcohol/drug consumption, less sexual desire, and less experience of sexual abuse.

    Place, publisher, year, edition, pages
    Dove Medical Press Ltd.(Dovepress), 2016
    Keywords
    Adolescents, sexual abuse, sexual behavior, late sexual debut
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-123026 (URN)10.2147/AHMT.S95493 (DOI)26811695 (PubMedID)
    Funder
    Swedish Agency for Youth and Civil Society (MUCF)
    Note

    At the time for thesis presentation publication was in status: Manuscript

    Available from: 2015-12-02 Created: 2015-12-02 Last updated: 2017-12-01Bibliographically approved
    4. Comparing quality of life between Swedish adolescents and young adults from sexual minorities and heterosexual groups
    Open this publication in new window or tab >>Comparing quality of life between Swedish adolescents and young adults from sexual minorities and heterosexual groups
    Show others...
    2015 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Objectives: To investigate the relationship between sexual identity and socio- demographics, sexual experience, health, experience of child abuse, sexual exploitation and present behavior among Swedish adolescents and young adults.

    Methods: A cross-sectional survey with 3,503 adolescents completing a  survey  about their sexuality, health and abuse at a mean age of 18.3 years. In addition, 362 members of the Swedish Federation for Lesbian, Gay, Bisexual and Transgender Rights completed the same survey at a mean age of 21.4 years.

    Results: Sexual minority respondents were more likely to say that their parental relationship was based on low care and high overprotection and they used alcohol and other drugs to a significantly higher extent than their heterosexual peers. Multivariate analysis showed a positive correlation between sexual minority and  low  self-esteem, poor mental health and experience of sexual abuse, physical abuse and sexual exploitation.

    Conclusion: The sexual minority group had a lower quality of life than their heterosexual peers and professionals need to be more aware that they are more vulnerable in a number of respects, including an increased risk of having experienced child abuse, and offer them different forms of support.

    Keywords
    Sexual minority, child abuse, health, self-esteem
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-123027 (URN)
    Available from: 2015-12-02 Created: 2015-12-02 Last updated: 2015-12-02Bibliographically approved
  • 188.
    Kazdaglis, G.
    et al.
    Aristotle Univ Thessaloniki, Greece.
    Molina-Moya, B.
    Autonomous Univ Barcelona, Spain.
    Manika, K.
    Aristotle Univ Thessaloniki, Greece.
    Ioannidis, P.
    Sotiria Chest Dis Hosp, Greece; Sotiria Chest Dis Hosp, Greece.
    Papaventsis, D.
    Sotiria Chest Dis Hosp, Greece; Sotiria Chest Dis Hosp, Greece.
    Vogiatzakis, E.
    Sotiria Chest Dis Hosp, Greece; Sotiria Chest Dis Hosp, Greece.
    Panopoulou, M.
    Democritus Univ Thrace, Greece.
    Melidou, A.
    Aristotle Univ Thessaloniki, Greece.
    Dominguez, J.
    Autonomous Univ Barcelona, Spain.
    Malisiovas, N.
    Aristotle Univ Thessaloniki, Greece.
    Gioula, G.
    Aristotle Univ Thessaloniki, Greece.
    GENETIC DIVERSITY OF MYCOBACTERIUM TUBERCULOSIS IN NORTHERN GREECE2018In: Journal of Biological Regulators and Homeostatic Agents, ISSN 0393-974X, E-ISSN 1724-6083, Vol. 32, no 4, p. 931-936Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to describe the genetic diversity of Mycobacterium tuberculosis (M.tuberculosis) strains circulating in the region of Northern Greece. A total of thirty-seven M. tuberculosis clinical isolates were analysed by the spoligotyping method. According to the results, six clusters comprising seventeen strains were detected, and the remaining twenty strains showed unique patterns. The M.tuberculosis families according to SITVITWEB were distributed as follows: Haarlem (H) (27.0%); T (24.3%); Beijing (13.5%); Latin-America and Mediterranean (LAM) (5.4%) and S (2.7%). The remaining isolates (27%) did not match any isolates within the database and they were characterized as orphans. Regarding GenoType MTBDRpIus results, two strains (5.4%) were Multi-Drug-Resistant, four strains (10.8%), were isoniazid monoresistant, while the remaining thirty-one strains (83.8%) were susceptible. In conclusion, in the region of Macedonia-Thrace (Northern Greece), there was high phylogenetic diversity among M. tuberculosis isolates. Molecular tools used and data presented can have regional and national impact on tuberculosis control.

  • 189.
    Kelfve, Susanne
    et al.
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden; Stockholm Univ, Sweden.
    Wastesson, Jonas
    Karolinska Inst, Sweden; Stockholm Univ, Sweden.
    Fors, Stefan
    Karolinska Inst, Sweden; Stockholm Univ, Sweden; Karolinska Inst, Sweden.
    Johnell, Kristina
    Karolinska Inst, Sweden; Stockholm Univ, Sweden.
    Morin, Lucas
    Karolinska Inst, Sweden; Stockholm Univ, Sweden.
    Is the level of education associated with transitions between care settings in older adults near the end of life? A nationwide, retrospective cohort study2018In: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 32, no 2, p. 366-375Article in journal (Refereed)
    Abstract [en]

    Background: End-of-life transitions between care settings can be burdensome for older adults and their relatives. Aim: To analyze the association between the level of education of older adults and their likelihood to experience care transitions during the final months before death. Design: Nationwide, retrospective cohort study using register data. Setting/participants: Older adults (65 years) who died in Sweden in 2013 (n = 75,722). Place of death was the primary outcome. Institutionalization and multiple hospital admissions during the final months of life were defined as secondary outcomes. The decedents level of education (primary, secondary, or tertiary education) was considered as the main exposure. Multivariable analyses were stratified by living arrangement and adjusted for sex, age at time of death, illness trajectory, and number of chronic diseases. Results: Among community-dwellers, older adults with tertiary education were more likely to die in hospitals than those with primary education (55.6% vs 49.9%; odds ratio (OR) = 1.21, 95% confidence interval (CI) = 1.14-1.28), but less likely to be institutionalized during the final month before death (OR = 0.83, 95% CI = 0.76-0.91). Decedents with higher education had greater odds of remaining hospitalized continuously during their final 2 weeks of life (OR = 1.12, 95% CI = 1.02-1.22). Among older adults living in nursing homes, we found no association between the decedents level of education and their likelihood to be hospitalized or to die in hospitals. Conclusion: Compared with those who completed only primary education, individuals with higher educational attainment were more likely to live at home until the end of life, but also more likely to be hospitalized and die in hospitals.

  • 190.
    Kernell, Kristina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Cardiac disease in pregnancy and consequences for reproductive outcomes, comorbidity and survival2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

    Advances in medical treatment during the last 50 years have resulted in more individuals with congenital heart disease (CHD) and Marfan syndrome reaching childbearing age. The substantial physiological changes during pregnancy result in a high-risk situation, and pregnancy is a major concern in women with these conditions.

    Aims

    • To describe the socio-demographic characteristics, birth characteristics and reproductive patterns of individuals with CHD and women with Marfan syndrome.
    • To investigate obstetric and neonatal outcomes in the firstborn children of individuals with CHD and women with Marfan syndrome.
    • To study long-term cardiovascular outcomes after childbirth in women with Marfan´syndrome.

    Methods

    The studies are population-based register studies. The study population in the first paper included all women born between 1973 and 1983 who were alive and resident in Sweden at the age of 13 (494 692 women, of whom 2 216 were women with CHD). In the second paper, the same definition of the study population was chosen, except that it involved all men born between 1973 and 1983 (522 216 men, of whom 2 689 men with CHD). The third and fourth papers involved a study population of all Swedish women born between 1973 and 1993 who were still living in Sweden at age 13. This population consisted of 1 017 538 women, 273 of whom had been diagnosed with Marfan syndrome.

    Results and conclusions

    The individuals studied were more often born preterm, and were small-for-gestational age babies. They were more likely to have been born by cesarean section. In women with CHD, these characteristics were repeated in their firstborn children. No increased risks were found in children of men with CHD or in children of women with Marfan syndrome. There was no increased risk of aortic dissection in women with Marfan syndrome during pregnancy compared to women with Marfan syndrome who did not give birth. Higher frequencies of cardiac arrhythmia and valvular heart disease were found after childbirth in women with Marfan syndrome. Pregnancy in women with CHD is a high-risk situation associated with increased risk of adverse neonatal outcomes for the expected child. Pregnancy in women without CHD, but where the father has CHD is not so associated with increased risk of adverse obstetric or neonatal outcomes. Pregnancy in women with Marfan syndrome is not associated with adverse outcomes for the expected child.

    List of papers
    1. Reproductive patterns and pregnancy outcomes in women with congenital heart disease - a Swedish population-based study
    Open this publication in new window or tab >>Reproductive patterns and pregnancy outcomes in women with congenital heart disease - a Swedish population-based study
    Show others...
    2011 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 6, p. 659-665Article in journal (Refereed) Published
    Abstract [en]

    Objective. To study women diagnosed with congenital heart disease (CHD) with respect to characteristics related to their own births, their subsequent likelihood of giving birth and the obstetric and neonatal outcomes of their pregnancies. Design. Population-based register study. Population. All women born in 1973-1983 who were alive and living in Sweden at 13 years of age (n=500 245). Methods. Women diagnosed with CHD (n=2 216) were compared with women without CHD (n=492 476). A total of 188 867 mother-firstborn-offspring pairs were identified and available for analysis. Results. Mothers of women with CHD were more often older and single/unmarried. Women with CHD were more often born preterm or small-for-gestational age (SGA) than women without CHD, more likely to have been born with a cesarean section, to have given birth during the study period, and to be younger at the time of their first pregnancy. Women with CHD were also more prone to give birth to children preterm or SGA and their babies were more often delivered by cesarean section with a higher frequency of congenital abnormality. Conclusions. Women with CHD were more likely to have been born preterm or SGA and these outcomes were repeated in the next generation. Women with CHD should not be discouraged from pregnancy. Prenatal diagnostics should be discussed and offered to these women, as there is an increased risk for congenital abnormalities.

    Place, publisher, year, edition, pages
    Wiley, 2011
    Keywords
    Congenital heart disease; reproduction; high-risk pregnancy
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-69887 (URN)10.1111/j.1600-0412.2011.01100.x (DOI)000291433600016 ()
    Available from: 2011-08-09 Created: 2011-08-08 Last updated: 2019-06-28
    2. Congenital heart disease in men - birth characteristics and reproduction: a national cohort study.
    Open this publication in new window or tab >>Congenital heart disease in men - birth characteristics and reproduction: a national cohort study.
    Show others...
    2014 (English)In: BMC pregnancy and childbirth, ISSN 1471-2393, Vol. 14, p. 187-Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Women with congenital heart disease (CHD) are more often born preterm or small-for-gestational age and with a caesarean section. This pattern together with an increased risk of congenital anomalies seems to be repeated in the next generation. Information on the effect of paternal CHD on their offspring is sparse. In this study we investigated if men with CHD differ from those who do not have CHD with respect to characteristics related to their own births, their reproductive patterns and the neonatal outcomes of their children.

    METHODS: In this national cohort study data were derived from Swedish population-based registries. The population consists of all men born in 1973-1983 who were alive and living in Sweden at 13 years of age (n = 522 216). The index group is men with CHD (n = 2689). Men diagnosed with CHD were compared with men without CHD. The CHD were also divided into two groups, complex and simple CHD and comparisons between the groups were made.

    RESULTS: Men with CHD are more likely to have been born preterm (p < 0.001), small-for gestational-age (p < 0.001) or large-for-gestational-age (p < 0.001) than men without CHD. They are also more likely to have been the result of a twin pregnancy (p < 0.001) and to have been delivered by caesarean section (p < 0.001). Men with CHD have a decreased likelihood to become fathers compared to non-CHD men and in this study their offspring do not have a higher incidence of CHD than offspring to non-CHD fathers. The neonatal outcomes of children of men with CHD do not differ from the outcomes of children of non-CHD men.

    CONCLUSIONS: Men with CHD were more often born with non-optimal characteristics compared to men without the condition. However, the increased risk does not repeat itself in the next generation. This knowledge can lead to improved preconception counselling for couples in which the father has a CHD.

    Place, publisher, year, edition, pages
    BioMed Central, 2014
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-115269 (URN)10.1186/1471-2393-14-187 (DOI)000338566400002 ()24890365 (PubMedID)2-s2.0-84905053219 (Scopus ID)
    Available from: 2015-03-11 Created: 2015-03-11 Last updated: 2019-06-28Bibliographically approved
  • 191.
    Khedidja, Hedna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Nordic School of Public Health NHV, Gothenburg, Sweden.
    Hakkarainen, Katja M.
    Nordic School of Public Health NHV, Gothenburg, Sweden, EPID Research, Espoo, Finland.
    Gyllensten, Hanna
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Jönsson, Anna K
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Pharmacology.
    Petzold, Max
    Centre for Applied Biostatistics, University of Gothenburg,, Gotenburg, Sweden.
    Hägg, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Pharmacology.
    Potentially inappropriate prescribing and adverse drug reactions in the elderly: a population-based study2015In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 71, no 12, p. 1525-1533Article in journal (Refereed)
    Abstract [en]

    Purpose

    Potentially inappropriate prescriptions (PIPs) criteria are widely used for evaluating the quality of prescribing in elderly. However, there is limited evidence on their association with adverse drug reactions (ADRs) across healthcare settings. The study aimed to determine the prevalence of PIPs, defined by the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria, in the Swedish elderly general population and to investigate the association between PIPs and occurrence of ADRs.

    Method

    Persons ≥65 years old were identified from a random sample of 5025 adults drawn from the Swedish Total Population Register. A retrospective cohort study was conducted among 813 elderly with healthcare encounters in primary and specialised healthcare settings during a 3-month period in 2008. PIPs were identified from the Swedish Prescribed Drug Register, medical records and health administrative data. ADRs were independently identified by expert reviewers in a stepwise manner using the Howard criteria. Multivariable logistic regression examined the association between PIPs and ADRs.

    Results

    Overall, 374 (46.0 %) persons had ≥1 PIPs and 159 (19.5 %) experienced ≥1 ADRs during the study period. In total, 29.8 % of all ADRs was considered caused by PIPs. Persons prescribed with PIPs had more than twofold increased odds of experiencing ADRs (OR 2.47; 95 % CI 1.65–3.69). PIPs were considered the cause of 60 % of ADRs affecting the vascular system, 50 % of ADRs affecting the nervous system and 62.5 % of ADRs resulting in falls.

    Conclusion

    PIPs are common among the Swedish elderly and are associated with increased odds of experiencing ADRs. Thus, interventions to decrease PIPs may contribute to preventing ADRs, in particular ADRs associated with nervous and vascular disorders and falls.

  • 192.
    Kilander, Helena
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Contraceptive counselling in abortion care2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Improving women’s knowledge about contraception, and their access to contraceptive methods, is central in order to strengthen their sexual and reproductive rights at the time of an abortion. Contraceptive counselling aims to support women’s reproductive control and prevent unintended pregnancies (UPs). It is unclear, however, how to provide contraceptive counselling and how to organise services at the time of an abortion, in order to achieve this.

    Aim: The overall aim was to study women’s choices and use of contraceptive methods post-abortion. The research also aimed to describe contraceptive counselling in the context of an abortion from women’s and health professionals’ (HP’s) perspectives. Initial studies informed subsequent improvement efforts, also evaluated in the thesis, regarding contraceptive counselling and services at the time of an abortion.

    Design and Methods: The studies in this thesis involve both quantitative (studies I and IV) and qualitative (studies II–IV) methods, performed at six departments in southeast Sweden. Study I had a quantitative and longitudinal design. The medical records of women (n=987) were reviewed regarding women’s choice of contraceptive method at the index abortion and the odds of repeat abortion within three to four years. Studies II and III were qualitative interview studies, in which 13 women (study II) and 21 healthcare professionals (HPs) (study III) described their experiences of contraceptive counselling at the time of an abortion. The interviews were analysed using interpretive phenomenology (study II) and conventional content analysis (study III). Study IV was a case study regarding a qualitative improvement collaborative (QIC), designed to improve contraceptive counselling and services. Three multi-professional teams involved in abortion care participated in the QIC and two women provided user-experience input. Both qualitative and quantitative data were collected and analysed.

    Results: The findings of the thesis are organised into three themes: I) Women and HPs described contraceptive counselling at the time of an abortion as an often - complex meeting. There was scepticism about contraceptive methods and limited receptivity to information among women. Respectful counselling facilitated women’s choice of contraceptive method even if they were sceptical and found the situation emotionally charged. II) Women’s choices, need for guidance and access to the contraceptive methods was described in the second theme. Choice of oral contraceptives (OC) dominated. Overall, 25% of the women experienced repeat abortion during followup. Women who chose long-acting reversible contraception (LARC) experienced fewer repeat abortions compared to women who chose OC. Both women and HPs reported barriers in access to LARC post-abortion. III) In a Quality Improvement Collaborative (QIC), two volunteering women provided user-experience input. HPs participating in this QIC reported strengthened skills in counselling and enhanced ability to evaluate their performance. Despite the team’s prediction that they would reach the QIC goal that ≥50% of women would start LARC within 30 days post-abortion, and the fact that a majority of the women in QIC units chose LARC, none of the teams managed to reach the goal, primarily due to insufficient capacity for timely initiation of LARC.

    Conclusion: The findings suggest that women need respectful counselling and guidance at the time of an abortion. Access to a range of contraceptive methods, particularly LARC, is important to prevent repeat UPs. There is room for further improvement in offering coordinated and timely access for women who choose LARC, and to evaluate counselling, in the present settings.

    List of papers
    1. Likelihood of repeat abortion in a Swedish cohort according to the choice of post-abortion contraception: a longitudinal study
    Open this publication in new window or tab >>Likelihood of repeat abortion in a Swedish cohort according to the choice of post-abortion contraception: a longitudinal study
    Show others...
    2016 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, no 5, p. 565-571Article in journal (Refereed) Published
    Abstract [en]

    IntroductionDespite high access to contraceptive services, 42% of the women who seek an abortion in Sweden have a history of previous abortion(s). The reasons for this high repeat abortion rate remain obscure. The objective of this study was to study the choice of contraceptive method after abortion and related odds of repeat abortions within 3-4 years. Material and methodsThis is a retrospective cohort study based on a medical record review at three hospitals in Sweden. We included 987 women who had an abortion during 2009. We reviewed medical records from the date of the index abortion until the end of 2012 to establish the choice of contraception following the index abortion and the occurrence of repeat abortions. We calculated odds ratios (OR) with 95% CI. ResultsWhile 46% of the women chose oral contraceptives, 34% chose long-acting reversible contraceptives (LARC). LARC was chosen more commonly by women with a previous pregnancy, childbirth and/or abortion. During the follow-up period, 24% of the study population requested one or more repeat abortion(s). Choosing LARC at the time of the index abortion was associated with fewer repeat abortions compared with choosing oral contraceptives (13% vs. 26%, OR 0.36; 95% CI 0.24-0.52). Subdermal implant was as effective as intrauterine device in preventing repeat abortions beyond 3 years. ConclusionsChoosing LARC was associated with fewer repeat abortions over more than 3 years of follow up.

    Place, publisher, year, edition, pages
    WILEY-BLACKWELL, 2016
    Keywords
    Long-acting reversible contraception; post-abortion contraception; repeat abortion; subdermal implant; termination of pregnancy
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-128136 (URN)10.1111/aogs.12874 (DOI)000374349400012 ()26871269 (PubMedID)
    Note

    Funding Agencies|Futurum - the academy for healthcare; Jonkoping County Council; Medical Research Council of Southeast Sweden (FORSS)

    Available from: 2016-05-19 Created: 2016-05-19 Last updated: 2018-11-26
    2. Womens experiences of contraceptive counselling in the context of an abortion - An interview study
    Open this publication in new window or tab >>Womens experiences of contraceptive counselling in the context of an abortion - An interview study
    Show others...
    2018 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 17, p. 103-107Article in journal (Refereed) Published
    Abstract [en]

    Objective: To identify and understand womens lived experiences of contraceptive counselling given at the same time as abortion counselling. Methods: We interviewed 13 women aged 20-39 who had experienced an abortion and the related counselling. The women were recruited from five hospitals in Sweden. Interviews were analysed using an interpretative phenomenological approach. Results: We identified two themes: need for respectful counselling and needs for guidance and access to contraceptives. The essence "Being in a state of limbo and feeling sceptical" was coalesced from the themes. The women described a state of limbo, as being caught in an unwanted and emotionally charged situation. They reported that respectful counselling and meeting a skilled health professional helped to dispel their scepticism and influenced their plans for contraceptive use post abortion. Furthermore, women who wanted an intrauterine device described difficulties in access post abortion. Conclusion: The women seem to have a limited receptivity to contraceptive counselling when they have an unwanted pregnancy and are sceptical about contraceptives. Women, who experience respect in the counselling, report being helped in contraceptive decision-making. To receive respectful counselling and to have good access to intrauterine devices emerged as central needs among women at the time of an abortion.

    Place, publisher, year, edition, pages
    ELSEVIER IRELAND LTD, 2018
    Keywords
    Accessibility; Contraception; Family planning; Intrauterine device; Pregnancy termination; Respect
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:liu:diva-152074 (URN)10.1016/j.srhc.2018.07.007 (DOI)000445980700018 ()30193713 (PubMedID)
    Note

    Funding Agencies|Futurum - the academy for healthcare in the Jonkoping County Council; Medical Research Council of Southeast Sweden (FORSS)

    Available from: 2018-10-24 Created: 2018-10-24 Last updated: 2018-11-26
    3. Contraceptive counselling of women seeking abortion - a qualitative interview study of health professionals experiences
    Open this publication in new window or tab >>Contraceptive counselling of women seeking abortion - a qualitative interview study of health professionals experiences
    Show others...
    2017 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 22, no 1Article in journal (Refereed) Published
    Abstract [en]

    Objectives: A substantial proportion of women who undergo an abortion continue afterwards without switching to more effective contraceptive use. Many subsequently have repeat unintended pregnancies. This study, therefore, aimed to identify and describe health professionalg experiences of providing contraceptive counselling to women seeking an abortion. Methods: We interviewed 21 health professionals (HPs), involved in contraceptive counselling of women seeking abortion at three differently sized hospitals in Sweden. The interviews were recorded and transcribed verbatim and analysed using conventional qualitative content analysis. Results: Three clusters were identified: Complex counselling, Elements of counselling and Finding a method. HPs often experienced consultations including contraceptive counselling at the time of an abortion as complex, covering both pregnancy termination and contraceptive counselling. Women with vulnerabilities placed even greater demands on the HPs providing counselling. The HPs varied in their approaches when providing contraceptive counselling but also in their knowledge about certain contraception methods. HPs described challenges in finding out if women had found an effective method and in the practicalities of arranging intrauterine device (IUD) insertion post-abortion, when a woman asked for this method. Conclusions: HPs found it challenging to provide contraceptive counselling at the time of an abortion and to arrange access to IUDs post-abortion. There is a need to improve their counselling, their skills and their knowledge to prevent repeat unintended pregnancies.

    Place, publisher, year, edition, pages
    TAYLOR & FRANCIS LTD, 2017
    Keywords
    Contraception; decision-making; family planning; pregnancy termination; prevention; providers perspective; repeat abortion
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:liu:diva-136329 (URN)10.1080/13625187.2016.1238892 (DOI)000394925200002 ()27689407 (PubMedID)
    Note

    Funding Agencies|Futurum - the academy for healthcare, in the Jonkoping County Council [306501]; Medical Research Council of Southeast Sweden (FORSS) [467241]

    Available from: 2017-04-10 Created: 2017-04-10 Last updated: 2018-11-26
  • 193.
    Kiwi, Mahin
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Dementia across cultural borders: Reflections and thought patterns of elderly Iranians with dementia in Sweden, their relatives and staff at a culturally profiled nursing home2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Today’s multicultural society has resulted in major changes, with healthcare undergoing significant modifications. Healthcare workers and patients are increasingly confronted with “cultural” backgrounds other than their own. The world’s population is ageing, and the number of people with dementia is growing, resulting in a growing number of older people with a foreign background whose care needs have increased at different rates. Migration does not only mean moving from one place to another; it also involves the transition of an individual’s lifestyle, life views, social and economic adjustments that may lead to certain changes. These transitions from the “old” to the “new” way of life and from a life without dementia to a life with dementia involve making sense of life’s changes.

    Aim: The aim of study I was to explore the experiences and perceptions of dementia among Iranian staff working in a culturally profiled nursing home (CPNH). The aim of studies II and III was to explore relatives’ decisions to end caregiving at home, and Iranian families’ and relatives’ attitudes towards CPNHs in Sweden. The aim of study (IV) was to explore how the residents with dementia at the CPNH expressed the feeling of “home”.

    Method: This thesis is based on more than one year’s fieldwork. The empirical material is based on interviews and observations. Three groups of participants were interviewed and observed: 10 people with dementia (IV), 20 family caregivers and relatives (II and III, respectively) and 34 staff members (I). The interviews were conducted in Persian/Farsi, Azerbaijani, English and Swedish. The choice of language was always up to the participants. All the interviews were audio-recorded, transcribed verbatim in the respective languages and then translated later into Swedish. The analysis of the material was based on content analysis blended with ethnography.

    Results: Study I shows that people from different culturally and linguistically diverse backgrounds could have different perceptions of what dementia entails. A lack of knowledge concerning dementia affects how staff approach these people.

    Study II shows that the CPNH is crucial when deciding to cease caregiving at home. It is important to ensure that relatives with dementia are cared for by someone who speaks the same mother tongue. The results indicate that positive feelings of relief or comfort are dominant responses among the participants, some of whom even feel pride in the high standard of care provided by the home.

    In Study III, most participants based their views on a comparison between the CPNH and Iranian nursing homes after the Islamic Revolution. Negative views of the nursing home were evaluated alongside what the respondents considered to be typically Iranian. In Study IV, the results show that people with dementia’s personal experiences of home played a great role, and although none of the participants felt at home, all of them stated that the CPNH was a place to live in.

    Conclusion: Perceptions of dementia can be based on cultural and traditional understanding, although this can shift through transition and knowledge accumulation. A lack of knowledge concerning dementia and residents’ sociocultural background, generational differences and incoherence, aligned with staff members’ different sociocultural backgrounds, created many challenges. The staff wanted to learn more about dementia, to be able to manage daily communication with the residents. On another point, the staff admitted that only being able to speak a person’s native language was not enough to claim that they were actually communicating. Family caregivers’ decisions to end caregiving at home involve mutuality, capability and management, but decision-making sometimes has nothing to do with violating a person’s autonomy and is more about protecting the person. The family caregivers do care for frail elderly family members. What has changed due to a transition is the structure and construction of family caregiving. The consequences of communication difficulties between staff and the residents have led to a small degree of social involvement, which in turn affects residents’ daily social state. Overall, many family members stated that the CPNH resembled Iran too much, which disturbed them.

    The residents thought of home as a geographical location, but also connected it with both positive and negative feelings. Furthermore, the CPNH reminded some of the residents of the nicer side of life back home in Iran, while for others it brought back sad experiences and memories from the past. Nevertheless, the nursing home, due to memories and experiences of life in Iran, “home”, was a place to be and to live.

    List of papers
    1. Frankly, None of Us Know What Dementia Is: Dementia Caregiving Among Iranian Immigrants Living in Sweden
    Open this publication in new window or tab >>Frankly, None of Us Know What Dementia Is: Dementia Caregiving Among Iranian Immigrants Living in Sweden
    2015 (English)In: Care Management Journals, ISSN 1521-0987, Vol. 16, no 2, p. 79-94Article in journal (Refereed) Published
    Abstract [en]

    In quite a short amount of time, Sweden has gone from being a relatively homogeneous society to a multicultural one, with a rapid expansion of immigrants having culturally and linguistically diverse (CALD) backgrounds growing old in Sweden. This is particularly interesting in relation to studying age-related dementia diseases. Research shows that not only do CALD persons with dementia diseases tend to mix languages, have difficulties with separation of languages, or revert to speaking only their native tongue as the disease progresses, but they also show tendencies to experience that they live in the cultural environment in which they were brought up, rather than in the current Swedish one. In this article, we explore findings in relation to one such CALD group in Sweden, Iranians. The article is empirically driven and based on data gathered in 2 separate settings with specific ethnocultural profiles, offering dementia care with Middle Eastern, Arab, and/or Persian profile. Observations were carried out in combination with semistructured in-depth interviews (n = 66). By using a combination of content and ethnographic analysis, 4 main findings related to ethnocultural dementia care were elucidated. These include (a) a wider recognition of people from different CALD backgrounds possibly having different perceptions of what dementia is, (b) a possibility that such ascribed meaning of dementia has a bearing on health maintenance and health-seeking behavior as well as the inclination to use formal services or not, (c) choosing to use formal service in the forms of ethnoculturally profiled dementia care facility seems to relate to being able to “live up to ideals of Iranian culture,” and (d) “culture,” however ambiguous and hotly debated a concept it is, appears to be a relevant aspect of people's lives, an aspect that is both acquired as well as ascribed to oneself and to others. As such, we argue that culture needs to be further addressed in relation to dementia care in multicultural societies because ascribing culture boxes people in as well as out. In addition, ethnocultural contextualization of dementia care needs to be understood in relation to this because it affects the care provided.

    Keywords
    dementia, caregiving, illness, ethnoculturally profiled care
    National Category
    Gerontology, specialising in Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-119110 (URN)10.1891/1521-0987.16.2.79 (DOI)
    Projects
    Ethnic diversity and dementia: cultural, social and linguistic aspects
    Funder
    Riksbankens Jubileumsfond
    Available from: 2015-06-09 Created: 2015-06-09 Last updated: 2018-11-20
    2. Deciding upon Transition to Residential Care for Persons Living with Dementia: why Do Iranian Family Caregivers Living in Sweden Cease Caregiving at Home?
    Open this publication in new window or tab >>Deciding upon Transition to Residential Care for Persons Living with Dementia: why Do Iranian Family Caregivers Living in Sweden Cease Caregiving at Home?
    2018 (English)In: Journal of Cross-Cultural Gerontology, ISSN 0169-3816, E-ISSN 1573-0719, Vol. 33, no 1, p. 21-42Article in journal (Refereed) Published
    Abstract [en]

    Previous research has shown how filial piety is strong among people of Iranian background and that traditional Iranian culture result in most families’ preferring to care for their elderly (and sick) family members at home. While acknowledging this, this article highlights what living in diaspora could mean in terms of cultural adaption and changing family values. By interviewing people with Iranian background living in Sweden (n = 20), whom all have been former primary caregivers to a relative living with dementia, we are able to show how the decision to cease caregiving at home is taken, and what underlying factors form the basis for such decision. Results indicate that although the existence of a Persian profiled dementia care facility is crucial in the making of the decision, it is the feeling of ‘sheer exhaustion’ that is the main factor for ceasing care at home. And, we argue, the ability to make such a decision based upon ‘being too tired’ must be understood in relation to transition processes and changes in lifestyle having an affect upon cultural values in relation to filial piety. Because, at the same time the changes on cultural values might not change accordingly among the elderly who are the ones moving into residential care, resulting in them quite often being left out of the actual decision.

    Place, publisher, year, edition, pages
    Springer-Verlag New York, 2018
    Keywords
    Caregiver, Dementia diseases, Iranian immigrants, Care at home, Care at residential nursing home, Transition
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology Nursing
    Identifiers
    urn:nbn:se:liu:diva-152760 (URN)10.1007/s10823-017-9337-1 (DOI)000427289500002 ()29170865 (PubMedID)2-s2.0-85034757762 (Scopus ID)
    Available from: 2018-11-20 Created: 2018-11-20 Last updated: 2019-03-07Bibliographically approved
    3. Iranian relatives' attitudes towards culturally profiled nursing homes for individuals living with dementia
    Open this publication in new window or tab >>Iranian relatives' attitudes towards culturally profiled nursing homes for individuals living with dementia
    2017 (English)In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, p. 1-17Article in journal (Refereed) Epub ahead of print
    Abstract [en]

    This article discusses Iranian family members attitudes towards the culturally profiled nursing home, their relationships with the staff, the obstacles, their hopes and their fears. This study is based on qualitative research using 29 semi-structured interviews with family members who had previously been informal caregivers, as well as using fieldwork, all in the same nursing home. The interviews were analysed by the three steps of content analysis. The results show the identification of three main categories with nine main subcategories. The categories and subcategories in the table clarify and explain how the interviewees tended to compare the situation in Iran with that in Sweden, how they perceived the situation in Sweden and finally how they also saw the culturally profiled nursing home.

    Place, publisher, year, edition, pages
    Sage Publications, 2017
    Keywords
    culturally profiled nursing home; nursing home
    National Category
    Nursing
    Identifiers
    urn:nbn:se:liu:diva-144853 (URN)10.1177/1471301217743835 (DOI)29192514 (PubMedID)
    Available from: 2018-02-05 Created: 2018-02-05 Last updated: 2018-11-20Bibliographically approved
  • 194.
    Kiwi, Mahin
    et al.
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Hydén, Lars-Christer
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Antelius, Eleonor
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Deciding upon Transition to Residential Care for Persons Living with Dementia: why Do Iranian Family Caregivers Living in Sweden Cease Caregiving at Home?2018In: Journal of Cross-Cultural Gerontology, ISSN 0169-3816, E-ISSN 1573-0719, Vol. 33, no 1, p. 21-42Article in journal (Refereed)
    Abstract [en]

    Previous research has shown how filial piety is strong among people of Iranian background and that traditional Iranian culture result in most families’ preferring to care for their elderly (and sick) family members at home. While acknowledging this, this article highlights what living in diaspora could mean in terms of cultural adaption and changing family values. By interviewing people with Iranian background living in Sweden (n = 20), whom all have been former primary caregivers to a relative living with dementia, we are able to show how the decision to cease caregiving at home is taken, and what underlying factors form the basis for such decision. Results indicate that although the existence of a Persian profiled dementia care facility is crucial in the making of the decision, it is the feeling of ‘sheer exhaustion’ that is the main factor for ceasing care at home. And, we argue, the ability to make such a decision based upon ‘being too tired’ must be understood in relation to transition processes and changes in lifestyle having an affect upon cultural values in relation to filial piety. Because, at the same time the changes on cultural values might not change accordingly among the elderly who are the ones moving into residential care, resulting in them quite often being left out of the actual decision.

  • 195.
    Kjellström, Sofia
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Arts and Sciences.
    Ansvar, hälsa och människa: en studie av idéer om individens ansvar för sin hälsa2005Doctoral thesis, monograph (Other academic)
    Abstract [en]

    That people should take responsibility for their health is a prominent contemporary idea. But what does such responsibility actually entail, and what demands are being put on people? The objective of the dissertation is to describe and critically examine various ideas on personal responsibility for health. In the first step, I identify and describe a wide variation of uses of responsibility and in the second step, I problematize them. The analyzed material consists of Swedish government reports and various types of health advice literature, including medical books and alternative medicine literature. I employ a framework of philosophical, social scientific, and developmental psychology theories on responsibility to critically examine the material.

    The study shows that taking responsibility involves both body and mind. Common ideas are that it requires maintaining a healthy lifestyle and managing one's self-care. But it is also considered important to take responsibility for beliefs and emotions and to adopt an accepting attitude. Another idea is that spiritual insights expand the scope of responsibility. Some important abilities required to take responsibility are conscious healthy choices, self-knowledge, and critical thinking. The view of responsibility is also influenced by individual factors, cultural beliefs about health and disease, and social structures. In the literature, health responsibility is regarded both as a social duty and as a never-ending task performed by an active individual.

    Finally, I use Robert Kegan's theory of adult development to show that taking responsibility imposes psychological demands on people's awareness. The demands are often higher than many people can manage. Some of the stress and poor health that people experience may be the product of an inability to manage all of life's demands. The developmental perspective also asserts that people can develop the requisite capacity. One conceivable conclusion of the study is that if we want people to take more responsibility, we should not only invest resources in health information, but also in measures that generate self-knowledge, reflection, and personal development.

  • 196.
    Klinthäll, Martin
    Linköping University, REMESO - Institute for Research on Migration, Ethnicity and Society. Linköping University, Department of Management and Engineering. Linköping University, Faculty of Arts and Sciences.
    Etnisk bakgrund, integration och sjuklighet: Slutenvård bland invandrare i Sverige 1990–20012007In: Working Papers in Social Insurance, ISSN 1653-1353, no 1, p. 1-28Article in journal (Other academic)
    Abstract [en]

    Objectives: The purpose of this study is to analyze to what extent differences in health between groups of different origin remain after considering differences in education, income and labor market status, and whether there exists any patterns according to the socioeconomic character of the country of origin.

    Design: The study is based on two data sources; Longitudinal Database for Education, Income and Employment, (LOUISE) and the Hospital Discharge

    Register (HDR). The data set consists of all Swedish and foreign born individuals born in 1945, 1955 and 1965, who were Swedish residents in 1990. The risk of hospitalization is analyzed for the period 1990–2001 using binomial logit regression.

    Results: When only demographic characteristics are controlled for, most immigrant groups display higher rates of hospital discharge records than native Swedes, but when education, income and labor market status is introduced into the model, only Nordic immigrants display levels of severe morbidity that are significantly higher than the levels for Swedish born. Among welfare recipients, only immigrants from Finland display higher levels of severe morbidity than native Swedes; most immigrant groups display significantly lower levels of severe morbidity than native Swedes. The analysis shows no evidence of a systematic relationship between health status and the socioeconomic character of the country of origin.

    Conclusion: Higher levels of severe morbidity among immigrants compared to Swedes seem to be explained by the socioeconomic situation in Sweden, rather than health conditions and socioeconomic circumstances before immigration. There is a strong correlation between a weak labor market integration and high levels of severe morbidity in non-Nordic immigrant groups.

  • 197.
    Klinthäll, Martin
    Linköping University, REMESO - Institute for Research on Migration, Ethnicity and Society. Linköping University, Department of Management and Engineering. Linköping University, Faculty of Arts and Sciences.
    Integration bidrar till hälsa2007In: Tidskriften Välfärd, ISSN 1651-6710, no 4, p. 12-13Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    De flesta invandrargrupper i Sverige har en större sannolikhet än infödda svenskar att bli inskrivna för vård på sjukhus. En närmare analys visar att detta kan förklaras med skillnader i gruppernas socioekonomiska situation. En svag anknytning till den svenska arbetsmarknaden är förknippad med en högre risk för ohälsa som i sin tur leder till sjukhusvård.

  • 198.
    Kristenson, Karolina
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Risk factors for injury in men´s professional football2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis includes four papers based on three different prospective cohort studies on injury characteristics in men’s professional football. The same general methodology was used in all papers. Time-loss injuries and player individual exposure was registered for match and training separately. The general aim was to investigate potential internal and external risk factors for injury, with a focus on age, playing position, time in professional football, playing surface (artificial turf and natural grass), changes between surfaces and climate; and to evaluate the study methodology.

    Paper I was based on data collected between 2001 and 2010 from 26 top professional clubs in Europe; the UCL injury study. In total, 6140 injuries and 797 389 hours of exposure were registered. A decreased general injury rate was observed for newcomers compared with established players (hazard ratio (HR), 0.77; 95% CI 0.61-0.99). Using goalkeepers as a reference, all outfield playing positions had significantly higher age-adjusted injury rates. Using players aged ≤ 21 years as a reference, the overall adjusted injury rate increased with age, with a peak injury rate among players aged 29 to 30  years (HR, 1.44; 95% CI, 1.24-1.68).

    Paper II and Paper III are based on data collected during two consecutive seasons, 2010 and 2011, in the Swedish and Norwegian male first leagues. In total, 2186 injuries and 367 490 hours of football exposure were recorded. No statistically significant differences were found in acute injury rates on artificial turf (AT) compared with natural grass (NG) during match play (rate ratio, 0.98, 99% CI 0.79-1.22) or training (rate ratio 1.14, 99% CI 0.86-1.50) when analysing at the individual player level. However, when analysing at the club level, clubs with AT installed at their home arena had a significantly higher acute training injury rate (rate ratio 1.31, 99% CI 1.04-1.63) and overuse injury rate (rate ratio 1.38, 99% CI 1.14-1.65) compared to clubs with NG installed at their home venue. No association was found between frequent surface shifts and subsequent overuse injury risk (risk ratio 1.01, 95% CI 0.91-1.12). Analyses on the total cohort showed no difference in injury rates between clubs in the two climate zones (total rate ratio 1.01, 95% CI 0.92-1.10).

    Data included in Paper IV were collected during two consecutive seasons 2008 and 2009. During this period, two Norwegian elite football clubs were concurrently included in two research groups’ surveillance systems. The capture rate for match injuries was similar between the two audits, while the capture rate for training injuries was slightly higher with individual-based exposure recording. The inter-rater agreement in injury variable categorisations was in most aspects very high.